Policies & Forms

Learn about the policies that help us provide your children with the very best of care.

Patient Forms & Downloads

Please bring your completed forms with you to our office at the time of your visit. All forms and documents are in PDF format.

Office
Policies Insurance
& Billing After-Hours
Care Vaccination
Policy

Office & Appointment Policies

Appointments Are Required

Patients are seen by appointment only. Please send a secure text message using Spruce or call our office to schedule your child’s appointment anytime during our normal business hours.

Same-day sick appointments are scheduled on a first-come, first-served basis, though we will make every effort to work in an urgent visit if the schedule is full.

Well Visits

Well Visits & Immunizations

At Adventure Pediatrics we recognize the importance of routine well check-ups and follow the schedule recommended by the American Academy of Pediatrics (AAP).

We expect our families to follow these guidelines so that we may provide quality healthcare to our patients. Failure to do so may result in dismissal from the practice.
A grace period of up to 3 months will be applied for annual check-ups; after this, patients will be marked as ‘inactive’ and will need to re-enroll.
Adventure Pediatrics requires that our patients follow the immunization schedule recommended by the AAP.

Insurance companies may differ in how they define and cover preventative services; as such, you may be responsible for out-of-pocket costs, such as deductibles, copays, or charges for non-covered services. Please review your insurance plan carefully to understand which preventative services are covered, and how often, before receiving care.

A list of recommended screenings and labs can be found here.

Late/Missed Appointments

Late Arrivals & Missed Appointments

Appointment arrivals 10 minutes or later than the scheduled appointment time may result in the need to reschedule the appointment. Appointment dates and times can be found by logging into your patient portal.

We require a 24-hour notice for cancellations. Repeated same day cancellations or missed appointments, per family, may result in dismissal from the practice.

Medication Refills

Medication refills will be renewed at the appropriate follow up appointment or wellness exam.

If the appointment is rescheduled, we will renew one month to allow time for the new appointment.
If the appointment is missed, or rescheduled more than once, your child will need to be seen in the office before additional prescriptions will be sent.
If your child has unexpectedly run out of an “emergency” medication, such as an asthma inhaler, and is experiencing symptoms, please contact the office.

Medical Records & Forms

Medical Records

If you wish to obtain a copy of your medical records, you must complete the authorization to release records form. The form must be completed in its entirety to process the request. A summary of care can be provided at no cost, but any outstanding balances must be paid before the patient’s full medical record can be transferred.

Form Requests

Forms requested before or on the day of an appointment will be provided within 24 hours of the exam date. Forms requested after the date of the appointment will take up to 5 business days to complete. Some complex forms, such as Family Medical Leave Act paperwork, may require additional time.

Behavior

Patient Privacy

The team at Adventure Pediatrics is governed by and complies with the federal Health Insurance Portability and Accountability Act (HIPAA). A copy of our current HIPAA statement is available upon request.

We must abide by the terms of our office Privacy Policy. We may change the terms of this policy at any time; the most current copy may be found on our website adventure-pediatrics.com, or a paper copy can be provided on request. The new notice will be effective for all protected health information that we maintain.

Patients aged 18 and older must sign a waiver authorizing parental access to their account. Parents of patients over 18 will not be permitted to access any medical or billing information without this written consent.

Insurance & Billing

We are committed to providing the best possible care and service to you, and appreciate your understanding of your financial responsibilities as an essential part of your child’s care. If you have any questions concerning these policies, please contact our office.

Your Responsibilities

To know the limits and coverage of your health insurance policy.
To ensure that Adventure Pediatrics is assigned as your primary care physician, if required by your insurance policy.
To pay any copayments or deductibles at the time of service.
To show your child’s current insurance card and your photo ID at each visit.
To provide updated address, phone numbers, and insurance information to our office.

Accepted Insurance

We accept most major insurances and Mississippi Medicaid plans. We have also listed the plans that are still in process, and we will update this page when we can begin accepting patients covered by these plans.

