Financial Policy Disclosure and Agreement Sample Contracts

THE MARYLAND PEDIATRIC GROUP, L.L.C./PEDIATRIC CONSULTANTS, P.A. FINANCIAL POLICY DISCLOSURE AND AGREEMENT
Financial Policy Disclosure and Agreement • September 30th, 2021

Thank you for selecting The Maryland Pediatric Group, L.L.C./Pediatric Consultants P.A. for your pediatric healthcare needs. We would like to take this opportunity to inform you of our practice’s updated financial responsibilities. These policies protect our ability to successfully provide care and responsibly adhere to mandated guidelines established by patient selected and contracted insurance companies. Your familiarity with the following policy statements and your willingness to comply are imperative for the delivery of our pediatric care.

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THE MARYLAND PEDIATRIC GROUP, L.L.C./PEDIATRIC CONSULTANTS, P.A. FINANCIAL POLICY DISCLOSURE AND AGREEMENT
Financial Policy Disclosure and Agreement • August 15th, 2016

Thank you for selecting The Maryland Pediatric Group, L.L.C./Pediatric Consultants P.A. for your pediatric healthcare needs. We would like to take this opportunity to inform you of our practices updated financial responsibilities. These policies protect our ability to successfully provide care and responsibly adhere to mandated guidelines established by patient selected and contracted insurance companies. Your familiarity with the following policy statements and your willingness to comply, are imperative for the delivery of our pediatric care.

THE MARYLAND PEDIATRIC GROUP, L.L.C./PEDIATRIC CONSULTANTS, P.A. FINANCIAL POLICY DISCLOSURE AND AGREEMENT
Financial Policy Disclosure and Agreement • March 20th, 2017

Thank you for selecting The Maryland Pediatric Group, L.L.C./Pediatric Consultants P.A. for your pediatric healthcare needs. We would like to take this opportunity to inform you of our practices updated financial responsibilities. These policies protect our abili ty to successfully provide care and responsibly adhere to mandated guidelines established by patient selected and contracted insurance companies. Your familiarity with the following policy statements and your willingness to comply, are imperative for the delivery of our pediatric care.

THE MARYLAND PEDIATRIC GROUP, L.L.C. FINANCIAL POLICY DISCLOSURE AND AGREEMENT
Financial Policy Disclosure and Agreement • May 28th, 2024

Thank you for selecting The Maryland Pediatric Group, L.L.C. for your pediatric healthcare needs. We would like to take this opportunity to inform you of our practice’s updated financial responsibilities. These policies protect our ability to successfully provide care and responsibly adhere to mandated guidelines established by patient selected and contracted insurance companies. Your familiarity with the following policy statements and your willingness to comply are imperative for the delivery of our pediatric care.

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