Prairie Pediatrics
Office Policies & Forms
Cancellation & Late Arrival Policy
In respect of the time and schedules of our staff and your fellow patients, if you cannot make an appointment, please cancel at least 24 hours in advance. Also, to ensure we have sufficient time to care for your child, please arrive at least 5 minutes prior to your appointment time to get checked in.
The first time you cancel with less than 24 hours notice or arrive more than 5 minutes late to your appointment, you will be reminded of our policy. A second time will may result in a missed appointment fee. A third incident will lead to your possible dismissal from the practice.
Patient Rights & Responsibilities
Thank you for trusting us with your child's healthcare. I strive to provide care that is exemplary in quality and compassionate in delivery. In treating your child, we follow guidelines set up by the American Academy of Pediatrics and deliver evidence based recommendations. As a parent or patient, you have the right to hear options for your care along with my professional assessment and advice.
We practice shared decision making whenever possible and provide care in a developmentally appropriate way. In order to help your child, you agree to provide accurate information about their health, including their medications, allergies, past medical history, family medical history and social history
Financial Policies
Insurance Info: If you are enrolled in a health insurance please, please provide us with complete and accurate info before your appointment and we will bill your plan for covered services. Click here to see list of insurances currently accepted by our practice.
Insurance Coverage: We suggest you review the terms of your insurance coverage thoroughly to understand what is covered before care is provided. Payment for non-covered services or denied claims will be your responsibility. Please be aware that we may provide services that your insurance may deny as "not covered." If you have questions about coverage, please contact your insurance company. We are not responsible for knowing your coverage details.
Co-Pays & Fees: Co-pays are due at the time of visit and may not be waived for any reason. Prompt payment for service not covered by insurance, including deductibles, is expected. There is a $25 fee for invalid checks.
After Hours Care: Evening (after 5pm) and weekend visits have a $50 surcharge which may be covered by your insurance.
PCP Designation: If your insurance requires that a Primary Care Physician be designated, you must name our practice as the PCP prior to your visit. Failure to do so may result in denial of coverage and charges for your visit that you will be responsible for.
Well Care Scope Limitations: If issues are raised during a well care visit that need to be addressed and are not covered under well care, your insurance will be billed for an additional "sick" visit and you will be responsible for an added co-pay.
Form Return Process and Form Repository
Prior to your scheduled visit, you will receive any required forms via text through the Spruce app and you can access them below.
Completing and returning forms via Spruce prior to your appointment will save time during your visit and allow us to be fully prepared to care for you child's needs.
Forms can be printed, completed and then texted back using Spruce by scanning or taking a picture of all pages of your completed forms.
General Forms:
- New Patient Agreement and Consent Form
- New Patient Registration Form
- Telehealth Consent Form
- Release of Medical Information Form
- Notice of Patient Privacy Policies
- Co-Parenting Policy
Developmental Questionnaires for Well Visits:
Vaccination Policy
Vaccines are lifesaving and safe. We follow the vaccination schedule published by the Center for Disease Control.
In consideration for the health of your fellow patients and community members, we require all patients to be up to date on their vaccinations. Failure to adhere to the standard or agreed upon alternate vaccination schedule that causes vaccinations to be out of date for greater than 6 moths may result in dismissal from the practice.
Privacy Policy
We are dedicated to the protection of your family's personal data, that's why Prairie Pediatrics has adopted a formal policy on Patient Privacy Practices (linked below) and ensures all staff are fully trained on HIPAA requirements and our office's HIPAA compliant policies and processes.
Our Patient Privacy Practices policy fully describes the rights and control you have over your data, the protections provided to your children regarding their personal medical information and how your data will and will not be used.