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| Ptarmigan Pediatrics, LLC | ||
| HOURS: Mon-Fri: 8 am - 6 pm Lunch: 12 pm - 1 pm Closed Sat & Sun & some federal holidays |
Dr. Laura J. Peterson, M.D. Dr. Bruce W. Hess, D.O. Dr. Elowyn Smith, D.O. Randall Twenhafel, P.N.P. Lea Anne Abernathy, F.N.P. |
Ph: 907-357-4KID (4543)
Fax: 907-357-4533 Email: peds@ptarmiganpediatrics.com Mat-Su Regional Outpatient Center 950 E Bogard Rd; Ste 233 Wasilla, AK 99654 |
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PAPERWORK & FORMS (Yawn)
New Patients|
Medical Consents |
Health Assessment | Our clinic uses a state-of-the art electronic medical record where paperwork is scanned and stored electronically. Despite our efforts to reduce paper waste, there are simply some things that need to have pen put to paper. And it's not much fun sitting in the waiting room (no matter how well it's decorated!) filling out paperwork before your child can be seen. In most cases at least one of the forms linked below will be applicable to your child's visit. By printing them at home and filling them out before you get to your appointment, you'll make the check-in process quite a bit faster. And when your little tyke isn't feeling well, the less paperwork you do in our waiting room, the better for both of you! If you have any questions about which forms you may need, pick up the phone and give us a call. We're glad to help.
NEW PATIENT FORMS -- the "assignment of benefits" and the HIPAA forms are required parts of your file.
MEDICAL CONSENT FORMS -- If you want to transfer your medical records from your child's previous doctor to Ptarmigan Pediatrics -- or if you want to authorize someone else to given medical consent for your child, the following forms will be useful.
HEALTH ASSESSMENT FORMS -- If your child is sick, filling out the appropriate form ahead of time that most closely matches your child's chief complaint can be a time-saver in the waiting room. Your doctor will use the contents of this form in consultation with you to develop the most appropriate treatment plan for your child, so fill it out thoughtfully and completely.
PRENATAL / WELL BABY / WELL CHILD EXAMS -- Note that most insurance companies draw a distinction between "sick office visits" and "well child visits," and often have different benefits for each. Well Child Visits are a form of preventative medicine, meant to catch any potential problems in a child’s physical or developmental health. These visits also give parents an opportunity to ask any questions regarding physical or developmental changes they have noted in their child. Each exam is tailored to the individual child and to the child’s age, and may include necessary immunizations, vision, hearing, and developmental screenings. If your child requires significant medical intervention or you request noteworthy changes to management of existing chronic problems during this appointment, this may go above and beyond a preventative exam and may be coded and billed accordingly with your insurance. If your insurance carrier provides different benefits for well child and sick office visits, your financial responsibility may also change. Prenatal Questionnaire -- If you would like Dr. Peterson or Dr. Hess to be your newborn's pediatrician, attend the delivery if necessary, and take care of your newborn in the hospital after delivery, then they're happy to do so. We will gladly make a complimentary appointment to meet with you in our clinic in preparation for that day. This prenatal questionnaire will help us get to know each other better. Feel free to print this out and bring it with you to your prenatal visit. Call us a few weeks before your due date to schedule this appointment.
These ASQs are proprietary, copyright developmental screening forms sold to us by the publisher. Our license with them dictates that these forms must be behind a password-protected webpage if we offer them online for our patients. The username on that webpage is ptarmigan; We will gladly give you the password upon request. Give us a call. (No, unfortunately the password is not "pediatrics")! Print both forms (and any other forms if applicable) that correspond to your child's age from the list below. Our recommended schedule is highlighted in yellow below; if your appointment falls outside those ranges, please feel free to mix and match well child and ASQ forms to most closely match your child's age on the appointment date. NO NEED TO NOT FILL OUT THE LAST "SCORE PAGE" ON THE ASQs. Bring it with you and we will score it in the clinic. Note that vaccines are typically given at 2, 4, 6, 12, 15, and 18 months, as well as between 4-6 years and between 11-12 years.  Newborn:
Newborn (1st visit before
2 Weeks) &
EPDS form.
NOTE: For patients born at Mat-Su Regional Medical Center, the lab there is holding newborn screen cards effective April 20, 2009. Parents may get their child's 2nd newborn screen done at that lab or sign out their "metabolic screen card" and bring it with them to their 2 week appointment at our clinic. Parents are responsible for the security of the form if they choose the last option, and will be charged by MSRMC for replacement cards. Parents with newborns born at other facilities should follow the procedures for metabolic screen cards provided by that facility. FRIENDLY REMINDER: It is your responsibility to get your newborn added to your insurance policy within 30 days of birth, after which your charges will become your sole responsibility. See our financial policy page for more information!
Initial Evaluation:
Follow-up Evaluation:
School
District Health Forms
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The pdf files below
are school-specific forms that require a doctor's signature. We have
these on file in our office, but if you are coming in for a
specific school-related medical examination you can save time by
printing the appropriate form below and filling it out before
you arrive.
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Well child visits for patients older than
2 weeks will involve the most paperwork. If you have a chance to
print these out ahead of time, you will save significant time in the
waiting room and will help our office run more efficiently. Our
Well Child Forms address your
child's health history,
and the "ASQ" -- Ages and Stages Questionnaires
are screening tools that address your child's development.
