Policies

Consent for Treatment

In order for a patient under age 18 years, to be seen at Personal Care Pediatrics, they must be accompanied by an adult who is listed on the Consent for Treatment Form. 

Co-pays, Coinsurances, Deductibles and Non-contract charges

Co-pay, balances, deductibles, and non-contract charges are due at the time of the visit. We do not balance bill charges. Furthermore, it is the policy of our office that whomever brings the child in for the visit is responsible for copayment and any deductible amounts due at the time of service, regardless of that individual's legal responsibility for the child. Our office staff will be happy to print receipts upon request. Lastly, if you participate with a high-deductible health plan and have not met your deductible, we require a partial payment of from $50-$70 at the time of the visit. Your account will be adjusted once we hear from your insurance company.

Marketplace Health Care Policies

We are on many but not all of the insurance plans offered under the Affordable Healthcare Marketplace. Each participating insurance company has their own procedures and policies that they do not necessarily share with the physician providers. Therefore, to avoid your being faced with unforeseen and unnecessary expenses, it is your responsibility to clarify that Personal Care Pediatrics is an in network provider on the policy your purchased through the Affordable Healthcare Marketplace. In addition, you must present proof of premium payment each and every time the insured patient is seen in the office, Proof of premium payment includes: bank statement, credit card statement, or cancelled check.

Walk-ins 

In almost all situations we do not accept walk-in appointments. However, walk-ins will be fit into the schedule, if the time permits.  Patients who have called and scheduled appointments will be seen first. Therefore, it is always in your best interest, to call and schedule an appointment. You will save yourself a potentially long wait. We try to always accommodate patients who call in for a same day sick appointment.  Please note in all situations, if you feel your child is seriously ill - TELL US IMMEDIATELY.

Food and Drink

With the exception of infant formula for babies under 12 months of age, there is ABSOLUTELY no eating or drinking in our office. Please understand that some of the patients have serious allergies to foods, and an inadvertent drop of a cookie piece with a peanut in it could cause serious health issues. Furthermore, crumbs, drinks etc make our office more prone to insects and nobody wants that! Let's face it, with the childhood obesity problem in the country, children really do not have to have food with them all the time. We ask you to respect our wishes in this matter and keep all food items out of the office while you visit with us.

Strollers

Many of today's strollers are bulky and literally clog up our waiting room and exam rooms, making it hard for staff and other patients to move about which could become a fire hazard in case of emergency. Therefore, we cannot permit bulky strollers in the office except in the situation of twins under 2½ years of age. We have a stroller parking area just outside our front door for your convenience. If you need any help managing your children, our staff is eager to help, just ask. Infant carriers are always welcomed.

We work hard to not overuse antibiotics.

We educate families on appropriate use of antibiotics, but follow evidence-based guidelines and don’t automatically treat ear pain or a green snotty nose with antibiotics.

We do not routinely prescribe antibiotics over the phone as we do not believe that is good medicine. We will prescribe an antibiotic when we believe it is an appropriate treatment.

Everyone's Time is Equally Valuable.

We ask that you arrive 5 minutes before your scheduled appointment time. We understand sometimes things happen beyond your control that may cause you to be late. However, we reserve the right to ask you to reschedule if you arrive late for your appointment.

Our practice makes every effort to run on time with appointments, as we believe everyone’s time is equally valuable.

Missed Appointments: Broken appointments represent a cost to us, to you, and to other patients who could have been seen in the time set aside for you. We reserve the right to charge a fee for canceled or missed appointments. We request 24 hours notice for cancellation of appointments.

The third consecutive missed appointment will result in discharge from the practice.

Personal Care Pediatrics, P.A.'S Financial Policy

It is important to us that you understand our financial policy and know that we are always willing to answer any questions you might have.

Our Policy

• All patients/guardians must provide their personal information on their first appointment prior to seeing the physician.

• All patients/guardians must have their insurance verified monthly prior to seeing the physician.

• All the co-pays, deductibles and balances are due at the time of service.

• All patients/guardians must sign this financial policy statement and must be updated yearly.

• If you write checks for accounts with insufficient funds we will take legal action and will bill you a $40 service charge for each bad check.

