As part of our commitment to improve the quality and the coordination of medical care for the children and patients we serve, METROPOLITAN PEDIATRICS has elected to participate in the Children’s National Health System’s IQ Network. This innovative program is the first in the country to attempt to provide real-time coordination of care via an electronic medical record that allows an interface between your or your child’s health care provider and one of the country’s leading children’s hospitals.
This SINGLE CONSENT will allow us to share information, for example, with an ER doctor treating you or your child, or with a specialist to whom you have agreed we are to refer you or your child, so that they are able to quickly access critical information about you or your child from your medical record before beginning treatment. This should dramatically reduce the chance of medical errors, including adverse drug interactions or allergic reactions.
Your and your child’s healthcare information is encrypted (encoded) and can be accessed only by health care providers who are caring for you or your child and have a need to know.
As METROPOLITAN PEDIATRICS is a part of the Children’s IQ Network, this written SINGLE CONSENT will allow the sharing of information with any provider within the IQ Network whom you have elected to be involved in your or your child’s treatment. You do have the option to opt out of the Children’s IQ Network. If you choose to opt out, you will need to sign a separate consent form each and every time you or your child need to be seen by another member of the Children’s IQ Network other than those at METROPOLITAN PEDIATRICS.
PATIENT RIGHTS: I have received a copy of the Children’s IQ Network (CIQN) Information Sheet. I understand that patient information will still be stored electronically for my provider’s records, and that an electronic health summary will be available to other providers through the CIQN. I also understand that I have the right to not share (opt-out) health information with other providers within the CIQN.
PROTECTED DISCLOSURE OF INFORMATION: I understand that Children's National complies with all federal and local regulations including the Health Insurance Portability and Accountability Act; and that this Consent includes my agreement that Children's National can use private health information for my treatment or my child’s treatment as defined in the Notice of Privacy Practices. I agree to Children’s National use of de-identified health information about me or my child for appropriately reviewed and approved research and quality improvement activities.
I hereby request to not have my healthcare information shared with other health care providers within the Children’s IQ Network®. I understand that all of my healthcare information collected by my health care provider will not be submitted to the Children’s IQ Network®, and will not be seen by or shared with other health care providers within the Children’s IQ Network®. I understand that my healthcare information will continue to be available to my primary health care provider as this information makes up my personal medical record.
I further understand that I will be permitted to change my decision and allow sharing with other health care providers within the Children’s IQ Network® at any time in the future.
Here at Metropolitan Pediatrics the vaccine schedule recommended by the Centers for Disease Control (CDC) Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics (AAP) is followed. Alternate schedules put children at risk for serious illness and as such, cannot be followed. The staff at Metropolitan Pediatrics do not wish to put patients and the public at risk by allowing refusal or intentional delay of vaccination. We are passionate about the need for vaccinating children, including your children and our own. Trust is a very important part of the physician-patient-parent relationship. Unfortunately, not trusting a pediatrician or nurse practitioner about the effectiveness and safety of vaccination may lead to lack of trust regarding other aspects of pediatric care. We do not wish to put you or us in that position. If vaccination goes against your beliefs, please make arrangements to find another provider who can accommodate your requests.
Otherwise, please sign below stating that you are aware of our vaccination policies and that we strictly adhere to CDC/AAP guidelines.