Important forms from our pediatric office
The providers at our pediatric office in Plano want you to be informed about the medical care of your child. To help you, we have uploaded digital versions of important forms and a summary of how they are used.
- Demographic sheet
- Initial Patient History
- General office consent
- Office Policies
- Consent for Disclosure of Protected Health Information
- Over 18 HIPAA Release and Consent
- Records Release
We may periodically ask for updated versions of these or other forms as your child ages and your circumstances change.
Our pediatric office handles medical information with care
Many of the forms that we require our patients or their legal guardians to fill out are required under the Health Insurance Portability and Accountability Act, or HIPAA. HIPAA was enacted by Congress in 1996. These rules govern the way that medical providers, including our Plano pediatricians, handle confidential medical information. The types of medical information that are protected are:
- Information about an identifiable person’s past, current or future health
- Information about how an identifiable person’s healthcare is, has or will be provided
- Information about how an identifiable person has paid, is paying or will pay for healthcare
Medical providers are legally required to protect this information, and are limited from distributing it unless it is necessary for medical treatment, billing or at the patient’s request. This means that under HIPAA’s privacy rule, our pediatric office generally cannot release your child’s healthcare information to other people or organizations without your consent.
Contact us to learn more about how we use these forms or to schedule a visit for your child.
Our Phone Number
Pediatric Specialists of Plano
3405 Midway Road, Suite 650
Plano, TX 75093
To obtain our email address, please submit a contact us form. You will receive an automatic response with our email address.