In addition to the new patient form, please fill out foster information below – HIPAA protected. You can also use the printable PDF.
Due to HIPAA regulations, we require this paperwork BEFORE seeing a foster patient.
To provide appropriate medical care and meet KDHE requirements, please present or sign the release for the patient's past medical history, including but not limited to:
Please note: if a foster child has commercial insurance, we may not be able to see her/him, especially under HMO plans. If locked in to another provider, it may be advisable to seek care with the PCP listed with the HMO.
© 2021 Cottonwood Pediatrics. All Rights Reserved. Website Powered by Hubris Communications.