Parent and Child Handbook Spring 2008 Edition

REMINDER Please bring the following to each of

your child’s appointments and arrive 10 minutes early routinely in order to verify insurance:

Current Insurance Card Payment for Service Immunization Record List of Current Medications

Table of Contents Introduction . . . . . . . . . . . . . . . . . . . . 1 Mission Our Physicians Our Services Our Hours Contact Information Appointments . . . . . . . . . . . . . . . . . . 1 Consent for Care and Treatment Scheduling Well Child Exams Scheduling Sick Visits Walk-In Requests for Appointments Preparing for Appointment Arriving for Appointments Waiting for Appointments Canceling Appointments Missed Appointments Preventative Medicine . . . . . . . . . . . . 3 Well Child Exams Developmental Screening Sport and Camp Physicals Immunizations Immunization Records Patient Education Contacting the Office . . . . . . . . . . . . 5 Urgent Medical Matters Concerning Symptoms Routine Questions Office E-mail Medical Care After-Hours. . . . . . . . . 6 Physician-On-Call Service Weekend and Holiday Visits Hospital Care . . . . . . . . . . . . . . . . . . 8 Hospitalizations Newborn Care Emergencies

Other Services . . . . . . . . . . . . . . . . . 8 Consultations and Referrals Laboratory and Radiology Prescriptions and Refills Authorization for Medications at School Medications for ADD and ADHD School Excuses and Day Care Clearance Flu Clinics In-Office Minor Procedures Our Website Financial Policy . . . . . . . . . . . . . . . . . 11 Insurance Filing Verification of Benefits Payment Policy Outstanding Balances Medical Records. . . . . . . . . . . . . . . . . 12 Electronic Information Transferring Records to Pediatric Junction Request for Pediatric Junction Records Requests for Immunization Records Privacy Policy Other Policies . . . . . . . . . . . . . . . . . . . 12 Care for Minors Young Adults Services Not Available Privacy Issues for Pre-teens and Teens

Common Illnesses and Recommendations Fever . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Tylenol (acetaminophen) and Motrin (ibuprofen) Dosing Upper Respiratory Infections . . . . . . 15 Gastroenteritis (Stomach Bug) . . . . . 17

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Introduction Our Mission At Pediatric Junction our goal is to partner with families in order to promote the health and happiness of children from birth through adolescence. We are dedicated to empowering families through guidance and education. We pledge to provide high quality health care delivered with respect, compassion, and sensitivity in a safe and comfortable environment.

Our Physicians Pediatric Junction, PA is a professional association of two pediatricians, Karyn W. Collins, M.D. and Anna P. Lincoln M.D. Dr. Collins earned a Bachelor’s Degree in Nutrition from the University of Texas at Austin and a Medical Degree from Texas Tech University School of Medicine. Dr. Lincoln earned a Bachelor’s Degree in Speech Therapy from the University of Texas at Austin and a Medical Degree from Baylor College of Medicine. Both our physicians completed their pediatric residency training at Children’s Hospital of Austin (now Dell Children’s Medical Center) and are members of the American Academy of Pediatrics and the Texas Medical Association.

Our Services We provide complete pediatric care for children from birth through adolescence (graduation from high school) including well child exams, sick visits, sports physicals, developmental screening, breastfeeding support, vaccinations, hearing and vision screening, consultations and referrals.

Our Hours Pediatric Junction is open Monday through Friday from 7:30am until 4:30pm and is closed daily for lunch from noon until 1:00pm. Pediatric Junction families can leave messages for our staff 24 hours a day and, for urgent medical matters, may speak directly to one of our physicians (please refer to “After Hours Consultations” section of this handbook). Special weekend and holiday urgent-care clinics are periodically held to better serve your needs during times when the office would normally be closed. Contact Information

Phone 512.312.5312 Fax 512.312.5313 Voicemail

o Front Desk ext 1 - appointment requests, general information, and urgent medical matters during regular business hours

o Billing Office ext 3 - billing questions o Clinical Information ext 7 - non-urgent medical questions for our medical

assistant or physicians (calls are returned daily) o On-Call Physician ext 9 – urgent medical matters after-hours when the office is

closed E-mail

o info@pediatricjunction.com (general questions) o appointments@pediatricjunction.com (well child exam and non-urgent

appointment requests) o billing@pediatricjunction.com (billing questions) o patients@pediatricjunction.com (non-urgent medical questions for our medical

assistant or physicians - established patients only)

Appointments Patients are seen by scheduled appointments during our regular office hours. Whenever possible your child’s appointments will be scheduled with the same physician. This is your child’s

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primary doctor. You may select a doctor or if no doctor is selected, a primary doctor will automatically be assigned. This will be the first doctor your child has seen unless specifically requested otherwise. In establishing a small practice, Dr. Collins’ and Dr. Lincoln’s desire is to provide personalized consistent care. In order to better serve your child’s needs and establish this as his or her medical home, a primary doctor should be assigned. Having the same primary doctor for the entire family facilitates better care for the children. If you have questions regarding your primary doctor please speak to someone at the front desk.

Consent for Care and Treatment Your signature will be kept on file as consent for care and treatment of your child. Without this, your child will not be able to be seen for an appointment. In addition you may complete a consent form to allow other caregivers to bring your child to the office to receive medical care.

Scheduling Well Child Exams Patients are seen by scheduled appointments during our regular office hours. Please schedule well child exams at least one month ahead when possible. To schedule an appointment you may:

Call the office during regular office hours. Leave a message for the front office staff after regular office hours. Calls are returned the

following day. E-mail a request to our front office staff. E-mail is checked daily.

