Cross Creek Pediatrics, P.A.
2035 Valleygate Drive, Suite 101
Fayetteville, North Carolina 28304
Phone (910) 484-8009
Fax (910) 484-2205
Monday through Thursday
8: 00 a.m. to 4:00 p.m.
Closed from 12:00 – 1:00 for lunch
8:00 a.m. to 12:00 p.m.
Health Form Policies
It is the goal of the physicians and staff to accommodate as many requests as possible to the furthest reasonable extent, bearing in mind the following limitations:
- Blank forms will not be accepted. Forms will only be accepted for completion if the patient's name and other information has been completed. In some cases we may not be able to complete or certify a form if parents have not completed their parts of the forms prior to form submission.
- Turnaround time for form completion is usually fewer than 48 business hours. While every effort will be made to complete forms as quickly as possible, parents should realize that at certain times of the year we may receive hundreds of health forms in one week, and remember that each of these has to be carefully reviewed by a physician before it is released. Parents are strongly advised not to wait until the last moment to look at the paperwork they have received from the program their child is scheduled to attend.
- Forms will be held here for parents to pick up. Because of Health Insurance Portability and Accountability Act (HIPAA) regulations, forms will be released to parents only. Federal law prohibits doctors' offices from faxing or mailing medical information to nonmedical facilities. We cannot be responsible for delays or losses in the mail.
- Forms are completed for those whose accounts are in good standing. Delinquent accounts must be brought current before forms will be released. Forms must be paid for before they are released.
- Many forms require the information to be based on an examination completed within 12 months of the date the form is completed. These requirements notwithstanding, no form will be completed for any patient who has not had a physical examination in our office in more than 12 months.
- Physical examination requires checks of perceptual ability, ie, hearing and vision screening for children age 3 and up. We regret that we cannot certify a child fit for any program without appropriate perceptual (hearing and vision) testing.
- Forms are completed based on information abstracted by staff from your child's chart. All forms are reviewed by a physician for completeness and accuracy. In some cases, forms mandate that only the physician may complete them.
- There is no charge for Women, Infants, and Children (WIC).
- The minimum charge for review or completion of a non-WIC form is $10 per form. Charges vary with duration of physician involvement and time. The physician completing the form determines the charge. The front office staff does not have the authority to alter, reduce, or change charges.
- Insurance companies do not reimburse for form completion, and we do not bill insurance for completing any form.