1. UPON ARRIVAL, PLEASE NOTIFY RECEPTIONIST IF YOUR CHILD IS SICK WITH ANY CONTAGIOUS DISEASE.

2. NOTIFY RECEPTIONIST OF ANY CHANGE IN INSURANCE INFORMATION OR ADDRESS SO WE CAN UPDATE FILES, ROUTINELY DONE EVERY SIX MONTHS.

3. IT IS THE PATIENT RESPONSIBILITY, NOT THE OFFICE, TO HAVE UPDATED INSURANCE INFORMATION READILY AVAILABLE.

4. PRIORITY WILL BE GIVEN TO APPOINTMENTS.

5. DO NOT GET UPSET IF WE PASS AHEAD A PATIENT THAT ARRIVED AFTER YOU. CHANCES ARE THIS PATIENT HAD AN APPOINTMENT, IS TOO SICK TO WAIT, OR CAME EARLIER, SIGNED AND LEFT.

6. WALK-IN PATIENTS THAT SIGN BEFORE 8:00 AM OR AFTER 4:00 PM WILL BE SUBJECT TO AN ADDITIONAL $ 10.00 CASH CHARGE PAYABLE IN ADVANCE – NO EXCEPTIONS

7. WE ARE SORRY IF WAITING PERIOD IS LONGER THAN EXPECTED, PLEASE BE PATIENT SINCE WE HAVE TO ACCOMMODATE EMERGENCIES.

8. PLEASE, NOT MORE THAN 2 (TWO) ADULT RELATIVES WITH THE PATIENT INSIDE THE EXAMINING ROOM.

9. FOR YOUR OWN HEALTH, PLEASE KEEP DOOR CLOSED WHILE IN THE EXAMINING ROOM.

10. NO VIDEO CAMERAS ALLOWED.

11. BY LAW, ALL PAYMENTS AND COPAYMENTS MUST BE COLLECTED AT THE TIME OF SERVICE. AT TIMES, THEY WILL BE REQUIRED TO BE PAID IN ADVANCE.

12. WE WILL NOT ACCEPT ANY INSURANCE THAT CANNOT BE VERIFIED.

13. THERE WILL BE A $ 20.00 CHARGE FOR RETURNED CHECKS.

14. NO HRS FORMS OR SCHOOL PHYSICALS WILL BE GIVEN WHEN BALANCE IS PAST-DUE.

15. THERE WILL BE A $ 10.00 CHARGE FOR HRS FORMS, EXCEPT WITH MEDICAID PATIENTS.

16. THERE WILL BE A $ 30.00 CHARGE FOR EAR PIERCING (ONLY NEWBORNS)-EARINGS INCLUDED.

17. HMO’s HAVE CONTRACTED FACILITIES FOR LABORATORY TESTS AT NO CHARGE FOR THE PATIENT. THERE WILL BE A CHARGE FOR OFFICE LABS. IT IS THE PATIENT’S CHOICE AND YOU WILL BE NOTIFIED IN ADVANCE.


CBC WITH DIFF. (COMPLETE) $ 25.00
URYNALISIS $ 20.00

HEMOGLOBIN & HEMATOCRIT $ 15.00

GLUCOSE $ 15.00
LEAD $ 20.00


18. THERE WILL BE A CHARGE OF $ .50/ PAGE FOR COPIES OF MEDICAL RECORDS GIVEN TO PATIENTS ($15.00 MAX.). ALLOW 4-5 WORKING DAYS, UNLESS AN EMERGENCY.

19. DOCTORS DO NOT GET INVOLVED OR DISCUSS FINACIAL MATTERS WITH THE PATIENTS. THERE IS A DEPARTMENT FOR THIS.

20. PLEASE LEAVE ROUTINE CALLS FOR OFFICE HOURS.

21. AFTER OFFICE HOURS, PLEASE CALL DOCTOR OR STAFF FOR EMERGENCIES ONLY.

22. EMERGENCY CALLS WILL BE RETURNED IN ORDER OF IMPORTANCE ( WILL BE PRIORITIZED).

23. HAVE THE PHARMACY NUMBER AVAILABLE WHEN AN EMERGENCY CALL.

24. NO ANTIBIOTICS WILL BE PRESCRIBED OVER THE PHONE.

25. SINCE WE CANNOT ACCESS MEDICAL RECORDS, REFILL MEDICATIONS WILL NOT BE DONE AFTER OFFICE HOURS.

26. WHEN CALLING THE OFFICE OR SERVICE, ALWAYS ASK FOR THE OPERATOR OR RECEPTIONIST NAME. ALLOW REASONABLE TIME FOR A CALL TO BE RETURNED. IN A LIFE THREATENING SITUATION, CALL 911 FIRST.

27. ALLOW 3 (THREE) TO 5 (FIVE) WORKING DAYS FOR NON-URGENT REFERRALS.

28. NO REFERRALS WILL BE GIVEN THE SAME DAY, UNLESS AN EMERGENCY SITUATION AS ASSESSED BY DR. RUIZ-UNGER.

29. NOTIFY DR. RUIZ-UNGER IF YOUR CHILD IS BEING ADMITTED TO A HOSPITAL BY ANOTHER PHYSICIAN, LIKE A SUBSPECIALIST.

30. FOLLOW UP LAB RESULTS AS WELL AS ROUTINE OFFICE VISITS AND INMUNIZATIONS ARE RESPONSIBILITY OF THE PATIENT. WE WILL ADVISE ON WHEN TO SCHEDULE OR TO CALL FOR A RESULT, BUT IT IS ONLY UP TO THE PATIENT TO COMPLY.

31. PLEASE CLEAN AFTER YOUR CHILD’S VOMIT, URINE OR STOOL. NOTIFY IF ASSISTANCE IS NEEDED OR IF AN AREA NEEDS TO BE CLEANNED.

32. WE WILL NOT TOLERATE, UNDER ANY CIRCUMSTANCE, ANY IMPROPER BEHAVIOR OR LANGUAGE. IN RESPECT DUE TO OTHER PATIENTS, THIS PERSON WILL BE ASKED TO LEAVE THE PREMISES IMMEDIATELY.