(appointments@pediatricjunction.com) Newborns and young infants less than 2 months of age are asked to schedule well exams first thing in the morning and right after lunch whenever possible. During these clinic hours the wait time and exposure to sick children is minimal. During flu season older children (2 years and up) are asked to delay their well exams until spring whenever possible. Limiting well exams December though February ensures that timely appointment slots will be available when your child is sick. Please speak to the front desk or one of our medical assistants if you have questions about our well exam scheduling policies.

Scheduling Sick Visits When your child is sick the physicians and staff at Pediatric Junction are here to help. Daily appointment times are reserved for our physicians to see children who are ill. This means that same-day appointments are available in most cases. Please contact the front desk (ext 1) to schedule an appointment. If you are not sure whether or not your child needs to be seen, please call the office. You may leave a message for a member of the clinical staff at ext 7. Calls are returned daily. (See “Routine Medical Questions” for details on call backs.) Please do not e-mail requests for same day sick visit appointments.

Walk-In Requests for Appointments Sick patients are seen by scheduled appointments rather than walk-in visits. If you child is ill and needs an appointment it is best to call and speak to the front desk (ext 1). Every effort is made to see sick children in a timely manner. If you feel your child needs urgent medical care one of our doctors should speak with you immediately. Please contact the front desk at ext 1 and let them know your child has an urgent medical matter to discuss with the physician so someone can speak with you right away. At times you may be asked to bring your child to the office immediately rather than go to the emergency room. Urgent work-in visits are often necessary in pediatrics. Although this may cause regular appointments to run late at times it helps keep Pediatric Junction patients safe and out of the emergency room as much as possible. Your understanding and patience in regards to urgent work-in visits is appreciated.

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Preparing for Appointments It is very important that your child’s complete medical record, including vaccination record, be available for our physicians at the time of your first appointment and be kept up-to-date thereafter. Please see “Medical Records” for complete information. In addition please bring your current insurance card, payment for service, immunization record, and list of current medications to all appointments.

Arriving for Appointments In order to verify insurance coverage prior to each appointment, it is best to arrive 10 minutes prior to your appointment time. Late arrivals (15 minutes or more) will be rescheduled. They will be considered missed appointments and subject to a $25 missed appointment charge. New patients please arrive 30 minutes prior to appointment time to allow time to enter new patient information and to fill out paperwork. If you have new insurance please arrive 15 minutes ahead of time so you child’s file can be updated.

Waiting for Appointments You may wait in the well waiting room if you and your children are well and scheduled for a well exam. All other appointment types will be asked to wait in the general waiting areas. Our waiting room policy was established by Dr. Collins and Dr. Lincoln in order to best protect well children. Exceptions to the policy must be cleared with one of our physicians. All waiting areas are cleaned regularly and upon request. Clean toys are available at the front desk for your children to have in the sick waiting room. These toys are kept with you throughout your stay in the office and then cleaned before another use. Hand sanitizer is available in the waiting area for your convenience. Every effort is made to minimize your child’s exposure to infection while at the office. Please alert the front desk if your child has a rash with a fever so you can be moved to an exam room right away. The staff at Pediatric Junction is committed to seeing your child in a timely manner. However, in-office emergencies and urgent work-in visits mean that your appointment time may be delayed. Please speak to someone at the front desk if you have questions regarding the wait time or you are concerned about your child’s condition.

Canceling Appointments Your appointment time is a reserved time for you and your child. Please give 24 hours notice for cancellations so that your appointment time may be made available to other Pediatric Junction patients. Cancellations with less than 24 hour notice may be assessed a $25 charge.

Missed Appointments It is your responsibility to remember your appointments. We will attempt to make reminder calls for well child visits as we understand that these appointments are often booked in advance. Missed appointments may be assessed a $25 charge.

Diaper Policy In order to comply with safety standards diapers may not be discarded in office trash cans. Diaper changes may take place in exam rooms only. If your child needs a diaper change while you are waiting for an appointment please let the front desk know so that you can be taken to an exam room. All exam rooms are stocked with disposable plastic bags for your convenience. Please remember to take the diaper with you when you leave.

Preventative Medicine Well Child Exams The Well Child Exam is the cornerstone of your child’s healthcare. This is a special time set aside for you to discuss your child’s physical, emotional, social, and developmental health with your

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physician. Many families find it helpful to bring a list of concerns and questions with them to their appointment. Our physicians will discuss your child’s growth and development as well as age-specific related issues in regards to safety, behavior, nutrition, and immunizations. As medicine advances there will be new screening tools, lab tests, and other recommendations from medical organizations such as the American Academy of Pediatrics. In an information-rich society medical topics addressed in the media often raise questions for parents and families. The Well Child Exam is a crucial time for communication between your doctor and your family. In early childhood, the American Academy of Pediatrics (AAP) recommends well-child checkups at 2 to 4 days and 2 weeks of age and then at 2, 4, 6, 9, 12, 15, 18, 24, and 30 months of age. In addition, our physicians request a 1 month well exam for premature infants, infants with health concerns, and for first-time parents. Beginning at age 3, the AAP recommends yearly checkups up through adolescence. We encourage all families to adhere to the Well Child Exam schedule recommended by the AAP. All your child’s well exams will be scheduled with his or her primary doctor. It is especially important to understand the well child coverage for your insurance policy. Limitations may exist such as limited number per year or only through a certain age. Please see the Benefits Verification Form for more information.

Developmental Screening In accordance with the American Academy of Pediatrics recommendations all children are given a standardized developmental screen with score report at the 9 month, 18 month, and 30 month well child visits. Additional screens may be done if there are concerns about behavior or development. The screens are designed to help identify children with developmental difficulties early so that interventions can be made. Additionally all 18 and 24 month olds will be screened for autistic disorders. It is best to check ahead of time with your insurance to see if this is a covered benefit of your policy. Please see the Benefits Verification Form for more information.