Insurance Coverage

• You should be fully familiar with your insurance policy including participating hospitals and laboratories, and whether your plan requires referrals to see specialists.

• Insurance is a contract between you, your employer, and the insurance company. As part of this contract, we are required as providers to collect all co-pays, deductibles, and balances.

• Not every insurance company will cover all the services that we perform. This office does not always know what different insurance companies will pay. By signing this document, you are agreeing to pay for all coinsurance, deductibles, co-pays and non-covered charges that your insurance company deems are your financial responsibility to us as the providers.

• If you change insurance companies, it is your responsibility to inform our staff. If you fail to do so and we file the claim with the wrong company, you could be responsible for the entire fee if the claim surpasses the filing deadline with the correct company.

• If your insurance company does not pay the bill after repeated attempts by this office to file and obtain payment, the unpaid balance will become your responsibility. If you can get the insurance to pay, you will be promptly refunded minus the due coinsurance.

Patient Statements

• You may be receiving statements through mail and or email

• You may mail in payment, pay over phone, or email us a payment link. 

o Balances are due within 30 days of the date posted on your statement

o If you cannot pay the bill, you have 30 days to come to the office and set up a payment plan with the office staff, (first payment being due upon signing the payment agreement).

• Failure to comply with at least one of these options will result in your account being sent to collections. You will also receive a letter that you have been released from the practice and need to find a new physician. Late balances (greater than 60 days) are subject to a 1.5% monthly interest rate, annual percentage rate of 25%. The guardian assumes all costs of collections, including, but not limited to court costs, interest, and legal fees. In this eventuality the undersigned waives venue jurisdiction and submits to the jurisdiction and venue of the State courts of Broward County.

Non-Contract Fees

Personal Care Pediatrics charges the following fees for non-insurance covered services:

Missed appointments and Cancellations with less than 24-hour notice:

Missed appointments and cancellations with less than 24 hours’ notice increase the cost of medical care for everyone.  In this challenging economic time in our country, we all need to work together to improve healthcare efficiency and thereby reduce the cost for everyone and make more appointments available for everyone. Missed appointments and appointments canceled with less than 24-hour notice, work against this objective. When a family misses an appointment by failing to call to cancel 24 hours prior to the appointment a fee of $35.00 will be charged for each missed appointment. Please note you will be considered a "No Show" if you are 15 minutes late for a scheduled appointment and you will be responsible for the fee.

Forms

Filling out medical forms takes staff time, requires medical knowledge of routine pediatric care, communicates information about your child's health, and is a legal document between our practice and other agencies. We approach these forms with the medical expertise they deserve and therefore charge the following fees for filling out medical forms for our patients. Forms can only be filled out if your child has had a well child visit within the period specified by the American Academy of Pediatrics. Some forms do require a hearing and vision exam to be performed and if was not done on your last well visit, the child will have to come into the office to have this done.

Forms can be given to you at the time of visit if requested otherwise there is 24-48 hours turnaround time. 

Form & Price

• Blue /DH 680 - $5.00

• Yellow/ DH 3040 $5.00

• Blue and Yellow - $5.00 per set

• WIC - $0.00

• FHSAA/Sports Form - $25.00

• Camp Forms - $5.00 - 10.00

• FMLA - $25.00

• College Forms - $10.00- 25.00

**If you need another copy of the Sports or College form to be filled out there is a $5.00 fee, you will not have to pay the $25.00 again.

Record Requests

We charge $10.00 to prepare a patient's records for release to another physician or to you. This fee covers the reviewing of the medical information requested and the actual printing and mailing of the documents. We cannot begin this process until the monies are collected.

We do not charge if an insurance company requests information on the patient's chart if the insurance company was the insurer for the dates, they are requesting information. However, if an insurance company is requesting records on dates of service for which they were not the insurer, a fee will be charged depending upon the number of pages requested. All requests for documents by lawyers, life insurance companies, and family mediators will be assessed a fee depending upon the number of pages requested.  All fees must be collected before the record request is initiated.

Immunization records will be faxed immediately from receipt of release and the rest of the records will be mailed out within 2 weeks of request.

