Below we have provided copies of several office policies regarding financial arrangements, missed appointments and immunizations. For new patients or patients that have not yet signed this form, we are providing our Notice of Privacy Practices and the Patient’s HIPAA Acknowledgement documents, as well as a form to Request Restriction on Use or Disclosure of your PHI (Protected Health Information). Please feel free to print out and sign any of these forms and bring them with you to your first appointment. This will save you some time. There are also forms that allow patients 18 years of age and older to inform Raleigh Pediatric Associates how they would like their health information used and with whom such information may be shared.
- Financial Policy
- No Show Policy *revised 1/1/2018
- Immunization Policy
- Notice of Privacy Practices (HIPAA)
- HIPAA Acknowledgement
- Request for Restriction on Use or Disclosure of Protected Health Information (PHI)
- Divorce, Separation, Foster Care, and Custody Agreement
- Consent Form (18 & older)
- Declination Form (18 & older)
- Notice of Nondiscrimination
- Service Animal Policy
Our goal is to provide the highest quality health care to the children and families we serve. In order to do so, we strive to build long-term, partnering relationships built on trust and mutual respect.
- We believe in prevention of disease and promotion of healthy lifestyles for all children.
- We strive to be an efficient and cost-effective practice in meeting the needs of children during times of health as well as in times of illness.
- We practice medicine as a team and value the contributions of all of our staff to provide excellent medical care and service.
- We believe in the ethical practice of medicine, provide leadership throughout the community and provide service to those in our community in need.
fax: (919) 848-3054
Sat & Sun: 8:00am–11:00amurgent matters by appt only