Health Form Policies

It is the goal of the physicians and staff to accommodate as many requests as possible to the furthest reasonable extent, bearing in mind the following limitations:

1. Blank forms will not be accepted. Forms will only be accepted for completion if the patient’s name and other information has been completed. We may not be able to complete a form if parents have not completed their parts of the forms prior to form submission.

2. Turn around time for form completion is 5 - 7 business days. We may receive hundreds of health forms in one week, and each of these has to be carefully reviewed by a physician before it is released. Parents are strongly advised not to wait to the last moment to look at the paperwork they have received from the program their child is scheduled to attend. See # 10 below.

3. Forms will be held here for parents to pick up. Due to HIPAA regulations, forms will be released to parents or the patient only. Federal law prohibits doctors’ offices from faxing or mailing medical information to non-medical facilities without patient permission. We cannot be responsible for delays or losses in the mail.

4. Forms are completed for those whose accounts are in good standing. Delinquent accounts must be brought current before forms will be released. Forms must be paid for before they are released.

5. Many forms require that the information is based on an examination completed within twelve months of the date the form is completed. No form will be completed for any patient who has not had a physical examination in our office in more than twenty four months.

6. Forms are completed on the basis of examinations conducted by physicians in this medical group. Examinations performed by “check up centers” will not be cosigned by your physician, nor will (s)he complete any forms based on any information provided by such centers.

7. There is no charge for WIC forms.

8. The minimum charge for completion of a form is $5.00 per form. Charges vary with duration of physician involvement and time. The physician completing the form determines the charge. The front office staff do not have the authority to alter, reduce, or change charges.

9. Insurance companies do not pay for form completion.  We do not bill the insurance company for completion of any form.

10. Rush service may be available for an additional $20.00. We do not guarantee the availability of this service.

Some examples of Prices:

11. Prescriptions for over-the-counter (OTC) medications are $5.00 per prescription. These may be required for certain health care spending accounts.

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Last Updated 11/1/07

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Last modified: 02/16/11