Forms & Policies

Office Forms

Office Policies

Cancellation

If you cancel or change without 24 hours notice, you may be charged a missed-appointment fee. We will make every effort to see your child in a timely manner. Please try to be prompt for appointments as it affects all the patients for the rest of the day.

Immunization Policy

SF Bay Pediatrics makes the health and well-being of our patients, their families, the surrounding community and our staff a top priority. As a practice, we strongly believe that immunizing your child according to the current CDC schedule is the right decision.

In an effort to maximize the benefits of immunizations, while ensuring the health of our patients in a safe manner, the health care providers of SF Bay Pediatrics:

  • require that all patients be fully immunized according to the schedule recommended by the Centers for Disease Control and Prevention (CDC);
  • are willing to discuss any questions you may have regarding immunizations at a separate visit that is scheduled specifically for that purpose,
  • and require that patients must follow our standard well visit schedule to ensure that immunizations are up to date.

In some individual cases, exceptions may apply. Our providers may provide consultations with individual families to create an individualized immunization plan that is mutually acceptable. An individual immunization plan will incur additional visits and charges. A more in depth description of our immunization policy can be found here.

Fevers

If your child has a fever, please take his or her temperature before calling the office. Rectal temperatures are preferred in small children. This is important information that will help us make the best decisions in caring for your child.

Prescriptions

Our policy is to issue new prescriptions only after the patient has been seen by a physician. If refills are needed, please call on weekdays before 5:00 p.m. Have your pharmacy telephone number available.

Screenings

As we follow the guidelines of the American Academy of Pediatrics, your child will have specific periodic screening tests during the preventive health well child visits. These screens are intended to identify and address health problems at an early stage.

Some insurance policies may not fully cover these important screens and may assign full or partial patient responsibility as either a co-payment, co-insurance, or toward your deductible.  You will be billed for any balance due after the insurance processes the claim.

Below is the current schedule for these screens so that you can check your insurance benefits.

Screens/Test

CPT Code

Age Administered
(may vary as needed)

Charge to Insurance Company   
(patient responsibility varies by insurance carrier)

Vision Screen via Computerized Photoscreen

99174

1 year, 2 year, 3 year

$50

Vision Screen via Snellen Chart

99173

Annual 4-5 years

Every other year 6-12 years

Every three years 12-18 year.

$30

Hearing Screen

92552

Annual 4-5 years

Every other year 6-12 years

Every three years 12-18 years

$82

Autism Screen

96110

18 mos, 24 mos.

$25

Behavioral Screen (e.g. depression)

96127

Annual starting at 12 years old

$25

 

If you wish to opt out of hearing or vision screens, please let us know at the start of your visit. Declining screening may lead to delays in diagnosis.

We are a group of Board Certified Pediatricians who are dedicated to the care and well-being of children.