FORMS

Forms for New Patients
The office will need all completed forms and medical records prior to first appointment being made.
Initial History Questionaire
Information Sheet
Billing Policy
Referral Survey
Attendance Policy
Appointment Cancellation Policy
No Show Policy
Patient Discharge Policy
Consent to Treat Minor Child and Privacy Notice Acknowledgement
Third Party Authorization Form Use this form to authorize treatment if someone other than a parent or guardian is bringing in a child for a visit.
Prenatal Visit (complete form prior to birth of child for prenatal visit).

Release and Authorization Forms
Third Party Authorization Form Use this form to authorize treatment if someone other than a parent or guardian is bringing in a child for a visit.
Medical Records Release Form A, from AAKP. Use this form to release your child’s medical records from All About Kids to another medical practice.
Medical Records Release Form B, for new patients. Use this form to request your child’s medical records from another medical practice to All About Kids.
Disclosure Form Use this form to authorize us to share your child’s medical information with a third party, such as a school or a government agency.
Family Member Medical Release Form Use this form to allow us to release medical information to designated family members.

Other Forms
HIPPA Privacy Notice This is our written HIPAA privacy notice.

Introducing MyChart
In partnership with CHOA, AAKP now offers an online patient portal called MyChart. The portal allows you to send messages or request appointments and refills. Instead of waiting on hold, you can send your message directly to our staff. From the MyChart website, or the app on your smart phone, you can view your child’s growth chart, immunizations, current medications, and summaries of previous visits.  Best of all, the portal can be accessed anytime, day or night.

You can access MyChart here: http://mychart.choa.org

To enroll in MyChart, download and fill out the following form and give it to a front desk staff at the office: MyChart Registration Form