OFFICE POLICIES

       We are accepting new patients from birth to 18 years of age. For our established patients, we can provide medical services until they are 21 years of age.

       If your child is an established patient who has not been seen in any of our offices within a 3 year span, he /she will be considered a new patient and charged accordingly.

       Prescription refills should be requested during normal business hours only. It is not our policy to call in prescriptions without the child being seen first, unless it is a prescription refill for a recent or current illness.

       School, Daycare, Camp ,and Sports Physical Forms, WIC Forms, FMLA Forms, and other similar Forms or Papers that need physician certification require at least 72 hours of prior notice. Forms can be dropped off or faxed to our office. Unless the child has an up-to-date Well Child Check-up at our office, we cannot provide your child with any School or Daycare certification. For Camp and Sports Physicals Forms to be completed, your child needs to have had a Well Child Check-up within the past 30 days. Duplicate requests are subject to a service fee. To have completed forms mailed to you or to a specific address, please provide us with a written note with your permission to do so and a stamped and addressed envelope.

       We do request at least 24 hours prior notice to reschedule or cancel an appointment. Missed appointments are subject to a service fee. If scheduled appointments are missed on a continual basis without notification or cancellation, this may result in the termination of care of your child(ren).

PROTECTED HEALTH INFORMATION

       Information about your child's health is called "protected health information." It includes any information that DAVENPORT PEDIATRICS, PA receives or creates that identifies (or could identify) your child and deals with your child's physical and/or mental health, and any medical care we provide your child and/or payment for such medical care.

       DAVENPORT PEDIATRICS, PA understands the importance of privacy and is committed to maintaining the confidentiality of your child's medical information. We make a record of the medical care provided to your child and may receive other medical records from others. We use these records to provide and enable us and other healthcare providers to provide quality medical care, to obtain payment for medical services provided to your child and to enable us to meet our professional and legal obligations to properly operate our medical practice. We have a "Notice of Privacy Practice" (the "Notice"). The Notice describes in great detail how we might use or disclose protected health information. The notice also discusses your rights and our duties with respect to protected health information. You have the right to review the Notice before signing this consent. This notice is available on our website @www.davenportpediatrics.com or you may request a copy from our front office staff.