Please inform secretary of any change of address, phone number or insurance.

When calling for an appointment for a same-day sick visit, please be aware that you may have to wait. We try our best to stay on time, but there are occasions when patient visits take longer than expected. We appreciate you understanding!

If you are more than 30 minutes late for a well visit, we will ask you to reschedule.

If you have an appointment scheduled, and on three separate occasions do not call to cancel, this may result in dismissal from the practice.

Medical records will be released within 3 business days with a signed, written request. We will give you one copy of the medical records free of charge. However, any additional requests for copies will be assessed a fee of $1 per page.

Co-pays, old balances and deductibles are due BEFORE services are rendered. There will be a $5 charge if we need to bill you for the co-pay.

There will be a $25 charge for all returned checks and we will no longer accept checks as payment for your account in the future.

No vaccinations will be administered unless a parent or legal guardian is present.

Please do not allow your child to bring food or drinks to the examination rooms.

The philosophy of Pediatric Wizards is to treat all patients and their families with the utmost respect, courtesy, and integrity. Please let us know if you have any concerns about your visit or would like to make recommendations on how we can improve our service.

Adhere to the standards set forth in the Notice of Privacy Practices.

Collect, use and disclose PHI only in conformance with state and federal laws and current patient covenants and/or authorizations, as appropriate. Our practice and its physicians and staff will not use or disclose PHI for uses outside of practice’s TPO, such as marketing, employment, life insurance applications, etc. without an authorization from the patient.

Use and disclose PHI to remind patients of their appointments unless they instruct us not to.

Recognize that PHI collected about patients must be accurate, timely, complete, and available when needed. Our practice and its physicians and staff will

--Implement reasonable measures to protect the integrity of all PHI maintained about patients.

Recognize that patients have a right to privacy. Our practice and its physicians and staff respect the patient’s individual dignity at all times. Our practice and its physicians and staff will respect patient’s privacy to the extent consistent with providing the highest quality medical care possible and with the efficient administration of the facility.

Act as responsible information stewards and treat all PHI as sensitive and confidential. Consequently, our practice and its physicians and staff will:

--Treat all PHI data as confidential in accordance with professional ethics, accreditation standards, and legal requirements.

--Not disclose PHI data unless the patient (or his or her authorized representative) has properly authorized the release or the release is otherwise authorized by law.

Recognize that, although our practice “owns” the medical record, the patient has a right to inspect and obtain a copy of his/her PHI. In addition, patients have a right to request an amendment to his/her medical record if he/she believes his/her information is inaccurate or incomplete. Our practice and its physicians and staff will--

--Permit patients access to their medical records when their written requests are approved by our practice. If we deny their request, then we must inform the patients that they may request a review of our denial. In such cases, we will have an on-site healthcare professional review the patients’ appeals.

--Provide patients an opportunity to request the correction of inaccurate or incomplete PHI in their medical records in accordance with the law and professional standards.

All physicians and staff of our practice will maintain a list of certain disclosures of PHI for purposes other than TPO for each patient and those made pursuant to an authorization as required by HIPAA rules. We will provide this list to patients upon request, so long as their requests are in writing.

All physicians and staff of our practice will adhere to any restrictions concerning the use or disclosure of PHI that patients have requested and have been approved by our practice.

All physicians and staff of our practice must adhere to this policy. Our practice will not tolerate violations of this policy. Violation of this policy is grounds for disciplinary action, up to and including termination of employment and criminal or professional sanctions in accordance with our practice’s personnel rules and regulations.

Our practice may change this privacy policy in the future. Any changes will be effective upon the release of a revised privacy policy and will be made available to patients upon request.