Sports and Camp Physicals Most schools and private organizations require a recent complete physical exam (within 1 year) prior to allowing a child to participate in athletic programs. Please complete the parent portion of the form and bring it with you to your child’s well child exam. Alternatively you may drop the form off at the office if your child has had a recent well child exam (sick visits do not count). Please allow 3 business days for completion of forms. Our physicians will not be able to clear your child for participation if the parent portion has not been completely filled out.

Winter Well Exams In order to protect your child from winter illnesses such as influenza and to ensure timely visits for your child when they are ill, annual well child exams for children 2 years and older will not be scheduled between November and February unless absolutely necessary. Our winter well exam policy was established by our physicians to help keep healthy children well during the very busy winter months. (Remember children are the most contagious for many infections the day before they have symptoms.) If your child needs immunizations during this time then a nurse visit may be scheduled. If you have questions please feel free to discuss it with your physician.

Immunizations Vaccines are given to children in order to teach the immune system how to recognize and fight bacteria and viruses before an infection happens. Childhood vaccines help prevent deadly diseases such as meningitis, hepatitis, pneumonia, and influenza. They are especially important for infants whose immune systems are not yet well-developed. Our physicians feel strongly that children be vaccinated according to the American Academy of Pediatrics (AAP) Vaccine Schedule. (The vaccine schedule is updated yearly and is available at www.aap.org and www.cdc.gov)

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Each time your child is scheduled for vaccinations our pediatricians will review with you each vaccine, possible side effects, and the appropriate anti-fever medication dosing. You should also receive a VIS (Vaccine Information Sheet) from the CDC which reviews each vaccine in detail. If your child is unvaccinated or behind on vaccines, our doctors can work with you to develop a catch-up schedule. Families who alter from the recommended AAP vaccine schedule must have a vaccine agreement with planned catch-up schedule on-file in order to be seen at the office. If you have questions regarding protecting your child’s health through vaccinations please speak to Dr. Collins or Dr. Lincoln.

Immunization Records When you establish care at Pediatric Junction your child will be provided a courtesy permanent Health Record. This is a place to record valuable information such as immunizations, chronic health conditions, and allergies. It should be brought to every appointment so it can be kept up-to-date. THIS IS YOUR CHILD’S SHOT RECORD. Your child’s Health Record can be replaced for a $10 fee. If you fail to bring your record and later need it completed (for school, daycare, etc.), please bring it to the office to be updated. It will be ready to pick up in 3 business days or can be mailed. Due to privacy laws, shot records cannot be directly sent to third parties such as daycare without your written consent. It is best to keep you child’s shot record up to date at all times. Patient Education Dr. Collins and Dr. Lincoln are dedicated to empowering families through guidance and

education. We will provide age-related written information at well child visits on growth and development, safety, behavior, immunizations, and nutrition. By providing up-to-date written information on chronic conditions and acute illnesses families can have access to accurate information and their pediatrician’s recommendations at home where they need it most. Our website is another valuable tool to help Pediatric Junction families keep current on health and safety issues which affect children.

Contacting the Office

You should always feel free to call your pediatrician's office, either during office hours for routine questions or at any time for an urgent matter. Realize, though, that sometimes your pediatrician may not be able to answer your questions without seeing your child first. When you are not sure whether to call, trust your instincts.

Urgent Medical Matters Call immediately: If your child is less than 2 months of age and has a rectal temperature greater than or equal to

100.4. If you are worried that your child has a serious illness or injury. If during regular office hours press ext1. Let the front desk know why you are calling, so a

member of the clinical staff can speak with you right away. If after-hours or on the weekend, please contact the physician on-call (ext 9 - see “Medical Care

After-Hours” section below).

Concerning Symptoms An appointment within 24 hours is generally required for the following symptoms.

Your child is between 2 months and 36 months of age and has a rectal temperature greater than or equal to 102.2.

Blood in the urine. Blood in the stool.

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Temperature greater than or equal to 100.4 daily for 5 consecutive days. Unable to walk or bear weight. Any other symptom you are concerned about.

If you are unsure when your child needs to be seen, please call the office and speak with a member of our staff. Please do not e-mail questions regarding same-day appointments. You may choose to contact the physician on call if it is after hours or on the weekend.

Routine Medical Questions and Call-Backs Routine questions include questions about medicines, minor illnesses and injuries, behavior, or parenting advice. You will usually not need urgent care for a simple cold or cough, mild diarrhea, constipation, temper tantrums, or sleep problems, for example. For these cases you may just need proper medical advice and may leave a message at ext 7 or send an e-mail to (patients@pedaitricjunction.com). Your call will be returned by one or our physicians or medical assistants. Working directly with our physicians, our medical assistants can get you the information you need to properly care for your child. They are also able to advise you regarding whether your child needs an appointment with the pediatrician. Callback times are as follows:

Calls made before 11am - returned by 2:30 pm

Calls made before 4:30 pm - returned at the end of the day.

When you leave a message for a member of our staff please be available during the call-back times as voicemail does not allow us to serve your needs. E-mails are checked daily. If you do not hear from a member of our staff as expected please try your call again. A member of our front desk staff (ext 1) is also available during regular business hours to help you with urgent matters. As your doctor may wish to contact you while off-site please accept calls marked as private and un-do your call-block option if you are expecting a return call from a member of our staff.

Office E-mail The office can be contacted by e-mail for your convenience. Keep in mind that electronic information sent by e-mail may not be totally secure and confidential. Your written permission is required in order to e-mail information to you regarding your child. (See the Secure E-mail Policy and Permissions Form for details.) E-mail should not be used for emergencies, urgent matters, questions regarding same-day appointments or highly sensitive matters such as mental health issues. All e-mails are permanently placed in your child’s medical record. If you are uncomfortable sending or receiving e-mail please inform the office. E-mails are checked daily and every effort is made to respond within 24-48 hours. If you do not hear from a member of our staff as expected please call the office. Be sure the settings for your e-mail is set-up to allow e-mails from pediatricjunction.com.