PERSONAL CARE PEDIATRICS, P.A.

Notice of Privacy Practices (3/03)

This notice describes how health information about you may be used and disclosed and how you can get access to this information. It is effective April 14, 2003, and applies to all protected health information contained in your health records maintained by us. We have the following duties regarding the maintenance, use and disclosure of your health records:

We are required by law to maintain the privacy of the protected health information in your records and to provide you with this Notice of our legal duties and privacy practices with respect to that information.

We are required to abide by the terms of this Notice currently in effect.

We reserve the right to change the terms of this Notice at any time, making the new provisions effective for all health information and records that we have and continue to maintain. All changes in this Notice will be prominently displayed and available at our office.

There are a number of situations in which we may use or disclose to other persons or entities your confidential health information. Certain uses and disclosures will require you to sign an acknowledgement that you received this Notice of Privacy Practices. These include treatment, payment, and health care operations. Any use or disclosure of your protected health information required for anything other than treatment, payment or health care operations requires you to sign an Authorization. Certain disclosures that are required by law, or under emergency circumstances, may be made without your Acknowledgement or Authorization. Under any circumstance, we will use or disclose only the minimum amount of information necessary from your medical records to accomplish the intended purpose of the disclosure.

We will attempt in good faith to obtain your signed Acknowledgement that you received this Notice to use and disclose your confidential medical information for the following purposes. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office once you have provided Consent.

Treatment: We will use your health information to make decisions about the provision, coordination or management of your healthcare, including analyzing or diagnosing your condition and determining the appropriate treatment for that condition. It may also be necessary to share your health information with another health care provider whom we need to consult with respect to your care. [If there are other such disclosures that you might make, list them here.] These are only examples of uses and disclosures of medical information for treatment purposes that may or may not be necessary in your case.

Payment: We may need to use or disclose information in your health record to obtain reimbursement from you, from your health-insurance carrier, or from another insurer for our services rendered to you. This may include determinations of eligibility or coverage under the appropriate health plan, pre-certification and pre-authorization of services or review of services for the purpose of reimbursement. This information may also be used for billing, claims management and collection purposes, and related healthcare data processing through our system.

Operations: Your health records may be used in our business planning and development operations, including improvements in our methods of operation, and general administrative functions. We may also use the information in our overall compliance planning, healthcare review activities, and arranging for legal and auditing functions.

There are certain circumstances under which we may use or disclose your health information without first obtaining your Acknowledgement or Authorization. Those circumstances generally involve public health and oversight activities, law-enforcement activities, judicial and administrative proceedings, and in the event of death. Specifically, we may be required to report to certain agencies information concerning certain communicable diseases, sexually transmitted diseases or HIV/AIDS status. We may also be required to report instances of suspected or documented abuse, neglect or domestic violence. We are required to report to appropriate agencies and law-enforcement officials information that you or another person is in immediate threat of danger to health or safety as a result of violent activity. We must also provide health information when ordered by a court of law to do so. We may contact you from time to time to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. We will try to speak quietly to you in a manner reasonably calculated to avoid disclosing your health information to others; however, complete privacy may not be possible in this setting. If you would prefer to be adjusted in a private room, please let us know and we will do our best to accommodate your wishes.

Others Involved in Your Healthcare: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person's involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your healthcare.

Communication Barriers and Emergencies: We may use and disclose your protected health information if we attempt to obtain consent from you but are unable to do so because of substantial communication barriers and we determine, using professional judgment, that you intend to consent to use or disclosure under the circumstances. We may use or disclose your protected health information in an emergency treatment situation. If this happens, we will try to obtain your consent as soon as reasonably practicable after the delivery of treatment. If we are required by law or as a matter of necessity to treat you, and we have attempted to obtain your consent but have been unable to obtain your consent, we may still use or disclose your protected health information to treat you.

