Policies, Practices & Forms for GROW Patients
Please read our policies!
If you are a GROW family, or plan to be, please take some time to review ALL of our policies posted here – we have done our best to keep them as simple and easy to review as possible (while retaining all pertinent info). This information (along with the physician and staff bios) may also be helpful in deciding if we are a good fit for your family.
Vaccine Policy
GROW Pediatrics is proud of our commitment to our vaccine compliance policy. In keeping with industry standard, we require families within our practice to adhere to our Vaccine Policy and acknowledge such at registration. To promote best practices of public health, and in the interest of all families seen in our office, we follow American Academy of Pediatrics recommended schedule of required vaccinations. You can read more about this by clicking here, courtesy of HealthyChildren.org.
You’ll find our full policy, in detail here; GROW Vaccine Policy. We do not offer accommodations for any delayed or alternative vaccine schedules.
Divorced or Separated Parent Policy
We have a practice policy relating to family dynamics. It is important to clearly outline expectations regarding GROW’s involvement with families who are not residing in the same home, but are sharing in custodial responsibilities. It is our goal to clearly set boundaries related to communication, access to records and appointments, and parental responsibility. We’ve found it necessary to share these details with families upon registration, or as the policy becomes applicable. GROW Pediatrics does not engage in mediating conflicts, assisting families with scheduling logistics, or relaying communication between parents. Our greatest priority is the health and well-being of our patients. If it becomes difficult for our practice to appropriately prioritize your child’s healthcare due to parental conflict, we will ask that your family find another practice that may accommodate you better. Details of our policy can be found here; Divorced/Separated Parent Policy.
Forms
| Form Name | Type | Description | |
|---|---|---|---|
| Flu Vaccine Questionnaire | Form | This completed form is required for all patients and parents who are receiving a flu shot from GROW. | DOWNLOAD |
| New Patient Paperwork- Family | Forms Packet | Please review ALL policies and sign these forms including: Demographics, Medical History Questionnaire, Consent to Treat, Financial Policies, Office Policies, Records Request, and ImmTrac Registration. | DOWNLOAD |
| Adult Patient HIPAA Consent and Release | Form | For patients age 18 and older, this form gives the option to grant or restrict access to their personal health information. | DOWNLOAD |
| Consent to Treat | Form | Authorizes our practice to provide care to your child if a parent/legal guardian unable to make an appointment and permits another individual (grandparent, nanny, etc.) to be present. | DOWNLOAD |
| Medical Records Request | Form | Authorizes the release of medical records to or from our practice. | DOWNLOAD |
| ADHD Initial Questionnaire | Form | Vanderbilt Assessment Scale | DOWNLOAD |
| ADHD Follow-up Questionnaire | Form | NICHQ Vanderbilt Assessment Follow-up | DOWNLOAD |
Policies and Practices
| Policy Name | Type | Description | |
|---|---|---|---|
| Adolescent Confidentiality Policy | Disclosure | Explains our support of confidentiality with our adolescent patients and how we promote the collaboration between patient, parent, and provider. | DOWNLOAD |
| Divorced or Separated Parents Policy | Disclosure | This policy relating to family dynamics clearly outlines boundaries and expectations surrounding communication, access to records and appointments, and parent responsibility. | DOWNLOAD |
| Financial Policy | Disclosure | Notifies you of our policies regarding the financial responsibilities associated with services rendered to your child, in compliance with the Federal Consumer Protection Act. |
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| Notice of Administrative/Forms Fees | Disclosure | Informs you of fees for forms completion outside of an appointment. | DOWNLOAD |
| Notice of Privacy Practices | Disclosure | Describes how medical information about you may be used and disclosed and how you can get access to this information. | DOWNLOAD |
| Vaccine Policy | Disclosure | Describes our commitment to vaccinations for disease prevention and our ethical reasoning for this policy. |
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| Vaccine Schedule | Disclosure | Lists our interpretation of the CDC recommended vaccine schedule. |
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| Website Privacy Policy | Disclosure | Informs you of our goals and intentions for this website. Your use of the site implies your consent to this policy. |
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