Medical Care After-Hours You may need medical advice regarding your child in the evening or over the weekend when the office is normally closed. Dr. Collins and Dr. Lincoln are committed to getting you the information you need when you need it, which may be in the middle of the night. As a service to you our physicians are available 24 hours a day. (See “Physician-On-Call Service.”) If you need medical advice after-hours and do not wish to use our after-hour service you may choose to contact the nurse line provided through your insurance company if available. (See your insurance card.) Utilizing minor care centers or clinics staffed by non-physician providers in retail stores is not recommended by the American Academy of Pediatrics (AAP). The AAP supports the medical-home model of care offered by Pediatric Junction. Please read the information below to see how you can assure the best continuous care for your child.

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Physician-On-Call Service As a service to you our physicians are available 24 hours a day. If you are an established patient with an urgent medical matter simply call the main number and press 9. Dr. Collins and Dr. Lincoln are committed to getting you the information you need when you need it, which may be in the middle of the night. With electronic medical records our staff has 24 hour access to your child’s chart. Depending on your insurance there may be a fee for this service. (See the Benefits Verification Form for details.) This fee does not apply when your child is sent to the emergency room, when your doctor has advised you to call them after-hours for certain symptoms as may have been discussed at a recent appointment or over the phone, or if an appointment is made as a result of the phone call. As providers for your insurance carrier our physicians follow the American Medical Association’s CPT (Current Procedural Terminology) Guidelines for billing and coding for all health care interactions. When utilizing the Physician-On-Call service please:

Take your baby’s temperature rectally before you call. For older children an oral temperature should be taken. If your child has a fever, write down the temperature and time you took it. Anything less than 100.4 is not TRUE fever.

Have your child near the phone, if possible, to help you answer questions when you call your pediatrician.

Remind the doctor about past medical problems. Be sure to mention medications. If your child is taking any medication, including

prescription or nonprescription drugs, inhalers, supplements, vitamins, herbal products, or home remedies, tell your pediatrician.

Keep immunization records at hand. These are especially helpful if your child has an injury that may require a tetanus shot or if pertussis (whooping cough) is in your community.

Have your pharmacy phone number ready. Unblock your telephone “call block.” (Your telephone carrier can provide instructions.)

Keep phone lines open so your pediatrician can return your call in a timely manner. Do not leave pager numbers. If you leave your cell phone number, be sure your cell phone is on and able to receive calls.

IF YOU HAVE NOT HEARD FROM ONE OF OUR PHYSICIANS WITHIN 15 MINUTES PLEASE TRY YOUR CALL AGAIN.

Weekend and Holiday Visits Although we do not have set weekend hours there may be times your doctor will plan an office visit on a Saturday or Sunday or on a holiday in order to provide your child with the care they need. In addition special Holiday clinics are planned during the Thanksgiving and Christmas Holiday to better serve you. Our goal is to provide complete and timely care for your child and to avoid unnecessary trips to urgent care facilities and emergency rooms. If you think your child needs urgent medical care please contact the physician-on-call. Our physicians are available to help you decide if your child needs emergency room care, an after-hours visit at the office, or medical advice over the phone. If you are seen in an emergency room, please have the treating physician call the Pediatric Junction physician-on-call. Depending on your insurance there may be a charge in addition to your regular co-pay for after-hours visits. (See the Benefits Verification Form for more information.)

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Hospital Care Emergencies If your child has a medical emergency, call 911. Dr. Collins and Dr. Lincoln feel confident that, when possible, children in need of emergency care should be seen at Dell Children’s Medical Center located 15 miles north of Buda at 4900 Mueller Blvd, Austin, TX. From IH-35 take 51st St exit, turn right onto 51st St headed east, then right onto Mueller Blvd. The hospital main entrance is to the right. The facility provides specialized hospital care for the children of Central Texas. It is devoted exclusively to the care of children and is staffed with pediatric-trained hospitalists, specialists, emergency personnel, and nursing staff. Depending on your child’s condition, if you are seen at another emergency room your child may need to be transported to Dell by ambulance. Our doctors strongly recommend that families, when possible, call and speak to one of our physicians prior to going to the emergency room.

Hospitalizations If your child should need to stay overnight at Dell Children’s Medical Center he or she will be cared for by the Pediatric Consultation and Referral Service (PCRS), a specialized group of pediatricians dedicated to the care of hospitalized children and adolescents since 1997. The PCRS physician is highly available (24 hour on-site physician coverage), skilled in providing quality hospital care, and effective in keeping the primary physician fully informed. Through this service, Dell Children’s Medical Center and PCRS work in collaboration with Pediatric Junction to serve your child and your family.

Dell Children’s Medical Center 4900 Mueller Blvd Austin, TX 78723

512.324.0000

Newborn Care Due to our location and our commitment to be available to the sick children in our community, Pediatric Junction physicians do not care for newborn infants in the hospital. Your infant will be seen by the hospital staff pediatrician. We are always available to discuss your concerns about your baby, with you or with the hospital physician. As recommended by the American Academy of Pediatrics, your infant needs to be seen in our office 24 – 72 hours after hospital discharge for routine follow up. Please call our office to schedule this appointment before you are discharged from the hospital. BE SURE TO BRING YOUR INFANT’S HOSPITAL BIRTH RECORD TO THIS APPOINTMENT. At times the hospital pediatrician may advise a weekend lab or visit with one of our physicians following your baby’s discharge. Depending on your baby’s condition and your insurance we may be able to arrange this for you. Please contact the office as soon as possible to discuss your follow-up. If discharged on a weekend, please contact the physician-on-call. (This call will NOT be charged an after-hours fee).

