Sometimes things happen…illness, work, life. We understand.
***However, NYS law requires written consent from an adult 18 or older (who is the parent/guardian, on patient’s hippa or has been named on the form below signed and sent to the office) for a vaccine to be administered in the office.***
Your child cannot have vaccines administered in our office without a person that is 18 years of age or older AND has the appropriate consent (named above) to sign for administration for the vaccines. This is a NYS law and unfortunately we cannot accept children who are of driving age with written consent from parents to administer vaccines to your child. You must be present or have an adult accompany your child to whom you have given written consent (forms below) to sign for your child’s medical care in office.
The only exception is acute sick visits for 16 - 17 year old children who have written consent from a parent (form below) to be seen in the office. However, this does not give permission for them to be seen at other offices IF they need imaging, labs, specialists or treatment at an emergency dept., etc.
Please fill out the appropriate form(s) below if:
you need someone (18 years or older) other than yourself to bring your child(ren) into the office for a sick visit or injury.
you need someone to bring your child(ren) to the office for a routine physical that may or may not need vaccines.
yOUR CHILD IS 16 YEARS - 17 YEARS OF AGE & BEING SEEN IN OFFICE ALONE FOR AN ACUTE SICK VISIT OR INJURY.
**Choose the appropriate form, download and sign before the scheduled appointment**.
Please have YOUR CHILD or PERSON who is accompanying your child(ren) bring this completed form to the office, or email the completed form to Riverviewpediatric@gmail.com, or fax to 315-592-3571 BEFORE the scheduled appointment. If we do not have the form on file in a timely manner we may need to reschedule the appointment as to be fair regarding time for other patients who are scheduled.
Thank you,
River View Pediatrics