Forms and Office Policies

 

Forms

The following forms were created with the intent to make a visit to the office as easy as possible. Please select the form you want to download, print it, fill it out, and bring it with you to the office.

Administration Forms

ADHD Forms*

* If Dr. Shawn Reathaford is handling your ADHD assessment, make sure to contact the office (859-525-8181) for special forms. 

Developmental Forms


 

Privacy

Our Privacy Practices


 

The following policies and procedures were created with the intent to make a visit to the office as easy as possible. Please select the click the policy or procedure to get more information.

Policies and Procedures

ADD/ADHD Medication Procedure

Most ADHD medications are from a group of medications called stimulants, and are classified as controlled substances by the Drug Enforcement Agency. These medications are carefully regulated and require that certain procedures be followed in order to fill the prescriptions.

Because of the condition and the possible side effects of the medication, children with ADHD need close follow up. WE need to check on how school is going, his/her emotional well being at home and at school, as well as closely monitor his height, weight, and blood pressure.

Your child will need to come to the office about once a month until he/she is stable on the medication and all is going well. After that, we will need to see him in the office every 3-4 months for re-evaluation. If he/she is having any problems at home or at school, or if you have any concerns about his behavior or the medication, please call the office and schedule an appointment, so that we can re-evaluate the medications and/or the dosage to make sure you child’s needs are being met.

Stimulant Medication Procedures for ADD/ADHD

  • You must come to the office and pick up a written prescription (the medication cannot be called in). It is possible to get a 90 day supply of medication, but there are no refills allowed for this type of medication.
  • Please call the office at least 3 days before the medicine runs out so that we can have your prescription ready for you to pick up.
  • Please schedule your office visits at least one month in advance (when you pick up your prescription). We do not schedule ADHD consultations on Saturday, and we cannot guarantee after school appointment times, so please try and check ahead of time to see when your child has off days from school (he/she will need to be seen only 3-4 times each year as long as he/she is doing well on medication). If it is necessary to take your child out of school for an appointment, we will be happy to provide you with a doctor’s note for school. No appointments will be available after 3:00 pm unless they are scheduled at least one month in advance.
  • Please be advised that no prescriptions will be given without the necessary medical checkups…..so make sure you plan ahead.
  • If you need to cancel your child’s ADHD consultation, please do so at least 24 hours in advance so that we can make room for other children to be seen, and to avoid a “missed appointment” charge.

The symptoms of ADD/ADHD are usually treated very successfully with medication…..please help us to take the best possible care of your child’s needs, as well as those of the other patient’s in our practice.

Financial Policy

Due to the ever changing insurance plans/ policies and the growing costs associated with those plans/policies, we are instituting a new office policy beginning July 1, 2014.

We accept most private insurance plans. Please contact us (859-525-8181) to verify with our staff that we accept your insurance.

If you are uninsured…
We do offer a self pay discount. Full payment is due at the time of service. We would also like to encourage you to visit the Kentucky Healthcare Exchange to see if you may qualify for an insurance plan.

If your child is a newborn…
Please add newborns to your insurance policy within 30 days of birth. We do accept WellCare and Coventry (for newborns only).

High Deductible Insurance Plans

If you have a high deductible insurance plan, you will be required to make a payment $50 per child at the time of your child’s visit. For example, If Bobby has an appointment you would need to pay $50. If Bobby and Sally both have appointments you will need to pay $100 at the time of service.  You will be billed for the balance due that is determined by your insurance company.

This payment will be due regardless of who brings the child to the appointments, so please make any necessary arrangements. If you are sending your child with a grandparent or another caretaker, please make sure you send the payment with them or call to make the payment over the phone before your child’s scheduled appointment time so as not to delay their visit. We do understand that in some situations custody agreements dictate who is responsible for medical balances. This is the responsibility of the parent or guardian to organize and make arrangements before the visit. Pediatrics of Florence’s primary goal is to provide the best possible medical care for your child. We do not want to have to act as a collection agency.

Well Child Preventative Care Visits Do Not Apply To The New High Deductible Insurance Policy…
This type of payment will not be collected on Well Child Preventative care visits. The majority of these insurance companies pay for these visits in full.  It is extremely important that you educate yourself on your insurance plan and its coverage. You should know if you have a copay or deductible. Are your child’s well care and immunizations covered at 100%? Will your flu vaccine be covered this year? Do you have to have a primary care physician listed with your insurance company?  Do you have a maximum benefit for well care per year? Can you go to Children’s hospital or St Elizabeth? Is your insurance accepted at both? These are just a few things that are important to be aware of.

Copays

If your insurance plan requires a copay this is also due at the time of service.  There is a $10 billing fee for any copay not paid at the time of service and there must be arrangements made prior to your child’s visit.

Self-Pay / No Insurance

If you are without insurance and are self- pay, payment in full is due at the time of service. We would also like to encourage you to visit www.healthcare.gov to see if you may qualify for an insurance plan.

Newborns

If your child is a newborn, please add them to your insurance policy within 30 days of birth. We do accept Wellcare and Coventry for newborns only.

We are happy to answer any questions that you may have regarding this new policy.  We look forward to continuing to care for your family and hope this is an easy transition for everyone.

Missed Appointment Policy

The goal of our office is to give the best care possible to your child and all of our patients. When appointments are scheduled and then not kept we feel your child is not receiving good care. It also takes an appointment away from a potentially sick child that we could have seen sooner but had to schedule at a later time.

There is a $20 charge for missed appointments that are not cancelled 24 hours in advance. If you make a same day sick appointment for your child and need to cancel we ask that you call at least 2 hours ahead of time so that we can use that appointment time to see another child. We do understand that emergencies come up, however we still must require a phone call to let us know you are not going to keep an appointment prior to your appointment time.

If missed appointment fees are not paid or payment arrangements are not made, your family may be dismissed from the practice and asked to transfer their records to another healthcare provider.

Walkin Hours Procedure

We see patients for walk-ins from 7:30am-8:30am Monday-Friday. We want to be able to use this time to see sick patients only, so that children can make it to school and parents can get to work on time.

Who is eligible for a walk-in?

We will see acute sick problems such as, ear aches, sore throats, cough, pink eye, etc. This is not a time that we will be able to see your child for well checks, sports physicals or on going problems.

What if I get there after 8:30am?

If you arrive after 8:30am, we will not be able to see your child as a walk-in patient but will gladly schedule an appointment for that day with one of our providers. Each day we have scheduled appointments for the morning and if we do not make a cut off time for our walk-ins; we would miss our scheduled appointments.

In a constant effort to provide you the best service possible, we hope that our walk-in hours and extended evening hours are beneficial for you.

Weather Closing Policy

In the event that we will have to delay the opening of our office, we will change our phone message to say that the office is closed due to weather. If you get this message in the morning wait a while and try to call back. We may need a little extra time to get into the office.

If you get the closed office recording in the afternoon, we didn’t make it into the office or we may have had to close the office early due to extreme weather conditions so that the staff may get home safely. BOTTOM LINE…If we are experiencing bad weather, call before you come into the office to make sure we are here.