OFFICE POLICIES

Our goal is to provide and maintain a good provider-patient relationship. Letting you know about our office policies in advance allows for a good flow of communication and enables us to achieve our goal. Please read each section carefully and initial. Do not hesitate to ask any questions you may have.

Appointments
Schedule an appointment by calling 516-944-8555
Please arrive a few minutes early so that we can verify insurance information. collect paperwork and collect copays.Before making an annual physical appointment, please check with your insurance company as to whether the visit will be covered as a well child visit.

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Patients who arrive on time are seen at their appointment time. Patients who have arrived on time will be seen ahead of those who arrive late. If you arrive late, you may need to wait or have to reschedule your child's appointment.

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Missed Appointments: Life happens and we understand that sometimes you cannot make your appointment. Please call us at least 24 hours to cancel and change appointment. No call to our office equals a "No Show" and if we can'y fill your slot, we will need to charge you a $25 fee.

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Late Arrivals: (>15 minutes and )after scheduler appointment will be offered the next available appointment. We will do all that is possible to accommodate you on the same day. We strive to minimize any wait time but emergencies do occur and will take priority over a scheduled visit. We appreciate your understanding

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Appointments for additional children should be made by phone prior to coming to the office. An additional $25 charge will applied to add-on appointments. If you would like another child to be seen, please schedule appointments for both children by phone prior to com to the office. Please note that our schedule does not allow us to schedule three back-to-back well visits for one family in the same day. If all three need to be seen in one day, there needs to be a gap of at least one hour in between the first two visits and the third.

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After-Hours Calls;

Please limit after-hour calls to urgent issues and emergencies. Please call the office during regular office hours for prescription refills, appointment requests and other routine mattes.

When calling in after-hours and leaving a message, please:

• Speak slowly and clearly and indicate
• Leave a call-back number and disable your call block feature
• Follow the doctor's instructions

We are here to provide the best care that we can to your children should the need arise. As always we welcome the opportunity to care for your children and appreciate your trust in the services that we provide.

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Our Vaccine Policy

Healthy Kids Pediatrics does not accept new patients whose parents or caregivers choose not to vaccinate or choose to delay recommended vaccines by more than four months. Parents or caregivers of established patients who choose not to vaccinate or who delay vaccines by more than four months.will be given a one month grave period to find another pediatrics practice. W will not be able to provide families with names of practices accepting unvaccinated or vaccine delayed patients. Healthy Kids Pediatrics strongly recommends vaccination according to the schedule published by the Advisory Committee on Immunization Practice (ACIP). Please recognize that an unvaccinated or vaccine-delayed child is at higher risk of life-threatening illness, disability, and death than vaccinated children. Furthermore, an unvaccinated or vaccine delayed child puts other children at risk, especially those who are too young for vaccination or those who cannot receive vaccinations for various reasons

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Referrals

Three to five days advance notice is needed for all non-emergent referrals. It is your responsibility to know if a selected specialist participates in your plan. Please call the office with with the name of the provider and his NPI or ID number, date of the appointment, reason for appointment and phone and fax number.

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Forms

There is a $20 annual form fee per child. This includes school forms, camp forms, sports forms, etc. Payment is due when the forms are dropped off. We require a minimum 5 day turnaround time.

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Prescription Refills

We require 72 hours' notice for monthly medication refills. Yo may be required to come in for follow-up visits for certain medication refills. Please plan accordingly,

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I have read, fully understand, accept and agree to comply with all of the above policies and accept the responsibility for any payment that becomes due. I agree to comply with any future amendments to office policy.