Other Services Consultations and Referrals When a child needs to see a medical specialist the Pediatric Junction office staff and physicians will help guide you through the referral process. Our physicians trained at Children’s Hospital of Austin (now the Dell Children’s Medical Center) and have established working relationships with the pediatric specialists and hospitalists in Austin. Although some insurance providers do not require a referral to see a specialist, many families seeking specialized care for their child find a

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visit with their pediatrician beneficial. Our physicians can help direct you to the appropriate provider to meet your child’s specific need. Other insurance providers will require an initial visit with Dr. Collins or Dr. Lincoln to establish a diagnosis prior to seeing a specialist. Our staff will work with you and your insurance company to obtain proper authorization for the specific specialist your child needs. If your child is already established with a specialist, our staff can assist you with a referral for follow-up care. (Please allow 72 hours for processing referral requests.) For PPO providers which do not require a referral, please contact the member services number on the back of your insurance card to verify that the specialist you would like to see is a preferred provider to avoid unanticipated charges. To inquire about the status of a referral please feel free to call the office and leave a message in our clinical mailbox (ext 7) or e-mail your questions to patients@pediatricjunction.com.

Laboratory and Radiology After your child has been evaluated by the physician, laboratory or radiology services may be needed. Pediatric Junction has an on-site lab where some basic screening studies may be performed. Depending on your insurance, most lab work may be drawn at our office then sent to area labs for analysis. Some insurance plans require a specific lab to be used. It is your responsibility to know in advance if a specific laboratory is required for your benefits. Our staff can assist you in this process to assure your lab work and x-rays are done properly and at the appropriate location for your particular insurance provider. However, it is ultimately your responsibility to understand your particular benefits.

If you feel your child needs lab work or an x-ray please schedule an appointment. Most lab results and radiology reports are available in 24 – 72 hours. We are committed to reporting your child’s results in a timely manner. For your convenience you may give permission to e-mail lab results. (See the Secure E-mail Policy and Permissions Form for details.)

Prescriptions and Refills In order to maintain complete and correct prescribed medications for your child, we request that you contact the preferred pharmacy of your choice for medication refills. The pharmacy will fax your refill request form to our office. Your doctor will then review your child’s chart and complete the request via fax to the pharmacy. Please allow 3 business days for refill requests. If the refill request cannot be processed, our staff will contact you to discuss the matter further. Please contact the pharmacy to verify refill authorization has been received. For new prescriptions, please contact the office to schedule an appointment.

Authorization for Medications at School If your child needs to take medication during the school day then permission must be in writing from the parents and the doctor. Your child’s school may have a special form to complete. For Hays CISD schools this form is available at our office. Whenever possible this form should be complete and on file for your child in advance. For example, children with asthma should complete this form annually at the start of school for permission to use their rescue inhaler. Please allow 3 business days for authorization requests. The form can be picked up or faxed to your child’s school.

Medications for ADD and ADHD Most medications used to treat attention deficit and hyperactivity disorder are Schedule II drugs as defined by the Federal Drug Enforcement Administration (DEA). The use and distribution of controlled (scheduled) drugs are tightly regulated under the Controlled Substances Act (CSA) because of their abuse potential or risk. Texas law requires prescribers of these drugs to use official prescription forms issued by the Texas Department of Public Safety (DPS).

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Unlike a regular prescription for a non-schedule drug, these prescription forms must be hand delivered to the pharmacy, must include an accurate address for the patient, must be filled within 7 days of being written, and cannot be filled for more than a 1 month supply at a time. This means that your child’s ADHD prescription will have to be picked up at the office monthly as it cannot be faxed or called in. Prescriptions that are lost will be reported and tracked by the Texas DPS. Please plan ahead and contact the office to request refills of your child’s medication before the medicine runs out. Once your request is received and approved by your doctor it will be ready to pick up at the front desk within 3 business days.

School Excuses and Day Care Clearance Whenever possible school excuses should be given at the time of your child’s visit. Medical assistants and front desk staff may only give excuses for the dates your child was seen. Additional dates require physician approval. If a daycare clearance form is needed then please request this at your child’s well exam. Pediatric Junction has a standard form for clearance that may be given unless another form is required by the daycare. For requests made outside of an appointment, please allow 3 business days for processing. The forms can be picked up or faxed if a number is provided.

Flu Clinics The flu is a contagious respiratory illness caused by the influenza viruses. It can cause mild to severe illness, and at times can lead to death. The best way to prevent the flu is by getting a flu vaccination each year. Every year in the United States, on average:

• 5% to 20% of the population gets the flu; • more than 200,000 people are hospitalized from flu complications, and; • about 36,000 people die from flu

Due to an increased risk of severe disease, complications, and hospitalization the American Academy of Pediatrics (AAP) and the Center for Disease Control (CDC) now recommends that ALL children 6 months of age and older be vaccinated yearly. In addition ANYONE who lives with a child less than 5 years of age or with a child with a chronic disease should be vaccinated as well.

Pediatric Junction is committed to providing timely and convenient opportunities for flu vaccination to our patients and families. Flu clinics are held September through February. (See the office for schedule details.) Families are encouraged to get vaccinated as early as possible to reduce the risk of the flu. As a courtesy, Pediatric Junction will file insurance for patients who receive the vaccine. (Unpaid balances after insurance filing will be the responsibility of the guarantor.) Non-patients such as parents and other family members can be vaccinated as well for a fee.

In-Office Medical Procedures When your child requires a minor procedure, our physicians may be able to perform it in the office depending on your child’s medical condition and insurance. Common minor procedures done in the pediatrician’s office include wart removal, simple laceration repair (depending on size and location), simple abscess drainage (depending on size and location), and foreign body removal. Since insurance policies vary it is best to determine your out-of-pocket expense for these procedures ahead of time. (For more information see the Benefits Verification Form.)

