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Forms & Policies

Please print the Patient Registration and HIPAA forms and bring to your scheduled appointment. Also please review the Office Policies and print them out for your records.

You may download and print any of our forms listed below before coming to our office.  This will get you out of the waiting room and in to see the doctor a lot quicker! Please bring the forms with you for your first visit

You may download Adobe Reader for free at www.adobe.com.

Policies

As with any professional office, our goal is to serve our patients efficiently and effectively. In order to achieve these goals, we request that each patient do their part by cooperating with the policies of our practice regarding insurance and payment.

Please download a copy of our Office policies.

Office Policies (English)
Office Policies (Spanish)

Payment Information

  • Aetna HMO/PPO/Golden/POS/EPO
  • All Florida PPO
  • Avmed
  • Baycare Health Network Choice
  • BCBS of Florida HMO/PPO/PPC, Blue Choice and Blue Card Health Options, Network Blue, Traditional
  • Beech Street
  • Children’s Medical Services (CMS)
  • Cigna HMO/PPO
  • Coventry
  • Evolutions PPO
  • GHI EPO/PPO
  • Great-West Healthcare
  • Humana Healthy Horizon Medicaid/Medikids
  • Humana HMO/PPO
  • Humana Military (Tricare)
  • Interplan Health Group
  • Medicaid
  • Multiplan
  • PHCS
  • Simply Healthcare Medicaid/Medikids/Healthy Kids
  • SouthCare
  • United Health Care HMO/PPO
  • United Healthcare Community Plan Medicaid
  • USA Managed Care

Billing

For accountability, documentation and accurate record keeping, our billing is directly linked to the electronic medical record system (EMR). Please bring your most current healthcare card every time you visit our office. The information on the card must be up to date and valid for the date of the appointment. Some healthcare plans require a primary care provider (PCP). Before your appointment it is your responsibility to make sure that the name of one of our pediatricians or the name Bayside Pediatrics is printed on the front of the card under PCP. If unsure you may call your healthcare plan or our office prior to your appointment. This pre-planning will ensure that by the time of your appointment your waiting time will be minimal and you will only be financially responsible for the co-pay and the balance being charged to your healthcare plan.

If your healthcare plan requires specific forms, it is your responsibility to provide our office with these forms. Your healthcare administrator does not provide us with any forms; however, we will gladly assist in completion of required forms and supplying additional information and/or patient records.

Payment

If you are enrolled in a healthcare plan that we accept, you should become very familiar with specificity of your coverage, exclusion, deductible and co-payments for sick or well visits as well. You are ultimately responsible for any charges incurred! The amount of the co-payment is determined by your healthcare administrator and will be collected at the time of your registration for the appointment (check-in). After visiting the pediatrician your child may be anxious to return home or restless after receiving an immunization. By collecting the co-payment at the time of the registration, you are able to immediately leave the office when your child’s appointment ends. You may stop at the check-out window to schedule your next appointment or you may call us at the later time.

The check-out window will have all the printed educational information your pediatrician has recommended you to follow to better your child’s well being. If prescriptions were ordered you may pick them up at the check-out window as well if you requested to have them printed. Our electronic medical records facilitate the electronic transmission of the prescription to the pharmacy of your choice. By using this advanced feature you should be able to pick up your prescription on your way home and avoid the drop off process.