Except as indicated above, your health information will not be used or disclosed to any other person or entity without your specific Authorization, which may be revoked at any time. In particular, except to the extent disclosure has been made to governmental entities required by law to maintain the confidentiality of the information, information will not be further disclosed to any other person or entity with respect to information concerning mental-health treatment, drug and alcohol abuse, HIV/AIDS or sexually transmitted diseases that may be contained in your health records. We likewise will not disclose your health-record information to an employer for purposes of making employment decisions, to a liability insurer or attorney as a result of injuries sustained in an automobile accident, or to educational authorities, without you written authorization.

You have certain rights regarding your health record information, as follows:

You may request that we restrict the uses and disclosures of your health record information for treatment, payment and operations, or restrictions involving your care or payment related to that care. We are not required to agree to the restriction; however, if we agree, we will comply with it, except with regard to emergencies, disclosure of the information to you, or if we are otherwise required by law to make a full disclosure without restriction.

You have a right to request receipt of confidential communications of your medical information by an alternative means or at an alternative location. If you require such an accommodation, you may be charged a fee for the accommodation and will be required to specify the alternative address or method of contact and how payment will be handled.

You have the right to inspect, copy and request amendments to you health records. Access to your health records will not include psychotherapy notes contained in them, or information compiled in anticipation of or for use in a civil, criminal or administrative action or proceeding to which your access is restricted by law. We will charge a reasonable fee for providing a copy of your health records, or a summary of those records, at your request, which includes the cost of copying, postage, and preparation or an explanation or summary of the information.

All requests for inspection, copying and/or amending information in your health records, and all requests related to your rights under this Notice, must be made in writing and addressed to the Privacy Officer at our address. We will respond to your request in a timely fashion.

You have a limited right to receive an accounting of all disclosures we make to other persons or entities of your health information except for disclosures required for treatment, payment and healthcare operations, disclosures that require an Authorization, disclosure incidental to another permissible use or disclosure, and otherwise as allowed by law. We will not charge you for the first accounting in any twelve-month period; however, we will charge you a reasonable fee for each subsequent request for an accounting within the same twelve-month period.

If this notice was initially provided to you electronically, you have the right to obtain a paper copy of this notice and to take one home with you if you wish.

You may file a written complaint to us or to the Secretary of Health and Human Services if you believe that your privacy rights with respect to confidential information in your health records have been violated. All complaints must be in writing and must be addressed to the Privacy Officer (in the case of complaints to us) or to the person designated by the U.S. Department of Health and Human Services if we cannot resolve your concerns. You will not be retaliated against for filing such a complaint. More information is available about complaints at the government's web site, http://www.hhs.gov/ocr/hipaa.

Efficiency through the use of technology

You will be encouraged to consult our website, register for and use our patient portal, and effectively use automated reminders for appointments and for routine care/immunizations that are due.

No application is needed to use DOXY.ME.  You will be directed to a welcome page and please type in your child’s name. You will be instructed to enable microphone and camera and you will now be in a virtual waiting room and you will see your provider shortly.

***There will be a $10 NO SHOW fee for any missed calls. Please be available at scheduled time with child. ***

As medical professionals, we feel very strongly that vaccinating children on schedule with currently available vaccines is absolutely the right thing to do for all children and young adults. We are making you aware of these facts not to scare you or coerce you, but to emphasize the importance of vaccinating your child. We are more than willing to discuss any questions you may have about vaccines, but do require all new patients to our practice to adhere to the vaccination schedule endorsed by the American Academy of Pediatrics (AAP)

• We firmly believe in the effectiveness of vaccines to prevent serious illness and to save lives.
• We firmly believe in the safety of our vaccines.
• We firmly believe that all children and young adults should receive all of the recommended vaccines according to the schedule published by the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP).
• We firmly believe, based on all available literature, evidence, and current studies, that vaccines do not cause autism or other developmental disabilities.
• We firmly believe that thimerosal, a preservative that has been in vaccines for decades and remains in some vaccines, does not cause autism or other developmental disabilities.
• We firmly believe that vaccinating children and young adults may be the single most important health promoting intervention we perform as health care providers, and that you can support as parents/caregivers.

The recommended vaccines and the schedule of administration are the results of years and years of scientific study and data-gathering on millions of children by thousands of our brightest scientists and physicians.

