Forms

 


For your convenience, we have made several forms available for download. This will have you better prepared for your visit and reduce the amount of forms you will have to fill out during your visit. Just click on the links below to download a pdf copy of each form. If you donít have a pdf reader on your computer, please download a free reader here.


New Patient Packet
The new patient packet contains all the necessary information for becoming a new patient at Carolina Pediatrics. It includes insurance forms, demographics, guarantor information, the immunization form, consent for treatment, disclosure of medical information, authorization for release of medical information, Carolina Pediatrics policies, and the GHS financial policy. For more information on becoming a new patient, click here.


Newborn Care Instructions and Tips
New parents have a lot of questions concerning the care of their newborn, and this short manual discusses a lot of the most common concerns. Feeding, SIDS prevention, basic infant care, newborn jaundice, bowel movements/urine output, illness, colic, normal findings, and circumcision care are all discussed. For any questions conerning your child, feel free to call our office and discuss with a nurse.


Authorization For Release Of Medical Information
If you need to have your childís medical records transferred from or to our office, you will need to fill out an authorization for release of medical information. This form is included in the new patient packet. For more information on the authorization for release of medical information, please see our FAQ page.


Immunization Schedule (Birth-6 years)
The above link is a list of the immunization schedule for birth-6 years old. It includes a detailed breakdown of all the vaccines that your child should receive. For more information on the immunization schedule, please see our FAQ page.


Immunization Schedule (7-18 years)
The above link is a list of the immunization schedule for 7-18 years old. It includes a detailed breakdown of all the vaccines that your child should receive. For more information on the immunization schedule, please see our FAQ page.


ADHD - Vanderbilt Assessment Scale - PARENT Informant
The above link is a resource toolkit for clinicians published by the Academy of American Pediatrics. It provides a number of rating scales and tools for parents that may aid the diagnostic process. The toolkit also provides support information for parents on how to deal with their child at home, help its treatment, and monitor their child's development and long-term outcome. These tools tie in with a resource kit that physicians can supply to teachers to monitor classroom behavior, gain a better insight in the disorder and help their pupil's treatment.


ADHD - Vanderbilt Assessment Scale - TEACHER Informant
The above link is a resource toolkit for clinicians published by the Academy of American Pediatrics. It provides a number of rating scales and tools for teachers that may aid the diagnostic process. The toolkit also provides support information for parents on how to deal with their child at home, help its treatment, and monitor their child's development and long-term outcome. These tools tie in with a resource kit that physicians can supply to parents.


Voiding Diary (Bladder Evaluation)
The above link is a form needed to help understand your child's bladder function. The diary is used in conjunction with a urology referral. If our office has made this request for your child's treatment, please download the voiding diary and fill it out prior to your urology appointment.