Completing the necessary medical practice forms, (i.e. medical history, patient information, financial forms) prior to your child's appointment can be a challenge, especially if when you are also watching your child, our patient.
To expedite your visit and make it more convenient, Decatur Pediatric Group has made several of our practice forms available for download. We recommend parents download and complete these forms in the convenience of your home and bring them with you to your child's appointment.
Medical Practice Forms - English
- Financial Responsibility Form
- Notification of Administration Service Fee
- HIPAA Notice of Privacy Practices
- Acknowledgement Receipt of HIPAA Notice of Privacy Practices
- Temporary Authorization for Medical Treatment of a Minor
- Decatur Pediatric Group Scholarship Application
- CHILDREN'S HEALTH PLAN Application
- Medical Records Release Form
Medical Practice Forms - Spanish/Español
- FORMA DE LA NOTIFICACIÁN HONORARIO DE SERVICIO DE LA ADMINISTRACIÁN (ASF)
- El Aviso de la Aislamiento Practica
- Recibo del Aviso de las PráÂ¡cticas de la Aislamiento Forma Escrita del Reconocimiento
- Autorizacián temporal para el tratamiento mádico de un menor de edad