Policies And Procedures Of Pediatric Partners printable pdf download

Pediatric Partners Policies and Procedures

Insurance Cards

Please bring your current insurance card each visit. It is your responsibility to know the benefits and provisions of your

individual policy. If you do not provide us with the current insurance information at the time of service, we will be unable to

file the insurance claim for you, making you responsible for the cost of all services.

Co-payments

If your insurance policy requires a co-payment, this must be paid before your child is seen. If you do not pay the co-payment

at the time of service, you will be charged an administration fee. For your convenience, we accept cash, checks, Visa and

MasterCard.

Forms

If you require a form for daycare, pre-school, camp, sports physicals or any other activity we request you bring the form with

you to your child’s well exam. Forms are available on our website for your convenience. If you request a form to be filled out

at a later date, there will be a fee charged. Please allow up to three business days for the form to be completed.

Missed /Late appointments

If you are unable to keep your child’s scheduled appointment, we simply ask that you call us 24 hours in advance to cancel.

Except for emergencies, appointments not cancelled at least 24 hours in advance will be subject to a charge. If you are more

than 15 minutes late for your appointment we may need to ask you to reschedule out of courtesy to our other patients. We

will be happy to try and work you in, but you will have to wait until there is an available appointment time or we may offer

you an appointment with another provider, if available.

Prescription Refills

If your child is on a controlled medication and you need a refill, we request you notify our office 5 business days in advance

to get the prescription written. For all other medication refills, please have your pharmacy send us a refill request. These will

be completed within two business days.

Prior Authorizations

Prior authorizations required by your insurance company may be subject to a fee. Our nurses spend a great amount of time

trying to get medications approved.

After Hours Calls

After hours calls should be limited to urgent matters. Remember to check our website:

where

you may find the answer too many common concerns. If you are calling after regular office hours for a non-urgent matter,

there may be a charge. Our physicians do not call out prescriptions after office hours.

Returned Mail / Check

Please remember to update your patient information sheet each time you are in the office. There is a charge if your bill is

returned to us due to a change of address. When a check is returned to us not paid by your bank due to insufficient funds or

other reasons, the bank charges our account a fee and that cost will be added to your account balance. After 2 returned checks

we will no longer accept a check on your account. Your balance will need to be paid by cash, Visa or MasterCard.

Medical Records

If you would like a copy of your child’s medical record there is a standard charge as allowed by Kansas law. At your written

request, we will transfer immunizations, growth chart and last well exam to another physician office one time without charge.

A request for additional records will be subject to a charge. Records will be transferred within 30 days of the written request.

11. Immunizations

We require that all of our patients be immunized for ALL state required immunizations. There are vaccines that aren’t

required but are recommended. Please refer to our website:

for more information concerning

immunizations.

12. Appointments

Please schedule an appointment for each child you feel needs to be examined or discussed. Remember to schedule well

exams in advance.

13. HIPAA

We do not fax any medical information to your home or work office. We will fax immunization records to your child’s school

or daycare. There is a fee for this service.

By my signature below, I state that I have read and understand the above policies for Pediatric Partners, P.A.

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Parent/Guardian Signature

Date

Account #

Version 6/2013

Policies And Procedures Of Pediatric Partners

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