Please note that our practice and providers may not be in-network with all plans under your insurance company. It is the patient’s responsibility to ensure that our practice is an in-network provider with your coverage plan.
A scanned copy of the assigned account holder’s current insurance card and driver’s license is required to be kept on file; in addition, you will be asked to present your insurance cards at every appointment, even if we already have a scanned copy.

Accepted Insurance

Aetna
Cigna
Magnolia MississippiCAN
Magnolia CHIP
MS Medicaid
Truecare MississippiCAN
Truecare CHIP
UHC

Awaiting Final Approval

Blue Cross/Blue Shield
Molina MississippiCAN
Molina CHIP
Molina Marketplace
Tricare EastSelect plan, *Prime plan may be available in the future

Payments

Payment in full is due at the time of service. This includes applicable co-insurance, co-payments, payments for services not covered/denied by your insurance company. Make sure that if you are unable to bring your child in yourself, that whoever brings the child in is prepared to make all payments.

For your convenience, we accept all major credit/debit cards and checks. If a check is returned for any reason, you will have 7 days to contact our office and arrange another form of payment and will be subject to a $35 returned check fee.

Self-Pay Accounts

Outstanding Balances

Divorce/Separation

After-Hours Care

If your child’s illness or injury is life threatening, dial 911.

Otherwise, for urgent matters that cannot wait until business hours, please send a secure text message using Spruce or call our office at (662) 443-4408 to speak to a triage nurse.

Poison Control Hotline
(800) 222-1222

Suicide & Crisis Lifeline
Dial/Text/Chat 988
www.988lifeline.org

Health Education Tools

Dosage CalculatorBe confident that you are treating your child with the correct dose of pain reliever, fever reducer, or allergy medicine.
Health & Wellness WebsitesOur recommendations for accurate online resources you can trust.

We are a vaccinating practice.

Vaccines are safe and effective in preventing serious diseases and long-term health complications. Adventure Pediatrics requires all patients to follow the current immunization schedule recommended by the American Academy of Pediatrics.

Families with vaccine concerns are encouraged to discuss questions directly with the doctor. However, if your family ultimately decides not to vaccinate, we will ask you to establish care with another pediatric office that better aligns with your beliefs.

Resources

Immunization ScheduleAmerican Academy of Pediatrics (AAP)
Vaccine Information Statements
Vaccine Education CenterChildren's Hospital of Philadelphia
Vaccine Safety: The FactsAmerican Academy of Pediatrics
VaccinateYourFamily.orgHelping to protect people of all ages from vaccine-preventable diseases
Institute for Vaccine SafetyJohns Hopkins Bloomberg School of Public Health
Immunize.orgFormerly Immunization Action Coalition (IAC)

Adventure Pediatrics

5960 Getwell Rd, Suite 102
Southaven, MS 38672-7318

Map & Directions

Phone
(662) 443-4408

Secure Text
Using the Spruce App

Get Spruce

Fax
(662) 214-6249

Office Hours

Monday – Thursday
8:30 am - 5:00 pm

Friday
8:30 am - 12:00 pm

Saturday – Sunday
Closed

After-Hours Care

If your child’s illness or injury is life threatening, dial 911.

Otherwise, for urgent matters that cannot wait until business hours, please send a secure text message using Spruce or call our office at (662) 443-4408 to speak to a triage nurse.

Poison Control Hotline
(800) 222-1222

Suicide & Crisis Lifeline
Dial/Text/Chat 988
www.988lifeline.org

Policies & Forms

Policies & Forms

Policies & Forms

Policies & Forms

Policies & Forms

Patient Forms & Downloads

Office & Appointment Policies

Appointments Are Required

Well Visits & Immunizations

Late Arrivals & Missed Appointments

Medication Refills

Medical Records

Form Requests

Respectful Behavior

Patient Privacy

Insurance & Billing

Your Responsibilities

Accepted Insurance

Accepted Insurance

Awaiting Final Approval

Payments

Self-Pay Accounts and Non-Covered Charges

Outstanding Balances

Divorce/Separation

After-Hours Care

Health Education Tools

We are a vaccinating practice.

Resources

Adventure Pediatrics

Office Hours

After-Hours Care