Information for Existing Patients
Click
https://mycw35.eclinicalweb.com/portal3877/jsp/100mp/login.jsp
to connect to the patient portal.
The Patient Portal uses leading edge technology to promote healthcare and make it easier to perform preventative care. The Patient Portal gives you 24x7 access to your medical information from the comfort and privacy of your own home or office.
Patients can:
Enter medical history on-line
Send messages to the office
Complete New Patient Registration
Refill prescription requets
Check lab results
View current and past account statements
Obtain patient education materials
Providers can:
Securely communicate with patients
View history
Post results to the portal
Send reminder notices
Post and upload patient consent forms
Obtain referral requests
Send appropriate patient education
materials directly to the patient
Important Forms and Documents
Katz Pediatrics functions most effectively as your child's medical home if parents provide a complete medical history and information about care obtained outside of Katz Pediatrics. When transferring to the practice please complete the records authorization form, this will allow our practice to request records from previous physicians. If you have questions regarding medical records please call our office manager, Eva at 772-678-7474
New Patient Registration Form
Patient Registration.xlsx
Microsoft Excel sheet [14.4 KB]
Health History for Children Under 1 year
Pediatric Health History for Under 1 yea[...]
Adobe Acrobat document [113.5 KB]
Health History For Children 1 year and Older
Pediatric Health History for Over 1 year[...]
Adobe Acrobat document [107.1 KB]
Financial Policy and Office Procedures
Financial Policy and Office Procedures e[...]
Adobe Acrobat document [124.3 KB]
MEDICAL RECORDS- Please complete this form and return it to us or bring it to your Previous Physician so that we may get your child's records
RR to Transfer Records To Us.pdf
Adobe Acrobat document [117.2 KB]
MEDICAL RECORDS- How to Obtain Your Records From Katz Pediatrics
If you move out of our area or need medical records for another purpose, please use this form to request what you need.
AUTHORIZATION TO RELEASE RECORDS FROM KP[...]
Adobe Acrobat document [111.9 KB]
Privacy Practices/ HIPPA form
PRIVACY PRACTICES Acknowledgment form (1[...]
Adobe Acrobat document [35.7 KB]
No Show Policy Form
No Show Fee Form.pdf
Adobe Acrobat document [111.0 KB]
Vaccine Policy for Katz Pediatrics
VACCINE POLICY established 2019.pdf
Adobe Acrobat document [88.2 KB]
Authorization For Medical Treatment by Non Guardians
Authorization of Medical Treatment (2).p[...]
Adobe Acrobat document [107.3 KB]
Credit Card On File Agreement Form