Your child’s health is our highest priority and to ensure that your interactions with us go smoothly we ask that Longwood Pediatric families review each of our policies below as a basis of us working together. Click on the pdf link to view that policy.
Our HIPAA policy explains how we protect your privacy. Please review prior to your first visit with us.
Please review our financial policy prior to you first visit with us.
Authorization for Release of information (download the pdf)
If you would like us to release your medical information to another provider or entity on referral, please complete this form and send it to us.
Form To Transfer Care To Another Provider (download the pdf)
If you need a copy of your child’s medical record because you are transferring to another practice, please complete this form and send it to our medical records department.
Patient Bill of Rights and Responsibilities (download the pdf)
We are committed to respecting and protecting the rights of our patients and families. Please review our policy.
Referrals
Many health insurance plans require that you obtain a referral authorization to see a specialist from your primary care provider. To request a referral authorization number you may contact the billing office at 617-277-1703 or use the patient portal to make a request. Be prepared with the following information: patient’s name and date of birth, name of your insurance, name of the specialist and the reason and date of the appointment scheduled, a phone number where you can be reached for questions or confirmation that the referral has been done.
Please remember that it is the insured’s responsibility to understand your benefits and that a referral is not a guarantee of payment. Please make sure the specialist you are seeing accepts your health insurance plan.
If you request a referral retroactively, we will make every effort to secure an authorization, however, we cannot guarantee that an insurance company will provide a retroactive authorization. If you have visited the specialist without the required authorization, we are not responsible for any charges incurred as a result of this visit.
If you are unsure if you need a referral, please contact your health insurance plan.
Health Forms
Your child is given a complimentary copy of his/her health form at their annual well check. This health form can be used for 1 year from the date it was created. Please keep the original for your files and give a copy to the school or camp (or any other entity) when they request it. Do not give away the original.
If you need an additional copy of your child’s health form, please request it from the medical records department. Depending on the volume of requests, it will take between 7-10 business days to generate a new health form for you.