Useful forms and links for you!
As many of you know, we are in the process of switching our electronic medical record (EMR) system and need to update our data base with the most current patient information. For existing patients only please fill out the registration form and return to us at least two days prior to your scheduled appointment or plan to come to your appointment 15 minutes earlier than scheduled.
This form needs to be filled out for ALL patients. You may list all children on the same form. Please email the form back to us at email@example.com or fax to 617-928-0178.
In order for your pediatrician to communicate with specialists outside of our practice the following form needs to be completed.
Authorization for Release of Information via Care Everywhere
Please review our Financial Policy.
We value the privacy and confidentiality of our adolescents and young adults. This form ensures that privacy. Please review and have your adolescent indicate his or her decision.
18+ years Authorization
Similarly if your child was seen at an Emergency room and we do not have access to the records of the visit, we may need you to fill out this form.
Permission to Release Medical Notes
Please fill out this form if you require a copy of your child's medical record for any reason (e.g., moving, transferring care to another doctor, or for your own personal use).
Medical Record Release
Behavioral Health/ ADHD- If your PCP requested you have a visit with one of our Nurse Practitioners we request that this form to be completed and returned to us prior to the visit.
The HIPAA document below describes how medical information about you may be used and disclosed and how you can get access to this information.
Please review it carefully.
If you have any questions about this notice, please contact our
Practice Manager at 617-969-8989.
7/2014 HIPPA- read only
We as a practice believe that all children should be vaccinated according to the CDC and AAP guidelines for vaccination schedule. You may review it here: CDC vaccine schedule