Our Website In order to keep Pediatric Families up-to-date we maintain a website with current health-related news, important medical alerts, family resources, community activities, practice events, and patient forms and handouts. We are also proud to feature artwork, short stories, and other creative work from the young artists at Pediatric Junction at www.pediatricjunction.com.

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Our website site has been prepared with you in mind. Our goal is to provide you with helpful information about our practice. If you find that you have suggestions on improving communication through our website, please contact us at info@pediatricjunction.com.

Medical Education Dr. Collins and Dr. Lincoln are community faculty members of the University of Texas Medical Branch (UTMB) at Austin. UTMB has been training health care professionals in the state of Texas for more than 100 years. Our physicians are proud to participate in the training process for medical students and residents. During your child’s care at Pediatric Junction you may occasionally meet health care professionals at various levels of training. Their presence in the office is for educational purposes. Your child’s information is always subject to our privacy policy and decisions regarding your child’s health are always between you and your doctor. Financial Policy Insurance Filing If Pediatric Junction physicians are providers for your insurance carrier we will file insurance reimbursement on your behalf. As providers for your insurance carrier our physicians follow the American Medical Association’s CPT (Current Procedural Terminology) Guidelines for billing and coding for all health care interactions. For out of network providers our staff can assist you by providing necessary forms or any additional information needed for you to file your claim directly with your insurance. It is your responsibility to make certain that the physicians are participating providers and to verify benefits prior to any visits so that you are not billed for unanticipated charges. We recognize that health care insurance policies and filing procedures can be confusing and the Pediatric Junction staff is available to help you through the process. As our list of insurance providers is continually updated, please confirm with the office staff accepted plans prior to incurring any billed charges. If you receive a bill for unanticipated charges please contact our billing department for clarification (ext 3 or billing@pediatricjunction.com).

Verification of Benefits Some insurance companies may not cover routine and non-routine services. Specific coverage may also vary depending on the individual plan secured by the policy holder’s employer. You are responsible for verifying benefits and coverage prior to any visits so that you are not billed for unanticipated charges. Non-covered services will be billed directly to the patient. Common exclusions are well visits, immunizations, hearing screens, vision screens and after-hours phone calls. You will be asked to complete the Benefits Verification Form when you establish care at Pediatric Junction. This MUST be completed prior to any well child visits. If your insurance plan changes you will need to complete a new form.

Payment Policy The patient’s portion of payment including any co-pays and deductibles are collected at the time services are rendered. For out-of-network services and self-pay patients, full payment is due at the time of service. Full payments made at the time of service will receive a 25% prompt-pay discount. There is a $25 charge for missed appointments and cancellations without 24 hours notice and a $10 charge for replacement of your child’s permanent health record. There may be a $25 charge for obtaining a copy of your child’s medical record. We accept payment by cash, check, VISA, Mastercard, American Express and Discover. There is a $25 charge for checks returned for insufficient funds.

Outstanding Balances All outstanding balances that have not been paid by insurance within 60 days will be billed to the patient and must be paid by 90 days, regardless of the insurance status. If you have questions

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regarding your insurance, payments, or balance please speak to someone at the front desk. At times our office manager or member of the billing department may need to speak with you. Medical Records Electronic Information Pediatric Junction is committed to maintaining secure medical records in a fast, efficient, and accurate manner. Our office maintains electronic medical records which are confidential and only accessible to authorized users. Your child’s electronic record is never lost or misfiled and can be accessed quickly 24 hours a day.

Transferring Records to Pediatric Junction It is very important that your child’s complete medical record, including vaccination record, be available to our physicians at the time of your first appointment at Pediatric Junction. Depending on the service requested our physicians may not be able to see your child without the complete medical record. A Medical Records Release Form is available from the front office or on the website and should be submitted to your previous physician at least 2 weeks prior to an appointment.

Request for Pediatric Junction Records In accordance with state law and regulatory agency requirements, the health record is the property of Pediatric Junction, PA. Due to privacy issues, requests for medical records must be made in writing. To obtain a copy of your child’s medical records, please fill out the Medical Records Release Form completely and submit to the front office. (This form is available from the front office or on the website.) Please supply all necessary information and allow up to 14 days for processing the request. Depending on the request, a charge may apply. As required by HIPAA, we will obtain your written authorization each time you request us to release information that is not used for treatment, payment, or health care operations. Examples: Immunization Records sent to daycare or school nurse, camp or sport physicals forms, etc.

Privacy Policy In accordance with HIPPA, we will secure and maintain the confidentiality of our patients’ medical and personal information and the treatment and services we provide. You may ask the front office staff for a complete copy of our Privacy Policy at any time.

Other Policies Care of Minors For patients not accompanied by a parent or legal guardian, written permission to treat the child is required before any treatment can be given. This can be done ahead of time by completing the “Consent for Treatment” portion of the Pediatric Junction Signature Page. The parent or legal guardian is responsible for payment at the time of the visit.

Young Adults As children grow their medical needs change. When adolescents reach 18 years of age our physicians will help transition their care to a family physician or internal medicine physician who can better meet the health needs of young adults.

Services Not Available Although Pediatric Junction does not perform the following services, we may be able to assist you in obtaining them for your child. Services not routinely done include:

• Gynecologic exams • Circumcisions • Mole Removal

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• Extensive Laceration Repairs • Biopsies • Toe Nail Removals • Spinal Taps • Procedures Requiring Sedation • Casting

Privacy Issues for Pre-Teens and Teens When children reach 10 to 12 years of age our pediatricians will speak with them and their parents and may suggest that they spend some time alone with Dr. Collins and Dr. Lincoln during future health care visits. What pre-teens and teens talk about during these visits will remain confidential. This serves as a valuable way for children to begin to learn how to take care of their own health.

