Patient information & consent (registered on portal)
Welcome & Sprout User Guide (registered on portal)
Expecting Parents Hospital and Clinic instructions
Health History (parent completes)
Health History (adolescent completes; coming soon)
Authorization for another provider to release information to Sprout Pediatrics:
- From any provider
- From Childhood Health
- From Salem Pediatric Clinic
- From VIDA
- From Salem Clinic
- From Salem Health
Authorization to release information from Sprout Pediatrics to another provider
Acknowledgement of Receipt of Notice of Privacy Practices (Hipaa release)
Self-pay & non-covered services agreement
Blank calendars for schedules, symptom calendars, behavior charts and family contests.
Chart for keeping track of alternating or scheduled medication (please ask me before alternating tylenol and ibuprofen) to help avoid errors & over-dosing.
School & Activity forms
HIPAA/FERPA Release: Permission for school to share information with us.
ADHD Questionnaires (Vanderbilt forms)
- Follow up for teachers (in Spanish)
- Follow up for parents/caregivers
- Initial evaluation for parents/caregivers
- Initial evaluation for teachers