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
Your Rights
- 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 treatment, 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.
Your Choices
- 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 instructions. 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 activities
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.
Our Responsibilities
- 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: Privacy.Officer@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
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 pediatric 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.
- COVID Specimen Collection Consent Form
- Please complete the form at home before bringing it in for the physician to sign.
Medical Insurance
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 new patient 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 and 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.
Children’s Medical Group, P.A.- Ear Piercing
We offer medical ear piercing for children and babies over 4 months of age to 12 months of age and older than 5 years of age. Please call the office to make an appointment.
We use the Blomdahl Medical Ear piercing system which is available ONLY to physicians. The Blomdahl Medical Ear piercing system uses single-use cassettes which minimizes chances for infection. It uses medical grade plastic and medical grade titanium studs which eliminates the risk of nickel allergy. Using this system also eliminates the possibility of patient-to-patient cross-contamination because the single use part of the equipment never comes in contact with the skin of the patient at the piercing site.
Children’s Medical Group recognizes that by offering these services, your child will have a professional service, a sterile system, and better outcome than at a mall or tattoo parlor.
Age restrictions: CMG will do ear piercing for infants aged 4 months to 12 months and for children 5 years of age and older. This ensures that infants have received the first two sets of vaccines, including the DTaP, and allows the ear to grow big enough for more accurate placement of the earring. After 12 months of age, children are more active making the actual piercing experience more difficult and less safe. For children over 5 years of age, it is important that the child has requested to have their ears pierced and the Parent/Guardian has agreed. The child needs to be able to sit still during the procedure and has to allow or participate in responsible after-care to ensure a good outcome. The child will sit beside the parent and will lean against the parent’s shoulder. Teens will simply sit quietly on the own.
Piercing location: We only pierce earlobes and will only do one piercing per earlobe. We do not pierce cartilage or other body parts.
Cost: The cost for medical grade plastic is $100.00 to pierce both ears and $50.00 for one ear only. The cost for medical grade titanium is 120.00 to pierce both and $60.00 for one ear only.
Payment is due in full when you check in for your ear piercing appointment. Since this is a cosmetic procedure, it is not covered by your insurance and will not be billed to your insurance.
The payment includes the ear piercing stud made of medical grade plastic or titanium, and the cost of the ear piercing procedure by the Provider.
Ear Piercing Appointments:
You may schedule an Ear Piercing Visit with our providers which would be to solely perform the medical ear piercing procedure. Ear piercing will not be performed during any other Well Check or Sick/Problem Visits.
Swimming after ear piercing: We recommend avoiding swimming for 2-3 weeks after ear piercing. Chlorine from pools and bacteria in chlorinated waters may irritate or contaminate the wound and delay healing.
What are the risks of ear piercing?
Before we begin the procedure, the Parent/Guardian will be asked to sign an Informed Consent Form which reviews the risks listed below.
Infection–There is a risk of infection anytime the skin is broken. We reduce this risk significantly by using sterile technique. The Blomdahl Medical Ear Piercing System utilizes sterile, single use piercing cassettes. This also eliminates any cross-contamination because only the sterile, single-use part of the equipment ever comes in contact with the skin at the piercing site. We also provide specific After-Care Instructions to keep the piercing clean and healthy during the healing process.
Pain—The experience is similar to a vaccine injection using the Blomdahl system. Some patients may complain of a warm, flushed feeling on their earlobes after the procedure.
Bleeding–There is a risk of bleeding anytime the skin is broken. However, the earlobes do not contain significant blood vessels so that this risk is minimal.
Nickel Allergy–Allergic Contact Dermatitis is an itchy rash that occurs when your skin comes in contact with a typically harmless substance. Nickel is one of the most common causes, and once you develop a nickel allergy, you will always be sensitive to it. Nickel is commonly used as a metal hardener and most metals used for ear piercing contain or “leak” enough nickel to trigger a potential allergic reaction. Fresh piercings allow direct and constant contact between a minor open wound and the metal which contains the nickel. However, the Blomdahl Ear Piercing studs utilize only medical grade plastic or medical grade titanium, the most superior non-allergenic metal, thereby eliminating this risk.
Keloids–Keloids are shiny, smooth and rounded skin elevations, which are a type of scar tissue, which can form at the piercing site in some patients after the earlobe piercing because of altered wound healing. Keloids tend to run in some families, are more likely to occur in patients with darker skin pigmentation, and generally occur in people 10 to 30 years of age.
Please inform us if your child has any health conditions that could cause excessive bleeding, difficulty fighting infections or keloid scar formation.
Cleaning and care after the procedure:
We recommend NOT replacing the original ear piercing studs for 6 weeks. The ear piercings studs we use are thicker (1.3 mm) than the standard earring post (1.0 mm). The larger piercing hole makes it easier to switch to normal earrings after the healing period and reduces the risk of repeatedly re-injuring the ear-piercing site when replacing earrings, which should, therefore, reduce the risk of piercing site infection.
How do I take care of the pierced ears afterward?
- Clean the piercing site thoroughly twice a day, using liquid soap and clean running water at least once a day (preferably after showering or washing the hair).
- Dry area well with clean gauze or a cotton tipped applicator and leave open to air.
- For supplementary cleansing, or when running water is unavailable, ear care solution is available at Claire’s or you may purchase Blomdahl® Ear Care cleansing swabs at our office.
- Leave the ear piercing studs in the ear lobe for 6 weeks before replacing with earrings.
- Unlike conventional ear piercings, there is no need to rotate the Blomdahl medical-grade plastic studs to prevent them from adhering to the skin.
Read more about medical ear piercing aftercare on Blomdahl’s website.