This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Revised April 2017
- When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
- Get an electronic or paper copy of your medical record – You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
- Ask us to correct your medical record – You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. We may say “no” to your request, but we’ll tell you why in writing within 60 days.
- Request confidential communications – You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will say “yes” to all reasonable requests.
- Ask us to limit what we use or share – You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
- Get a list of those with whom we’ve shared information – You can ask for a list (an accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatrment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
- Get a copy of this privacy notice – You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
- Choose someone to act for you – If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has the authority and can act for you before we take any action.
- File a complaint if you feel your rights are violated – You can complain if you feel we have violated your rights by contacting Children’s Medical Group’s Privacy Officer using the information on the bottom of this notice. You can also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights by sending a letter to 200 Independence Avenue, S W, Washington, DC 20201, calling 1-877-696-6775, or visiting http://hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.
- For certain health information, you can tell us your choices about what we share.
- If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your intructions. In these cases, you have both the right and choice to tell us to:
- Share information with your family, close friends, or others involved in your care;
- Share information in a disaster relief situation;
- Include your information in a hospital directory
- (If you are not able to tell us your preference, for example if you are unconscious, we may share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.)
- In these cases we never share your information unless you give us written permission:
- Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes
- Fund raising activites
Our Uses and Disclosures
- How do we typically use or share your health information? We typically use or share your health information in the following ways:
- Treat you – We can use your health information and share it with other professionals who are treating you.
- Example: A doctor treating you for an injury asks another doctor about your overall health condition.
- Run our organization – We can use and share your health information to run our practice, improve your care, and contact you when necessary.
- Example: We use health information about you to manage your treatment and services.
- Bill for your services – We can use and share your health information to bill and get payment from health plans or other entities.
- Example: We give information about you to your health insurance plan so it will pay for your services.
- How else can we use or share your health information?
- We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: http://hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
- Help with public health and safety issues – We can share health information about you for certain situations such as:
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health or safety
- Do research – We can use or share your information for health research.
- Comply with the law – We will share information about you if state or federal laws require it, including with the Department of Health and Human Services, if it wants to see that we’re complying with federal privacy law.
- Respond to organ and tissue donation requests – We can share health information about you with organ procurement organizations.
- Work with a medical examiner or funeral director – We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
- Address workers’ compensation, law enforcement, and other government requests – We can use or share health information about you:
- For workers’ compensation claims
- For law enforcement purposes or with a law enforcement official
- With health oversight agencies for activities authorized by law
- For special government functions such as military, national security, and presidential protective services
- Respond to lawsuits and legal actions
- We can share health information about you in response to a court or administrative order, or in response to a subpoena.
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy and security of your information.
- We must follow the duties and privacy practices described in this notice and give you a copy of it.
- We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: http://hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
- Changes to the Terms of this Notice
- We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, posted in our office, and on our website.
If you have any questions about this notice, you may contact the Children’s Medical Group Privacy Officer:
- Email: PrivacyOfficer@Childsmedgroup.com
- Mail: Privacy Officer
- Children’s Medical Group PA
- 3920 Airport Blvd-Ste A
- Mobile, Alabama 36608
- Phone: (251) 342-3810/(251) 639-1300
Telephones answered beginning at 7:30 AM on weekdays and 7:00 AM on weekends
- Airport Location (251) 342-3810
- Providence Location (251) 639-1300
We are open every day including Saturday, Sunday and all holidays except Thanksgiving and Christmas.
Well Child Checkups
Children’s Medical Group follows the American Academy of Pediatrics recommended well child physical exam schedule:
- 1 – 2 Days after Hospital Discharge
- 2 Weeks*
- 1 Month
- 2 Months
- 4 Months
- 6 Months
- 9 Months
- 12 Months
- 15 Months
- 18 Months
- 2 – 18 Years – Yearly Exams
*This is a weight check only and no appointment is needed. Hours are Monday – Friday 8:30 am – 11:30 am and 2 pm – 4 pm, no weekends or holidays.
Appointment Cancellation Policy
Our office policy is that an appointment for a sick visit be cancelled with a minimum of 2 hours prior notice. Cancellation of checkup/ADD/ADHD appointments require 24 hours prior notice. We allow a grace period for the first missed appointment; however, if a second appointment is missed without adhering to our policy your account will be billed $25 and can result in dismissal from our practice. THERE IS NO GRACE PERIOD ALLOWED FOR ADD/ADHD.
- (251) 342-3810 Airport Location – Option 3
- (251) 639-1300 Providence Location – Option 3
Each physician at Children’s Medical Group has their own pediatric registered nurse to answer any questions you may have, refill prescriptions, give test results and offer advice regarding your child. We begin answering our phones at 7:30 AM on weekdays and 7:00 AM on weekends.
