FORMS
FORMS
Whether new to our office or new to parenting altogether, we welcome you to the Rainbow Kids Clinic Family!
Our professional team provides quality care that your child needs and the advice and counsel you want.
All healthy children will be assigned to a nurse practitioner to provide continuity of care. You will be assigned to a doctor if your child has complex medical issues, such as cerebral palsy, or extreme prematurity, etc.
We at Rainbow Kids Clinic believe that your child should see the same provider each visit because your child needs someone who is familiar with him or her and knows you on a personal yet professional level.
We know that at times you may have particular concerns or a sick child when you want to see a physician, we assure you at these times a physician will be there for you and your child.
Registration for new patients less than 1 month old
Registration for new patients more than 1 month old
If you have any questions, please contact MediCopy:
Online chat: MediCopy.netPhone: 866-587-6274Email: contact@medicopy.net
We have partnered with MediCopy to fulfill your Release of Information requests. MediCopy is fully HIPAA compliant and adheres to all state and federal regulations concerning release of medical information.
We have partnered with MediCopy to fulfill your Release of Information requests. MediCopy is fully HIPAA compliant and adheres to all state and federal regulations concerning release of medical information.
Medical Records
Patients can request copies of their medical records at no cost, but delivery fees apply for postage, so provide an email address! Please provide an email address on the authorization to expedite the process and delivery method. Records sent via email or to another provider are complimentary. Requests are completed within two (2) business days after receipt by MediCopy.
To request your medical records please fill out one of the following authorization forms:
- Authorization for the Release of Medical Records (Online)
- Authorization for the Release of Medical Records (Paper)
- Learn more about MediCopy’s Release of Information service
Forms, Handouts and Policies
- Medical Release
- Identification of Personal Representatives
- Vaccine Schedule
- ADHD Initial Parent Form
- ADHD Initial Teacher Form
- ADHD Parent Follow-up Form
- ADHD Teacher Follow-up Form
- HPV Vaccine for Preteens and Teens
- HPV, a Parent's Guide
- HPV + Cancer Prevention
- Controlled Substances Contract for ADHD Therapy
- Asthma Control Test Children 4 to 11 Years
- Asthma Control Test Children 12 and Older
- Pediatric Symptom Checklist
- Postpartum Depression Screening
- Privacy Practices
- RKC Vaccine Refusal Policy
- School Note Policy Advisement
- Vaccination Law Letter
- Advance Vaccine Consent
- Office Policies
- No-Show Policy
- School Notes/ COVID
- Privacy Practices
- Acknowledgment of Privacy Practices
Spanish Version Forms
- ADHD Initial Parent Form (Spanish)
- ADHD
Parent Follow-up Form (Spanish)
- ADHD Initial Teacher Form (Spanish)
- HPV Vaccine for Preteens and Teens (Spanish)
- HPV, a Parent's Guide (Spanish)
- Controlled Substances Contract for ADHD Therapy (Spanish)
- Asthma Control Test Children 4-11 (Spanish)
- Asthma Control Test Children 12 and Older (Spanish)
- Pediatric Symptom Checklist (Spanish)
- Postpartum Depression Screening (Spanish)
- Privacy Practices (Spanish)
- RKC Vaccine Refusal Policy (Spanish)
- School Note Policy Advisement (Spanish)
- Vaccination Law Letter (Spanish)
- Office Policies (Spanish)
- No-Show Policy (Spanish)
- School Notes/ COVID
- Advanced Vaccine Consent (Spanish)
Hours
Monday through Friday 8:00 a.m. - 5:00 p.m.
Saturday 8:00 a.m. - 12 noon
Phone lines open at 7:30 a.m. for appointments.
If there is an emergency, dial 911.
Copyright © 2024 Rainbow Kids Clinic. All Rights Reserved.