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.
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
At Howard County Pediatrics, it is important to us that your time in our office is well spent. Therefore, if you have any change in your insurance coverage or personal information, please arrive early for your appointment so that your information can be updated and your visit can proceed in a timely manner. Also, please be aware that we require 24 hours notice of cancellation for routine check ups, pre-ops and consultation appointments. Cancellation of these appointments with less than 24 hours notice may be subject to a $50 cancellation charge
. Any appointment missed without prior notification will be assessed a $50 cancellation charge
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.
New Patient Forms
Protected Health Information