PATIENT NON-DISCRIMINATION POLICY
Discrimination is Against the Law, Howard County Pediatric, LLC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Howard County Pediatrics, LLC does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
In order to update insurance and demographic information, all patients are asked to arrive 10 minutes prior to their scheduled appointment time.
When calling with a referral request, please have ready the name and specialty of the doctor you wish to see, your insurance information and the appointment date (if known). Your referral will be processed within five (5) business days, so please allow us enough time to meet your request. You should also designate whether you wish your completed referral mailed to you or placed at the front desk for pick up.
We would also like to remind you that it is your responsibility to know your insurance company's rules regarding the need for referrals for medical specialists, lab, or x-ray requests.
PRESCRIPTION REFILL REQUEST
We are usually able to send presciption refills electronically. There are two ways to request your child(ren)'s medication refill by doing following:
- Directly contact your pharmacy and have them send a refill request electronically (as an eFax)
- Send an electronic request through the Patient Portal.
CANCELLATION/NO SHOW POLICY
It is our goal to provide medical care to all our patients in a timely manner. We will make every effort to accommodate your scheduling needs. We ask that you arrive 10 minutes prior to a scheduled appointment.
In order to be respectful of the medical needs of other patients, please call the office promptly if you are unable to keep an appointment.
A "No-Show" is also considered a "missed appointment". This occurs when you fail to show up for an appointment without a phone call.
We require 24 hours'notice of cancellation for routine checkups, consultation appointments, pre-ops, and med checks. Cancellation of these appointments with less than 24 hours'notice may be subject to a $50 cancellation charge.
Same day sick appointments require a cancellation of 2 hours prior to the appointment, otherwise a $25 charge
Any missed appointments without prior notification will be assessed a $50 cancellation charge.
If you are running late for your appointment, please contact our office. We will make every effort to accommodate you or reschedule an appointment. If you arrive late for your scheduled appointment, the appointment may be considered a no-show appointment.
To help us better serve you in the completion of this task, please be aware of the following information:
We will not complete any form that does not have the parent section filled out. By signing the form, we are verifying that we have reviewed the information contained in the form and have done the appropriate medical examination and screening tests necessary to ensure that your child is cleared to safely participate in a specific area or activity. We cannot do this if we do not have all of the necessary information.
Please allow 3-5 business days for completion of your forms. We are usually able to complete one routine form (e.g. Howard County Public School Form) at the time of your wellness visit. If you present forms at a sick visit, if you have multiple forms that require completion, or if there is more detailed information needed to complete your form, then you will have to leave your forms for later return.
There is a $10 fee associated with forms. This covers the administrative time necessary for review of relevant information and completion of the form. In the event your circumstances require completion of forms in less than 7 days we can offer an expedited service. The cost for the expedited service is $25 payable at the time the forms are presented, and you will receive your forms within 48 hrs.
A wellness assessment may be required before some forms can be completed. In order to determine if your child is medically cleared to participate in camps or sports, it is recommended that s/he has an annual wellness assessment. Some entities may require an evaluation by a physician within 6 months of the start of an activity. We ask parents to please be aware of the requirements for their child’s specific activity and to plan a visit accordingly. You will need to have a wellness assessment in the 12 months prior to start of the activity before we can complete a form asking for medical clearance for a physical activity. Please plan ahead so that you can have your wellness assessment with the physician of your choice.
Patients that receive a statement from our office are expected to remit a full payment upon receipt.
We realize that temporary financial problems may affect timely payment of your account. If such problems arise, please contact our billing office for assistance in the management of your account.
Patients who do not establish a payment plan and the account is over 90 days due, you will be referred to an outside collection agency. You will be notified by letter of this action. You will have 30 days to pay the balance and have your child/children seen before the account will be referred to collection.
Once an account has been referred to collection, your children will no longer be provided care with our office.
AUDIO, PHOTOGRAPHY, AND VIDEO DURING VISIT
Video, audio recording and photography in the exam room require the consent of both the patient and the provider and staff involved.
To assure safe provision of care, we do not allow recording during any procedure.
Howard County Pediatrics reserves the right to request that a recording be discontinued at any time during the visit, at the discretion of the staff or providers involved.
Any permitted recording is not part of the medical record and the parent/guardian assumes sole responsibility as to protect the privacy of the recording.
To ensure the privacy of other patients, only when consent is given by both staff/and or physician, recording can only take place in the exam room.
Any recording in the common areas such as waiting rooms, hallways, front desk, and back office areas are not permitted.
TREATING MINORS WITHOUT A PARENT PRESENT
If a child is being brought into the office for an appointment by anyone other than a parent, or if they are younger than the age of 18yrs old without a parent, we will require a written authorization to treat the child for the visit. Please ensure the authorization note is presented at the front desk during check in. If you are not able to provide a hard copy of a written authorization, an email message to us would be acceptable. Our email address is email@example.com
COVID Related Items
Family Member-COVID Questionnaire
COVID Testing-Insurance Information
COVID-19 Vaccine Sign Up Sheet
Protected Health Information
(Contact the office to get a PIN from our staff)
(For patients who are new to the practice)
Portal navigation, instructions for completing registration from a Welcome Email, and instructions for sending a portal message and scheduling an appointment (upcoming feature)
New Patient Forms