The vaccine campaign is truly a victim of its own success. It is precisely because vaccines are so effective at preventing illness that we are even discussing whether or not they should be given. Because of vaccines, many of you have never seen a child with polio, tetanus, whooping cough, bacterial meningitis, or even chickenpox, or known a friend or family member whose child died of one of these diseases. Such success can make us complacent or even lazy about vaccinating. But such an attitude, if it becomes widespread, can only lead to tragic results.

Over the past several years, many people in Europe have chosen not to vaccinate their children with the MMR (measles, mumps, rubella) vaccine after publication of an unfounded suspicion (later retracted) that the vaccine caused autism. As a result of under-immunization, there have been small outbreaks of measles and several deaths from complications of measles in Europe over the past several years. The United States experienced a record number of measles cases during 2019, with 1282 cases from 31 states reported to CDC's National Center for Immunization and Respiratory Diseases (NCIRD). This is the greatest number of cases since measles elimination was documented in the U.S. in 2000.

Furthermore, we firmly believe that by not vaccinating your child, you are taking selfish advantage of thousands of others who do vaccinate their children, which decreases the likelihood that a child will contract one of these diseases. We feel such an attitude to be self-centered and unacceptable. Even delaying or “breaking up the vaccines” to give one or two at a time over additional visits goes against expert recommendations, is not supported by any scientific data, can lead to unnecessary delays and errors, and can put your child, other children, and adults at risk for serious illness (or even death). It is therefore against our medical advice as professionals at Personal Care Pediatrics.

PERSONAL CARE PEDIATRICS

Notice of Privacy Practices

Effective Date 9/9/2013

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review this notice carefully.

Your medical record may contain personal information about your health. This information may identify you and relate to your past, present or future physical or mental health condition and related health care services and is called Protected Health Information (PHI). This Notice of Privacy Practices describes how we may use and disclose your PHI in accordance with applicable law. It also describes your rights regarding how you may gain access to and control your PHI. We are required by law to maintain the privacy of PHI and to provide you with notice of our legal duties and privacy practices with respect to PHI. We are required to abide by the terms of this Notice of Privacy Practices. We reserve the right to change the terms of our Notice of Privacy Practices at any time. Any new Notice of Privacy Practices will be effective for all PHI that we maintain at that time. We will provide you with a copy of the revised Notice of Privacy Practices by posting a copy on our website, sending a copy to you in the mail upon request or providing one to you at your next appointment.

How we may use and disclose health care information about you:

For Care or Treatment: Your PHI may be used and disclosed to those who are involved in your care for the purpose of providing, coordinating, or managing your services. This includes consultation with clinical supervisors or other team members. Your authorization is required to disclose PHI to any other care provider not currently involved in your care. Example: If another physician referred you to us, we may contact that physician to discuss your care. Likewise, if we refer you to another physician, we may contact that physician to discuss your care or they may contact us.

For Payment: Your PHI may be used and disclosed to any parties that are involved in payment for care or treatment. If you pay for your care or treatment completely out of pocket with no use of any insurance, you may restrict the disclosure of your PHI for payment. Example: Your payer may require copies of your PHI during the course of a medical record request, chart audit or review.

For Business Operations: We may use or disclose, as needed, your PHI in order to support our business activities including, but not limited to, quality assessment activities, employee review activities, licensing, and conducting or arranging for other business activities. We may also disclose PHI in the course of providing you with appointment reminders or leaving messages on your phone or at your home about questions you asked or test results. Example: We may share your PHI with third parties that perform various business activities (e.g., Council on Accreditation or other regulatory or licensing bodies) provided we have a written contract with the business that requires it to safeguard the privacy of your PHI.

Required by Law: Under the law, we must make disclosures of your PHI available to you upon your request. In addition, we must make disclosures to the Secretary of the Department of Health and Human Services for the purpose of investigating or determining our compliance with the requirements of the Privacy Rule, if so required.

Without Authorization: Applicable law and ethical standards permit us to disclose information about you without your authorization only in a limited number of other situations. Examples of some of the types of uses and disclosures that may be made without your authorization are those that are:

Required by Law, such as the mandatory reporting of child abuse or neglect or mandatory government agency audits or investigations (such as the health department)

Required by Court Order

Necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. If information is disclosed to prevent or lessen a serious threat it will be disclosed to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat.

