MEDICATION POLICY FORM

Effective 1/1/2017 for prescription refills for antidepressant or birth control pills

Please correct the errors described below.

To effectively monitor your child’s condition and maximize his or her medical therapy, we require yearly physical examinations, as well as intermittent office visits to evaluate progress. The frequency of these visits depends on the diagnosis, as well as on the prescribed medication. In addition, certain medications also require monitoring of lab work. In most cases, appointments are required one month after starting a new medication, and every three months or every six months for follow up visits.

ANTI-DEPRESSANT OR ANTI ANXIETY MEDICATIONS:

In accordance with insurance guidelines and current quality standards, Pediatric Health & Wellness requires medication-monitoring office visits every three months for patients who are prescribed anti-depressant or anti-anxiety medications. One of these visits may be combined with a complete physical exam each year. Patients requiring frequent prescription adjustments will need to be seen more often.

BIRTH CONTROL MEDICATIONS:

Patients who are prescribed birth control pills require an office visit every six months. One of these visits may be combined with a complete physical exam each year. Dr. Skiles has a responsibility to monitor her patients regarding their health and ensure that any serious underlying health issues are immediately addressed while under her care. We appreciate your cooperation with this policy. If you have any questions or concerns, please contact us.

DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

Your message will be encrypted.