Note to Pre-Teens and Teens Talking about personal things with your family and friends can sometimes be difficult. When you feel uncomfortable talking about certain things with your

parents, you can always ask your pediatrician. Getting answers about how your body works, how you can take care of yourself, how to handle your emotions, and

how to stay healthy, will help you make the right decisions about your health.

Your pediatrician will respect you as a patient. Because the pediatrician is your doctor, he or she will keep your discussions private whenever possible. However, your parents are obviously very concerned about your health and well-being, and

your pediatrician will want to keep them informed of extreme situations; for example, if your life, or someone else’s, is in danger. In most cases though, the

information you share with your pediatrician will stay between you and your pediatrician.

Common Illnesses and Recommendations Dr. Collins and Dr. Lincoln are committed to helping educate families about common illnesses. The information below is for your reference and is not meant to take the place of medical advice. If you are concerned about your child’s health for any reason please call the office and leave a message for your doctor (ext 7) or schedule an appointment (ext 1). Our physicians are always available if you feel your child is very ill and in need of urgent medical care. For urgent medical matter during regular office hours dial ext 1 so the front desk staff can get a doctor to speak with you right away. After-hours dial ext 9 if you would like to speak to the physician-on-call. Fever What to expect . . .

Fever is the body’s natural response to infection. It is a symptom not a disease. Any temperature taken correctly measuring > 100.4 is a fever.

Rectal- gold standard under 2 years of age Oral- okay for over 2 years of age

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Ear and other sensor methods- unreliable. Confirm with above. The term “low-grade fever” cannot be clearly defined. Fever from typical viral and bacterial illnesses usually lasts 2-3 days and seldom exceeds

105. Typical fevers (100.4 – 105) do not damage the body and do not cause brain damage. Fever helps the body better defend itself against infection. Even with medication you may

not be able to get your child’s temperature to be normal while he or she is fighting an infection.

The height of fever does not relate to seriousness of disease. It is how sick your child is that matters.

We treat fever to make the child more comfortable and better able to take fluids. The goal is comfort not to bring the number on the thermometer down to normal.

What to do . . . Treat all fevers with extra fluids and less clothing. NEVER GIVE ACETAMINOPHEN UNDER 2 MONTHS OF AGE. Give anti-fever medication at the appropriate dose if the child is uncomfortable. Consider the child contagious. Wash hands and avoid close contact with persons with

immune problems. Do not give a cool bath as this can cause shivering and be very uncomfortable. A warm

bath may be given if it helps your child feel more comfortable. Never add alcohol. Do not attend day care or school until at least 24 hours without fever and without anti-

fever medication. Do not give aspirin. This could cause serious liver damage.

What to watch for . . . Fever for more than 5 days. This may be a sign of more serious illness. Please call

the office as your child may need an appointment. Your child is less than 3 years and has a rectal temperature greater than 102.2. Your

child should be scheduled for an appointment within 24 – 48 hours. Your child develops other symptoms you are concerned about.

CALL OUR OFFICE IMMEDIATELY IF… Your child is less than 2 months old and has a rectal temperature greater than or equal

to 100.4 Your child has a temperature greater than 105. This can be a sign of serious reaction. Your child looks or acts very sick.

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Upper Respiratory Infections What to expect . . .

Infections primarily of the nose and throat. They are caused by a variety of viruses and they can involve the sinuses, ears, and larynx (voice box).

Symptoms often include nasal discharge and congestion, sore throat and hoarseness, headache, cough, sneezing, watery or red eyes, muscle aches, irritability, decreased appetite, and trouble sleeping.

Common cold viruses (as they are often referred to collectively) cause symptoms for 1-2 weeks but the worst part is the first few days.

Colds are extremely common in infants and children, and have become more prevalent as more children participate in child care. The average child gets 6 – 10 colds per years with cold lasting 10 – 14 days—that’s 140 days of cold symptoms per year.

There is no test for a cold and diagnosis is based on signs and symptoms.

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Young infants tend to have more fever with irritability predominating along with nasal symptoms.

Any temperature taked correctly measuring > 100.4 is fever. Please refer to fever section.

What to do . . . Help thin your child’s secretions by:

o Encouraging optimal hydration. Offer extra fluids if your child is greater than 6 months of age. This should be in addition to formula or breast milk in young babies, not in place of it.

o Use nasal saline drops or spray to help rinse and clear the nose several times per day. Suctioning is often not needed and can make the nose sore.

Try a cool-midst humidifier to add moisture to the air. Do not run daily for more than week as it can promote mold growth. Warm steam like with a vaporizer may help also but are not considered safe for younger children due to the risk of burns.

You may treat all fevers with extra fluid and less clothing. Medication may help your child be more comfortable and better able to take fluids but they are not needed for the body to get over the infection. Remember that fevers less than 106 do not hurt the body. The immune system is better able to fight off the infection in a hot environment.

Cough and cold remedies should be avoided. The side effects of most of these medicines far outweigh any very small, unproven benefit. The side effects can also make it difficult to tell if your child is getting worse. (Is his irritability and sleepiness due to the virus or the medication?) Please consult you doctor before giving any over-the-counter medications to you child.

** IMPORTANT SAFTEY ALERT ** All cold and cough medication have been removed from the market for children

under 2 years of age. These medications have no proven benefit in children under 6 years of age and have the potential for serious side effects even when dosed

correctly. If you have any of these products please discard them. If you have previously been prescribed cold or cough medicine by a doctor please discuss

this with your pediatrician due to possible safety concerns.

Consider the child contagious. Wash hands and avoid close contact with person with immune problems.

Do not attend day care until at least 24 hours without fever and without Tylenol or Motrin.

Do not participate in sports or vigorous physical activity if you still have fever.

Do not give aspirin to any child with a fever. This could cause serious liver damage. Please check labels as aspirin may be hidden in combination products.

