Policies & Forms

It is our goal to provide timely and convenient service to each family. In this effort, we ask that you arrive 15 minutes prior to your appointment time. In the event that you will be more than 15 minutes late, please call our office as soon as possible. At that time, our staff will advise you whether the patient can still be seen or will need to be rescheduledfor the next available appointment. It is unfair to others if you do not show up for your appointment or arrive late without advance notice. There will be a $25.00 No Show charge if you fail to notify us at least 4 hours prior to a scheduled appointment. This policy is not in place to punish, but to ensure that when your family needs an appointment, we are able to accommodate you the same day or next day for sick visit appointments.

We encourage you to schedule appointments; however, we are aware that occasionally walk-in appointments may be warranted. In this case, we are happy to see you IF time permits between scheduled patients. There is no guarantee that you will be seen. We can offer you the next available appointment to guarantee your appointment time.

NO SHOW POLICY

Our clinical staff is available to discuss problems and concerns you have regarding your child. They have been instructed on specific information to give about common pediatric illnesses and will consult with Dr. Knight prior to giving advice if there is an unusual problem. When contacting our telephone triage staff during early morning, all day on Mondays, and anytime during the winter "cold & flu season", please keep in mind that we tend to have a notably higher call volume. Our staff works hard to listen carefully and be certain they fully understand your child(ren)'s need. There is no way to determine what the call volume will be on a daily basis, nor is there any way to determine the length of time necessary to effectively address the concerns of each caller. We appreciate your patience as the clinical staff works steadily to accept all calls and provide appropriate/helpful direction.

Whenever possible, we ask that calls requesting medical advice be made when the office is open and our staff has access to your child’s medical records. If an urgent problem arises and you cannot wait for the office to open, you may call our after hours call center to speak with a nurse for medical advice that has been approved by Dr. Knight. They may contact Dr. Knight if the need arises.

Appropriate after-hours calls include:

*true emergencies, such as difficulty breathing, bleeding, seizures, acute injuries or alteration of consciousness

*fever in infants less than 6 months old or in any child who is ill appearing, persistent vomiting or diarrhea with signs of dehydration, or severe abdominal pain

*an acute allergic reaction

*acute fever associated with a rash (not diaper rash)

Calls which can probably wait until the next regular working day:

*appointment questions

*requests for prescriptions or prescription refills

*colds, sore throats, or coughs not associated with shortness of breath or difficulty breathing

*mild to moderate fevers in children over 6 months who are not otherwise ill appearing

*feeding problems or upset stomach (unless accompanied by severe abdominal pain or signs of dehydration)

*constipation

*school and behavioral problems

*rashes in the diaper area or other chronic skin rashes

Refills are generally available for medications used for ongoing conditions, such as allergies, eczema (other than steroids), and reflux. Refills are not available for antibiotics, steroid creams. conditions for which the child has not been evaluated for in the past 6 months, or new prescriptions the child has never taken before.

Refill requests for non-emergency medications will be handled within 48 hours. Please do not wait until your child's supply is completely depleted before requesting the refill. For emergency refill requests, please call the office and provide us with your pharmacy's name and telephone number with all requests

Refills for Asthma medications require a follow up appointment every 6 months. One of these visits can be the child’s annual well child exam/physical if the medications were listed as a current medication.

Medication refills must be handled through your pharmacy. Please call your pharmacy and initiate a refill, if the medication requires a refill, advise your pharmacy to notify us. At that time, allow 48 hours for us to respond to the refill request. Medication Requests will not be handled after hours being that the after-hours service does not have access to your child's medical records. All refill request or medication call-ins must be requested during normal business hours. Please be certain to check with your pharmacy prior to 6:00 PM to make sure they have received precriptions that were e-prescribed during your child's visit. You MUST notify the office of any precription that is not received by the pharmacy prior to 6:00 PM, any request after 6:00 PM will be handled the following business day. The phones automatically transfer to the After Hours Service at 6:00 PM and they do not have access to your child's chart.

If you are a new family to Premier Pediatrics of Houston, please print out our New Patient Packet to expedite the time spent completing them on the day of your appointment. You may also stop by our office and pick up a packet . ALL PATIENTS MUST BE ACCOMPANIED BY A PARENT OR LEGAL GUARDIAN FOR THE FIRST VISIT- NO EXCEPTIONS. Feel free to email or fax your completed forms prior to your appointment date.

New Patient Packet

Patient Demographic Form

This form is to be completed by every new patient and yearly for existing patients as well as with any change in insurance or address.

Patient Medical History Form

This form is to be completed by every new patient and yearly for existing patients as with any change in medical, surgical, or family medical history.

Release of Medical Record Form

This form should be completed to request medical records from your previous medical provider or for Premier Pediatrics to release your medical records to you or another medical provider. There is a charge of $0.75 per page for medical records released to a patient/parent/guardian.

Financial Policy

The following policy outlines your financial responsibilities related to payment for professional services.

Adolescent Policy and Consent Without Parent

Adolescents 16 years of age and older may seek medical care without a parent/guardian present as long as these two forms have been completed in advance. The Consent Without Parent form should be completed for all patients if someone other than the parent or guardian will be bringing your child to the office. ALL PATIENTS MUST BE ACCOMPANIED BY A PARENT OR LEGAL GUARDIAN FOR THE FIRST VISIT- NO EXCEPTIONS.

Notice of Privacy Policy

To help us comply with HIPPA regulations, please read our Notice of Privacy Practices that explains how health information about your child is kept confidential and secure.

No Show Policy & Appointments

Telephone Triage & After Hour Calls

Forms