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We are excited that you have chosen Rutherford Pediatrics for your child's medical care. To help you get acquainted with our office procedures, we have included helpful information on this page.

Filling Out a Medical Form

Before the Initial Visit
Before reading further about our onboarding process, please take a moment to verify that we are in network with your insurance by clicking here.

We require every patient to acknowledge our strict vaccine policy here at Rutherford Pediatrics. We firmly believe that all children and young adults should receive all of the recommended vaccines according to the schedule published by the Centers for Disease Control and the American Academy of Pediatrics. We do not offer any exemptions for religious reasons and we have the right to refuse individuals who are non-compliant. To read our full vaccine statement, please 
click here.

New Baby Patients
Congratulations on your little one! To register your newborn at Rutherford Pediatrics, please call (201)-842-0501 and be prepared to provide the baby's first and last name, date of birth, gender, and contact information. A member of our staff will also ask you for the following information over the phone:
    Where was the baby born?
    Was it a vaginal delivery or c-section?
    Were there any complications?
    Did the baby receive the Hepatitis B vaccine?
                  If no Hepatitis B was given at the hospital, please provide more information to our staff while scheduling

You will be instructed to complete the new patient registration form on our website prior to your first appointment and to bring the discharge papers from the nursery to your first appointment. 

As a reminder, it is your responsibility to call your insurance company to find out the following:
✓  Verify if your child enrolled in the insurance plan (infants must be enrolled within 30 days of birth)
✓  Check if your child is covered for preventive visits and how often (yearly/calendar year)
✓  If you are responsible for a copay or deductible
✓  If you have an HMO plan, you must choose us as your primary MD
✓  Choose Dr. Becz as your primary MD when asked to select a PCP (you may still see any provider in the practice)

Transfer-In Patients
We are excited to welcome your family to Rutherford Pediatrics! *Please note that the age limit for transfer-in patients is 16 years old, unless accompanied by a younger sibling(s) transferring in at the same time. The first visit to the office requires a lot of administrative time. In effort to minimize this time, we ask that all patients looking to transfer into our office call (201)-842-0501 for further instructions. A member of our staff will then ask you to complete the new patient registration form and send the following information to prior to your first visit: 
✓  Immunization Records
  ✓  Front and Back of Insurance Card
  ✓  Last Well Visit/Physical Exam Records

It is important to send clear images so they can be reviewed by our staff in a timely manner. Once your information is reviewed, you will receive a call from a member of our staff to inform you of your updated status as a registered patient. From this date onwards, you will be able to schedule appointments at our practice.
**Remember: You are not considered a patient of Rutherford Pediatrics until you receive a verbal approval.

Office Policies
Current Insurance Card 
You are required to bring your current insurance card to each office visit for verification of your eligibility. 

If your insurance card indicates you are responsible for a copay, it must be paid at the time of the visit. We accept multiple methods of payment including cash, credit/debit, and checks, and can provide a receipt for each transaction for your records. Any copay that is not paid will be charged a BILL HOME FEE ($10) and billed to your home address at the end of the month.

You are responsible for deductible payments and balances for any services not covered by your insurance. All balances over 120 days are forwarded to collections. It is important to understand your covered benefits to avoid any unexpected charges. If you are unsure of your benefits, call the number for member services on the back of your insurance card and speak to an insurance representative before your next appointment. 

We impose a surcharge of 3% when paying with a credit card, which is not greater than our cost of acceptance. The adjustment will appear on your receipt. We do not surcharge debit cards. We accept multiple forms of payment and any payments made with a debit card, cash, or check will not include a surcharge.

Travel Visits
If you are traveling internationally, the CDC recommends you make an appointment with your child’s primary health care professional or a travel medicine specialist at least one month before you leave to help you get destination-specific vaccines, medicines, and information.  If you are traveling to a country where your child will need to receive the typhoid vaccine, call and let the staff know prior to your appointment because we require a mandatory upfront payment of $150 to order the vaccine and allow sufficient time for it to arrive. **If the country you visit requires a yellow fever vaccine, please visit a travel medical clinic. You must get it at least 10 days before travel.

Plan ahead.
Get the shots required for all countries you and your family plan to visit.

School / Camp Forms
Please remember to bring all school and camp forms at the time of the visit. Write your child’s name and date of birth on every page of the forms and indicate any allergies, dietary restrictions, and medications that you feel the school or camp needs to be aware of. Universal health forms and physical exam forms for sports will be completed at the time of the visit free of charge. If an additional copy is requested at a later time, a fee of $5 will be applied.

If a form is emailed or dropped off at the office, please allow 3-5 days for completion. A member of our staff will contact you when it is ready using the primary phone number in your patient chart. You will then have the option to (1) pick up the completed forms in the office within the next two weeks or (2) have them scanned and emailed to the email address on file. **Please note that after 2 weeks we discard any forms that have not been picked up.

Update / Registration Form
Your child's information needs to be reviewed annually to insure that we have all of the proper contact and insurance information. You will be asked to complete this form at the time of your child's annual well exam. If you wish you download it prior to your appointment, please click here

Cancellations / No Shows
Any appointments that are pre-booked will be confirmed the day before through our “Patient Fusion” Portal. If you would like to cancel your appointment, please give us a call. If not, you will be charged with a NO SHOW FEE ($75). This includes well visits, ADHD follow-ups, and Asthma follow-ups.

10-Minute Late Policy
Anyone arriving later than 10 minutes to a pre-booked appointment is considered a "no show" and is subject to the NO SHOW FEE ($75). This applies to all wellness visits, ADHD follow-ups, and Asthma follow-ups. Our staff works hard to schedule efficiently to decrease time spent in the waiting room for our patients and their families. Please be courteous and arrive on time to your appointments. If you are unable to make it or are running late to a scheduled appointment, inform our office at (201) 842-0501 and depending on availability, a staff member will try their best to accomodate you or reschedule your appointment.

Transferring Out
Patients who are looking to transfer out of the practice and are requesting a copy of their medical records must complete the health records request form and pay the TRANSFER OUT FEE ($15 **per child). This fee will cover the costs of the USB(s) you will receive with all of your records, which you can then give to your new primary care physician. Please allow our staff 15 days to complete your request from the time you inform us and pay the applicable fee. Click here for more information.

Your family's safety is our priority at Rutherford Pediatrics. Masks are encouraged, but not required for parents and children ages 2+ in the office.

New Baby Patients
Transfer-In Patients
Office Policies
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