What to watch for . . . Watch for signs of dehydration. The minimum urine output is:

o 4 in 24 hours if < 6 months old. o 3 in 24 hours if 6 months to 2 years old. o 2 in 24 hours for older children.

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o A dry mouth and no tears are also signs of dehydration. Watch for lung involvement.

o Breathing faster than normal. Tummy breathing, ribs sucking in, or nostrils flaring. o If your child has asthma or a history of wheezing ALBUTEROL is cough medicine for

your child. Watch for secondary bacterial infections.

o Ear infections usually occur after several days of illness. Look for new fever, fussiness or trouble sleeping. 80% of these infections will clear without antibiotics.

o Sinus infections requiring antibiotics are uncommon in children younger than 2. The sinuses are not well developed at this age. Sinus infections can occur after 2 weeks of persistent nasal symptoms.

o Bacterial pneumonia is uncommon in normal children after a simple cold virus. It can develop after the flu.

Please call the office for an appointment if your child has any of the following: o Fever for greater than 5 consecutive days. o Fever greater than 102.2 in a child less than 3 years of age. o Symptoms you are concerned about.

CALL OUR OFFICE IMMEDIATELY IF…

Your child is less than 2 months old and has rectal temperature greater than 100.4. Your child has a temperature greater than 105. This can be a sign of serious reaction. Your child looks or acts very sick.

Gastroenteritis = Stomach bug What to expect . . .

Infection is caused by a variety of agents. Most are viral but a few are bacterial. The body is able to clear almost all intestinal infections without antibiotics.

Very contagious. Spread through fecal-oral route and some by respiratory as well. Usually self-resolving- no specific treatment or antibiotics needed in most cases. Vomiting and fever are common but typically last only 24 – 48 hours. Account for a wide variety of gastrointestinal complaints such as cramping, indigestion,

nausea, gas, as well as vomiting and diarrhea. The diarrhea phase can be very prolonged- up to two weeks of abnormally loose stools is

not uncommon.

What to do . . . The key is symptomatic care and prevention of dehydration. SLOW ORAL REHYDRATION

Let the gut rest for 1 -2 hours. Offer 1 – 2 tsp every 10 – 15 minutes. Start with clear liquid such as water or clear

pedialyte.

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After 1 – 2 hours may slowly increase. If tolerating clears may offer flavored pedialyte. Sports drinks such as Gatorade should be diluted with water since they have a higher sugar content than pedialtye.

If vomiting returns back down to the last tolerated amount. Use a syringe for young children if needed- fluids are medicine now!

THINGS TO TRY:

Probiotics (Lactobacillus, Acidophilus, Saccharomyces, etc.). This “good bacteria” is found in yogurt with active cultures and in over-the-counter supplements. It can shorten the diarrhea course in some cases.

HOW TO USE PROBIOTICS Available in capsules, tablets, granule packets and drops. For smaller children the packets can be sprinkled on favorite foods like applesauce or pudding, or added to a liquid. Children 4 months to 2 yrs may be given 2 doses per day and children 2 yrs and up is 3 doses per day. The typical dose is 1 full packet. Refer to the label directions for specific information or consult your pharmacist or doctor.

Less milk. Sometimes you can have lactose-intolerance temporarily associated with this

illness. REMEMBER: Infants in the first year of life must have breast milk or formula to stay healthy. PLUS 80% of children with diarrhea illnesses can tolerate full dairy diets without worsening their diarrhea. Yogurt is tolerated in most cases as well.

FOR INFANTS: Discuss with your doctor before going longer than 24 hours without breast milk or formula for any reason.

THINGS TO AVOID:

Avoid Ibuprofen. Tylenol has less stomach irritation. Use Tylenol if needed for fever. Avoid high sugar drinks. Juice, coke, punch, etc, worsen diarrhea. Sports drinks also

contain significant amount of sugar. However, they do not typically worsen diarrhea and are an okay alternative to oral rehydration fluids like Pedialyte as long as your child is not already dehydrated and they are alternating them with water.

Avoid sharing a toilet. This may be hard, but if possible designate the sick person a toilet.

Do not allow sick persons or persons changing the sick infant’s diaper to prepare food.

Important Note about Juices Juices should be avoided when your child has diarrhea, especially high-sugar juices such as apple, grape, and pear. These will worsen diarrhea and are actually used by doctors to treat constipation. (The fruit sugar is a natural laxative.)

Important Note about the BRAT Diet Although the BRAT Diet (bananas, rice, apple sauce, toast) has been recommended for many years it is not currently recommended by the Academy of Pediatrics for uncomplicated gastrointestinal illnesses. Early return to an age-appropriate and healthy diet has been shown to lessen diarrhea and shorten the duration of illness. Solid foods especially those rich in protein have been shown in studies to help maintain a healthy appetite and help the intestines heal.

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Although most cases are self-limited your child may need further evaluation or treatment if any of the following are present:

Blood in the vomit or stool. Stool that is mostly mucous. Vomiting that lasts > 48 hours. Persistent vomiting without development of diarrhea. Severe persistent abdominal pain. Development of rash. Pain with bowel movements. Signs of dehydration- dry mouth, rapid heart beat, no tears and less urine. Watch urine

output. Minimums: o 4 in 24 hours if < 6 months old. o 3 in 24 hours if 6 months to 2 years old. o 2 in 24 hours for older children.

CALL OUR OFFICE IMMEDIATELY IF…

Your child is less than 2 months old and vomits more than once! Your child is less than 2 months of age and has a rectal temperature of 100.4 or higher. Your child has a temperature greater than 105. This can be a sign of a serious reaction. Your child repeatedly vomits bright green or bright yellow liquid. This may represent bile.

Your child looks or acts very sick.

Trust your instinct- if you feel your child needs medical attention they probably do!