Patient Information

At Mid-Jersey Pediatrics, it is our goal to provide you with useful information. This section contains the forms that make up the new patient information packet. You can print these forms, complete them at home and bring them into office at the time of your child's visit. You can find a complete listing of our office policies. We have developed patient handouts covering various topics including illnesses as well as safety and guidance information. These handouts are available to give general information. If additional information is necessary or anything is unclear be sure to call our office. For our new parents, we have provided a complete copy of our newborn booklet which contains the frequently encountered issues of the newborn. Lastly, we have provided links to medically reliable websites. We know that medical information exists in many forms. We hope that these sites will offer you the security of knowing that they are trustworthy. We hope these items prove useful and allow for efficient of your time. We will continue to update this section with new information so check it periodically.

PATIENT FORMS

Face Sheet

This is the first page in every patients chart. It contains all of the patient's pertinent health information for each patient including medicine and food allergies, maternal pregnancy information, birth history, family history, and past medical history. This is very important because it provides our practitioners with information that assists them is doing the appropriate screening exams and tests. Download

Insurance Information Form

This form features all of the pertinent insurance information. Please be sure to keep this form up-to-date. Let our staff know when there is a change of insurance. Please bring your insurance card to each visit. Download

Records Release Form

This form is used to give another physician permission to transfer your child's medical records to our office. It is important that we have as complete a record as possible specifically vaccine records, diagnostic laboratory results, growth charts and letters from subspecialists. Download

Information Update Form

This form provides us with updated mailing address and/or phone numbers. This form can be faxed into the office at (732) 257-1177. Download

Notice of Privacy Practice

It has long been the mission of Mid-Jersey Pediatrics to provide you and your family with the highest quality healthcare and health related services. We are committed to making every effort to protect the privacy and confidentiality of your family's health information. In keeping with recently enacted federal legislation, we are pleased to present you our Notice of Privacy Practice. We believe this notice will help you understand our obligations and commitments relative to your privacy as well as your rights over medical information. As always, we welcome any suggestions or comments you might have on this or any other part of our practice. This notice describes how medical information about our patients may be used and disclosed and how you may obtain access to this information. PLEASE READ IT CAREFULLY. Download

 

OFFICE POLICIES

Missed Appointments
It is our goal to accommodate any child that requires medical attention. This at times can be difficult due to scheduling. We ask at all parents please notify our office as early as possible if you need to cancel an appointment. If a scheduled appointment is missed, you will be billed $35.00 for each offense. By canceling the appointment in a timely fashion you create an opportunity for another child to be seen. We thank you in a advance for your cooperation.

Late For An Appointment

Our office does not use walk-in visits. All appointments are scheduled. The practitioners of Mid-Jersey Pediatrics make every attempt to maintain a timely schedule. This is not always possible. We believe that it is of the utmost importance to give our full attention to each patient and family and assure that all questions and concerns are addressed. This may sometime cause a slight delay. In trying to maintain our schedule, some difficulty may arise when a patient arrives late. We understand that the reasons may be numerous. Again we ask for the courtesy of calling our office, notifying us that there is a delay and providing an approximate time of arrival. If you will be more than 30 minutes late for your scheduled well-child appointment, your practitioner will be informed and he/she will determine whether it is better to have the appointment rescheduled for later the same day or for another day.

Call Center Fee

When our office is closed, we direct all calls to the St. Peter's University Hospital Pediatric Call Center. This center features well-trained pediatric registered nurses who are available to answer any of your questions and concerns. They will triage your calls and determine whether your child requires prompt or emergency medical attention, routine health advice or the need to speak with our physician on call. For many years, this wonderful service was provided free of charge by the hospital. Changes in health care finances have redirected this cost to each individual practice. In order to continue to provide this important resource, we must charge each patient $5.00 for use of the call center. Please keep in mind that the practice still pays the majority of the fees. We are simply asking our families to help subsidize this expense.

School, Sports & Camp Forms/Working Papers

Parents receive numerous forms throughout the year from their child's school or extracurricular activities. We are happy to complete these forms however the increasing number of forms have added a significant amount of paperwork for our staff. Forms can be dropped off at any time. Our staff will complete these forms within seven days. Please provide us with as much lead time as possible. This will ensure that your forms are completed in a timely fashion. In order for forms to be completed, your child must have had a well child exam or annual physical within the past 365 days. This policy exists to ensure that there has not been a change in your child's health status that would pose a health risk during any activities. Please pay close attention to all special dates and deadlines that may be required by the sanctioning body of the activity. For example some forms require that child have a well child exam after a specific date. If that date occurs before your child's next scheduled well child exam, a sports physical may be required.

Vaccine Separation Policy

It is neither the recommendation of the office nor the American Academy of Pediatrics, to give the vaccines one at a time. We feel that it is better to immunize the children on the recommended schedule but will try to accommodate requests for an individualized schedule. We encourage you to review the facts and make an educated decision. Although we do not like to have to pass on increased costs to patients, we feel that the demand by parents to vaccinate their child(ren) on a schedule that they request, and not one we endorse, has required us to respond by passing on the additional costs. If you should still feel the need to separate vaccines, we will accommodate your requests, but you will be charged for a nurse visit. All insurance rules of copays, deductibles and out of pocket expenses will apply.

Office Tours

Please call our office and ask to speak with our office tour coordinator, Jean Stelicos. Tours can be arrangement on the same day you call.

PATIENT HANDOUTS

Bike Helmets Breast Exams Car Safety Cigarette Smoking Conjunctivitis (Pink Eye) Cradle Cap (Seborrhea) Croup Coxsackie Virus Dacrostenosis (Blocked Tear Duct) Diaper Rash Diarrhea Febrile Seizures Fever Fifth Disease Firearm Safety Fingernail/Toenail Infection (Paronychia) Gastoesophageal Reflux (G.E.R.) Head Injury Head Lice Hives (Urticaria) Impetigo Infant Feeding Infant Safety Introducing Your Newborn to the Family Dog Insect Bites and Stings Intoeing, Bowed Legs and Flatfeet Lyme Disease Masturbation (Preschoolers) Menstrual Periods

Molluscum Contagiosum Mononucleosis Nebulizer (Use and Care) Newborn Jaundice Night Terrors Nosebleeds Pacifier-Thumb Sucking Pediatric Specialists Pinworms Prickly Heat Ringworm (Body) Ringworm (Scalp) Scabies School Phobia Sea Lice Sinusitis Sleep Problems Stitches and Staples Strep Throat Sun Protection Swimmers Ear Temper Tantrums Testicular Exam Teething Uncircumcised Penis Care Vascular Birthmarks

NEWBORN INFORMATION

Congratulations to al our new parents. This new bundle of joy causes a great deal of excitement as well as many anxious and concerned moments. We have provided a copy of our newborn booklet for you review. This booklet many answer many of your questions and prepare you for a few of the experiences you may encounter. Please call our office if you have any questions. You may find the book, What to Expect in the First Year, by Arlene Eisenberg useful as a resource.

PATIENT RESOURCES

We are committed to providing you with credible online health information and are pleased to provide links to the following health resources. Mid-Jersey Pediatrics is not responsible for their content or for subsequent links that may be provided. Information contained in these sites should not serve as a substitute for medical advice from your child's doctor.

American Academy of Pediatrics - www.aap.org
Centers for Disease Control and Prevention - www.cdc.gov
eMedicine - www.emedicine.com
KidsHealth, the Nemours Foundation - http://kidshealth.org/
La Leche League International - www.llli.org
WebMD - www.webmd.com