After Hours Phone Calls
When our office is closed, pediatric nurses from Children’s Hospital in Birmingham, AL are available to return calls and offer advice regarding your child.
For medical emergencies, the physicians of Children’s Medical Group recommend USA Children’s and Women’s Hospital. With a new, expanded children’s wing including state-of-the-art equipment and pediaitric subspecialists, it is the best place along the Gulf Coast if your child requires an emergency room visit or hospitalization. Although we do not have hospital privileges, we will work closely with the physicians there to make sure your child receives the best care.
(251) 342-3810 Airport Office – Option 3
(251) 639-1300 Providence Office – Option 3
For your convenience, we have a dedicated nurse line to request prescription refills. This line is checked during the hours of 8 am and 5 pm Monday through Friday. Please allow 48 business hours for your request to be processed. If you do not hear from us in that time frame or if you have any questions regarding your prescription, please contact us. Prescription refills are NOT done after 5 pm, on the weekends or on holidays.
Prescription Refill Request
Please leave your name, your child’s name and date of birth, chart number, your phone number, name and strength of the medication and pharmacy number where you would like the medication phoned in. Failure to provide this information may result in a delay of the prescription being refilled.
Please be aware that regular medical supervision is required to refill prescriptions; therefore, you may be asked to make an appointment for your child to be examined and to review your child’s treatment plan. Prescriptions for controlled substances (i.e., ADHD medications) require a yearly medical evaluation – NO EXCEPTIONS. Please note that prescriptions for controlled substances must be picked up by the parent, guardian or their authorized representative and a valid photo ID must be shown.
Sports physical forms, school forms, camp forms, medication forms, WIC forms, etc. may be brought with your child and filled out at the time of your appointment. If not, we ask that you drop them off at the front desk along with a phone number where you can be reached if there are any questions. If your child has not had a current physical, one will need to be scheduled prior to the physician filling out and signing the form. For medication forms, please fill in the name of the medication you are asking us to authorize your child taking.
Please allow at least 24 business hours before returning to pick up the form. Due to HIPAA regulations, we are not authorized to fax any forms.
- Pre-Participation Sports Physical Form
- Please complete the health history questions on the front of the form before bringing it in for the physician to sign.
Our office accepts most insurance plans. We do not accept Medicaid. Please check with your insurance plan to determine if the providers of Children’s Medical Group are listed as participating (in-network) providers with your insurance plan. You are responsible for all applicable copays, co-insurance, annual deductibles and any non-covered services. Please understand that we cannot waive any patient balances. All copays are due at the time of service.
In the event you have an insurance plan that Children’s Medical Group does not contract with, you will be responsible for payment of all charges not paid by your plan. Most insurance plans refer to this as “out-of-network”. If you have an insurance plan that requires a primary care physician, you must specify your selection to your insurance plan prior to being seen at Children’s Medical Group. For newborns, parents have a period of 30 days to contact their insurance company and enroll the baby on the insurance plan.
Verification of Insurance
Proof of insurance is required by providing your insurance card at each visit. This is done to ensure that we are a participating provider in your plan and that all information and/or changes have been documented correctly. Please inform our receptionist of any changes in your insurance coverage, address, phone, etc. To avoid appointment delays and to expedite your visit, please bring your insurance card with you and present it at each visit.
Methods of Payment
Check, cash, debit. MasterCard, Visa, Discover and American Express are accepted for your convenience.
Return of Check Charge
If your check is returned for any reason, a thirty five dollar ($35) return check charge will be assessed to your account. Cash or credit cards are accepted to pay for these charges and is expected upon notification. After two returned checks we will no longer accept checks as payment for services.
The physicians of Children’s Medical Group, P.A. welcome your family to our group. New patients are asked to come in 30 minutes earlier than their appointment to allow our office staff time to establish a new chart for your family.
Please download and bring in this completed registration form, your insurance card, photo ID, immunization records and social security cards for each child. You will be required to pay any co-pays or deductibles due. Our bookkeeping and insurance departments can assist you with any questions you may have. If you cannot print out this form, you may come early and fill it out at the office.
To have medical records from a previous provider sent to Children’s Medical Group, please see our Medical Records Request section for more information.
Remember your first appointment with our office will need to be during normal business hours Monday-Friday, not on weekends or nights due to limited staff.
We look forward to serving you and your children.
To have medical records released TO Children’s Medical Group click here.
To have medical records released FROM Children’s Medical Group click here.
Completely fill out the appropriate form amd mail or fax it to our office.
These forms are also available at both of our locations if you are unable to download and print them.
Please call for any medical records questions.