Current Environment:

Each year, nurses and providers at Westwood-Mansfield Pediatrics are responsible for completing and signing thousands of letters, school forms, and doctor’s orders for patients in addition to the ones completed routinely at your child’s annual check-up.

Each form requires that the provider who most recently saw your child reviews the chart and attests to their health and the medical appropriateness of activities. As these are medical-legal documents, it is appropriate that only the provider who completed the last check-up be the one to sign the form.

Effective January 1, 2023, the following policy will go into effect:

  1. We will provide an annual School Physical Form, as well as any Asthma or Allergy Plans at the time of your child’s check-up (this form is posted to MyChart and is valid for 1 year from the date of the visit)
  2. For any additional forms during the year, we require up to 14 days to fill out and have the appropriate provider sign
  3. Any form needing to be completed more immediately will be subject to a “rush fee” of $25 for 5 days or $50 for completion within 24 hours (to be collected at the time of dropping off the form)
  4. Any form involving legal matters or complicated medical or behavioral health issues can only be completed by a provider who is knowledgeable of the patient and may, in certain situations, require more time to complete (and may not be amenable to a rushed completion)
    • this includes guardianship papers (among others)
  5. We will be unable to complete forms if:
    • it has been longer than 13 months since the last check-up
    • all sections of the form to be completed by the parent/patient are not filled out prior to us receiving the form


Westwood-Mansfield Pediatrics