Policies & Forms
Learn about the policies that help us provide your children with the very best of care.
Online Patient Forms & Handouts
For your convenience, you can download our forms here to complete and bring to your appointment. Questions about which forms you might need? Please call our office and we will assist you in preparing for your child’s visit.
New Patient Registration – Dr. Gioannetti
- If your kids are current patients of Dr. Gioannetti and you would like to follow her to Mesquite Pediatrics, complete BOTH of the forms below.
- Family RegistrationComplete this form once. Write the names of all of your children on each page
- Individual Patient RegistrationComplete this form for each child you are registering. For example, if you are transferring three kids, you will complete this three times.
New Patient Registration – One Patient
- If you are registering just one patient, complete ONE of the following forms.
- Newborn RegistrationFor patients under 1 month of age
- Single Patient RegistrationFor patients 1 month and older
New Patient Registration – Multiple Patients
- If you are registering multiple kids in your family at once, complete BOTH of the forms below.
- Family RegistrationComplete this form once. Write the names of all of your children on each page
- Individual Patient RegistrationComplete this form for each child you are registering. For example, if you are transferring three kids, you will complete this three times.
Release Forms
- Medical Records ReleaseUse this form to release or get a copy of your child's Mesquite Pediatrics medical records.
Educational Handouts
- Well-Child Exam HandoutsThese handouts were written by the doctors at Mesquite Pediatrics and contain valuable information and guidance for parents and patients, based on your child’s age.
- AAP Patient Education LibraryBrowse this library of expert advice from the American Academy of Pediatrics.
School & Services Forms
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 pay any coinsurance, copayments or deductibles at the time of service.
- To ensure that one of the doctors at Mesquite Pediatrics is assigned as your Primary Care Physician, if required by your insurance policy.
- To show your insurance cards to us at each visit.
- To provide updated address, phone numbers, and insurance information to our office.
Accepted Insurance
- In order to be as accessible as possible to the families in our community, we take most insurances. Please contact your insurance carrier to verify that Mesquite Pediatrics is in their network.
- Aetna
- AHCCCS PlansUnited Community Care Plan, Banner University Family Care, Mercy Care Plan (DES/CMDP)
- Ambetter
- Arizona Foundation for Medical Care/GEHA
- Blue Cross/Blue ShieldPimaConnect
- Cigna/Great West
- Coventry/First Health
- HealthSmart/Meritain/Ameriben
- Humana
- Indemnity PlansAny insurance company
- Private Health Care Systems/Multiplan
- TriWestPrime, Select, and Reserve Select
- United Health Care/UMR/Golden Rule
Office & Appointment Policies
Appointments Are Required
Patients are seen by appointment only, so please call ahead even if you feel your child needs to be seen right away. We will make every effort to see sick patients on a same-day basis. Well child visits should be scheduled in advance.
Please call our office to schedule your child’s appointment anytime during our normal business hours.
Mutual Respect of Time
We strive to stay on schedule. Although there can be emergency situations that prevent us from running on time, we pledge to provide quality care with minimal wait time to the best of our ability.
- If you cannot make your appointment, please call us as soon as possible to cancel or reschedule. We require 24 hours notice for cancellations, otherwise you will be charged a “no show” fee of $50.
- If you arrive 15 minutes after the scheduled appointment time you may be rescheduled to another day. If the doctor agrees to see late patients, realize you may wait until they can fit your child into their schedule which may be at the end of the clinic.
- Please complete any forms (ie sports physical, camp forms) ahead of the visit that the doctor needs to complete during the visit. If not completed before the visit we may ask to complete after the doctor has seen your child and upload them to the portal later.
Refills & Referrals
Please send us a message from the patient portal to request medication refills and referral requests. We do not monitor the portal after hours or on the weekends. Please allow 48 hours for all requests.
- You can also refill/renew medications through your pharmacy, who will contact us for authorization.
- For referrals, please include details about the specialist you would like to see, reason for referral, phone numbers and fax number.
After-Hours Care
If your child’s illness or injury is life threatening, dial 911.
Doctor On-Call
For urgent medical advice that cannot wait until business hours:
- Call our office to speak with our answering service. They can put you in touch with the on-call doctor, if needed.
- This service is not for routine calls that can wait until we are open.
- There may be a charge associated with phone calls.
For all other routine calls such as medication refills, dosing questions, etc:
- Please call during office hours or send a portal message. Please note that portal messages are not monitored after hours or on the weekends.
Urgent/Emergency Care
If it is determined that your child needs to be seen by a medical provider outside of business hours, you may be referred to a pediatric facility. We generally recommend a pediatric emergency room at Tucson Medical Center or Banner University Medical Center, especially for younger kids.
Health Education Tools
- Medication Dosage CalculatorBe confident that you are treating your child with the correct dose of Tylenol, Motrin, or Benadryl. We can guide you on how much to give, based on your child’s weight.
- Symptom CheckerUse this symptom checker to learn how serious your child’s symptoms are, whether you need to see the doctor, and how you can provide relief. Brought to you by the AAP and HealthyChildren.org.
- AAP Patient Education LibraryBrowse this library of expert advice from the American Academy of Pediatrics.
- Reliable WebsitesOur recommendations for accurate online resources you can depend on.
Poison Control Hotline
(800) 222-1222
Suicide & Crisis Lifeline
Dial/Text/Chat 988
www.988lifeline.org
Vaccines Save Lives
Vaccines are safe and effective in preventing diseases and health complications in children and young adults. Regular vaccinations help children ward off infections, and are administered as one of the safest and best methods of disease prevention. Therefore we have a vaccine policy that requires that our patients receive certain vaccines unless there is a medical reason why they cannot receive them. We are happy to discuss any concerns you have about vaccines at your child’s next visit.
At Mesquite Pediatrics, we firmly believe in the effectiveness of vaccines to prevent serious illness and to save lives. We firmly believe in the safety of our vaccines. We firmly believe that all children and young adults should receive all recommended vaccines according to the schedule published by the Centers for Disease Control and the American Academy of Pediatrics (AAP).
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All patients in the practice are required to receive a minimum of DTaP, Hib, polio, hepatitis B, pneumococcal and rotavirus vaccines by three months of age.
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By 9 months of age patients must have all immunizations recommended by the AAP in the first six months of life.
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By 18 months of age patients must have all immunizations recommended by the AAP in the first 15 months of life.
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Additional requirements include 2 doses of Hepatitis A vaccine by age 2, all AAP recommended kindergarten booster vaccines by age 5, the meningococcal and Tdap vaccines by age 12, and the second dose of meningococcal vaccine by 17.
If you refuse to vaccinate your child despite all our efforts, we will ask you to find another health care provider who shares your views. We do not keep a list of such providers nor would we recommend any such physician. Please recognize that by not vaccinating, you are putting your child at unnecessary risk for life-threatening illness, disability, and even death.
Finally, if you agree to vaccinate your child, we draw up or open a vaccine, and then you change your mind and decide not to vaccinate, you agree to pay us for the vaccine unless there is another patient for whom we are able to use it.
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
- Centers for Disease Control (CDC)
- Immunize.orgFormerly Immunization Action Coalition (IAC)