Verbal Permission: We may use or disclose your information to family members that are directly involved in your receipt of services with your verbal permission.

With Authorization: Uses and disclosures not specifically permitted by applicable law will be made only with your written authorization, which may be revoked. Your explicit authorization is required to release psychotherapy notes and PHI for the purposes of marketing, subsidized treatment communication and for the sale of such information.

Your rights regarding your PHI

You have the following rights regarding PHI we maintain about you. To exercise any of these rights, please submit your request in writing to our Privacy Officer:

Right of Access to Inspect and Copy. You have the right, which may be restricted only in exceptional circumstances or with documents released to us, to inspect and copy PHI that may be used to make decisions about service provided.

Right to Amend. If you feel that the PHI we have about you is incorrect or incomplete, you may ask us to amend the information although we are not required to agree to the amendment.

Right to an Accounting of Disclosures. You have the right to request an accounting of certain of the disclosures that we make of your PHI. We may charge you a reasonable fee if you request more than one accounting in any 12-month period.

Right to Request Restrictions. You have the right to request a restriction or limitation on the use or disclosure of your PHI for services, payment, or business operations. We are not required to agree to your request.

Right to Request Confidential Communication. You have the right to request that we communicate with you about PHI matters in a specific manner (e.g. telephone, email, postal mail, etc.)

Right to a Copy of this Notice. You have the right to a copy of this notice.

Website Privacy

Any personal information you provide us with via our website, including your e-mail address, will never be sold or rented to any third party without your express permission. If you provide us with any personal or contact information in order to receive anything from us, we may collect and store that personal data. We do not automatically collect your personal e-mail address simply because you visit our site. In some instances, we may partner with a third party to provide services such as newsletters, surveys to improve our services, health or company updates, and in such case, we may need to provide your contact information to said third parties. This information, however, will only be provided to these third-party partners specifically for these communications, and the third party will not use your information for any other reason. While we may track the volume of visitors on specific pages of our website and download information from specific pages, these numbers are only used in aggregate and without any personal information. This demographic information may be shared with our partners, but it is not linked to any personal information that can identify you or any visitor to our site.

Our site may contain links to other outside websites. We cannot take responsibility for the privacy policies or practices of these sites and we encourage you to check the privacy practices of all internet sites you visit. While we make every effort to ensure that all the information provided on our website is correct and accurate, we make no warranty, express or implied, as to the accuracy, completeness or timeliness, of the information available on our site. We are not liable to anyone for any loss, claim or damages caused in whole or in part, by any of the information provided on our site. By using our website, you consent to the collection and use of personal information as detailed herein. Any changes to this Privacy Policy will be made public on this site so you will know what information we collect and how we use it.

Breaches:

You will be notified immediately if we receive information that there has been a breach involving your PHI.

Complaints:

If you believe we have violated your privacy rights, you have the right to file a complaint in writing with our Privacy Officer at

PERSONAL CARE PEDIATRICS. If you have questions and would like additional information, you may contact us at  954-974-3006.

Your insurance carrier may require you to obtain a referral before seeing a specialist. We obtain a referral for you only after an appointment has been made by you with the specialist you intend to see. Therefore, when one of our physicians requests that you to see a specialist, they will give you a list of physicians we recommend in that specialty. It is then your responsibility to call the physician you wish to see, confirm that the specialist takes your child's insurance, and if they do take your insurance, book the appointment. At that point you are to notify our office by email or phone that an appointment was made. Tell us when and with what doctor and we will process the referral, according to the directions we have in your electronic chart and the information you give us. You will need to pick up the referral from our office. We cannot email it nor fax it to the specialist. We cannot mail it to your home. Please do not call us from the specialist's office. Failure to obtain a referral will leave you at risk for payment of all charges associated with the appointment. We require 3-5 business days to process non-emergent referrals. Emergent referrals will be done on the direction of one of our physicians.

You may contact the front desk for Referral requests using the following methods:

• Using our Patient Portal. Log in and click here
• By Phone at: (954) 974-3006