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Pediatric Associates of Charlottesville, PLC Patient Authorization for Another Health Professional to Release Protected Health Information to Pediatric Associates of CharlottesvillePatient(s)Name(s)Dobro
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Pediatric Associates of Charlottesville is a pediatric healthcare practice that provides comprehensive medical care for infants, children, and adolescents in the Charlottesville area.
Individuals seeking pediatric care for their children, parents, or guardians are required to file with Pediatric Associates of Charlottesville when accessing services.
To fill out documentation for Pediatric Associates of Charlottesville, parents or guardians should provide personal information, insurance details, and the child's medical history on the designated forms provided by the practice.
The purpose of Pediatric Associates of Charlottesville is to provide specialized medical services to ensure the healthy growth and development of children through preventative care, diagnosis, and treatment.
Information that must be reported includes the child's name, date of birth, medical history, current medications, insurance information, and the names of guardians.
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