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Get Well Here! | What to Bring? | New Patient Forms | Billing & Insurance | Our Locations | FAQ
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Patient Data Form – Please download, print, and fill out the new patient data form. (Required) |
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Patient Authorization Form – Please download, print, and fill out the new patient authorization form. (Required) |
| Medical Release Form | Please download, print, and fill out the medical release form. (Required) |
| The HIPAA Disclosure | Please download, print, and fill out the HIPPA discolsure form. (Required) |
| Parental Consent for Treatment | The parental consent for treatment form is for a parent/guardian to complete if they are not bringing the child into the office. |
| Parental Consent for Minor Form | The Parental consent for Minor form is for a parent/guardian to complete if the child is 16 or 17 bringing themselves into the office. |
| HPA Privacy Notice | Hamblen Pediatrics Privacy Notice |
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ADD New Evaluation Packet | Please download, print, and fill out this form if it pertains to your needs. |
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ADD & Autism Evaluation Cost & Insurance | Please download, print, and fill out this form if it pertains to your needs. |
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Failed No Show Policy (English) | Please download, print, and fill out this form if it pertains to your needs. |
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Failed No Show Policy (Spanish) | Please download, print, and fill out this form if it pertains to your needs. |
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Electronic Internet Contact Permission Form (English) | Please download, print, and fill out this form. (Required) |
Billing & Insurance
Patient Financial Services: 423-318-7919
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Insurance:
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Refferals:
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Our Locations
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Morristown Location
Monday - Friday 8:00 am - 5:00 pm Saturday 8:00 am - 12 noon for sick appointments only Phone: (423) 581-3904 Fax: (423) 581-6120
E-Mail:
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Google Maps Directions 1817 West Morris Blvd. Morristown, TN 37813 |
Jefferson City Location E-Mail: This e-mail address is being protected from spambots. You need JavaScript enabled to view it Google Maps Directions 1405 S. Sizer Street, Suite E Jefferson City, TN 37760 |
FAQ
May I request a particular physician?
Yes, you may request to see a particular physician within the group. Just notify the staff when you call to make the appointment.
However please recognize that the physician you prefer to see may not be in the office that day or may have an extremely high
patient volume for the day. At that time, you will be asked to see another physician within the group.
On occasion, why do two physicians exam my child on the same visit?
One of the many advantages of being with a pediatric group versus a solo practitioner is that consults are readily available. This is
done to benefit the child and to establish the best course of treatment for your child.
When I bring my child in for an illness, I do not always receive an antibiotic for him/her why?
For viral illnesses, antibiotics do not help and in certain situations, may have an adverse affect. Over the years it has been found and
reported that in the United States, people have built up resistance to antibiotics. It is the recommendation of the American Academy of
Pediatrics and other Medical organizations that the use of antibiotics not be used to treat viral illnesses. While it is frustrating for the
parents and the patients, the only way a viral illness will leave is with time.
Financial
We are contracted with many insurance plans/networks. We also accept BlueCare and PHP TennCare. As part of our contract with the
insurance companies/Managed Care Organizations, we are obligated to collect all co-payments or co-insurance at the time of service.
We are not allowed to charge these to your account.
Hamblen Pediatric Associates accepts cash, checks, Visa, Mastercard and Discover. A $30.00 returned check fee will be charged.
A 5% discount is given to patients who pay the bill in full at the time of service. If payment cannot be made at the time of service, financial
arrangements must be made prior to the office visits.
Payment for all well child check-ups and immunizations must be made at the time of service.
Appointments
Appointments must be made for all services. The following is the policy for scheduling of appointments.
Urgent/Sick: It is the policy of Hamblen Pediatric to see acutely sick children the same day. Appointment times are given to reduce waiting
time. It is extremely important that parents call the office as soon as possible to make an appointment. If you wish to see a particular
physician/nurse practitioner we will try to accommodate your request. However, please understand that the particular physician may not
be in the office that day or may already have a high volume of patients for the day and will be unable to see you. We will see your child
however, it may be with a different physician.
Well Child Care/Physicals: Hamblen Pediatric follows the recommended well care schedule of the American Academy of Pediatrics. The
physicians are staunch advocates of well child care. Appointments are available within 2-3 weeks. It is important to tell the appointment
scheduler if your child is on any routine medications or has any problems or chronic illness so that there is a sufficient amount of time
scheduled for the physician to care for your child.
Routine Appointments: Routine appointments (such as warts, ADD evaluations, non-urgent/acute illnesses are available within 2-3 weeks
(if not sooner).
Walk-in patients will be triaged and an appointment time made. In order to serve our patients, appointments are seen before any walk in
appointments UNLESS an emergency exists with the walk-in patient.
Hamblen Pediatric Associates requires 24 hour notice for cancellation of appointments.
Referrals
Many managed care organizations and TennCare require referrals by the Primary Care office/physician. A minimum of 72 hours' notice
must be given before the appointment. Referrals will not be granted unless documentation exists in the patients chart of the need for
the referral. This is the policy of the insurance company that you have contracted with.
Emergency Room
A Hamblen Pediatric Physician is on call 24 hours a day 365 days a year. If a patient goes to the emergency room without speaking to
a physician, a referral will not be given. The only exception to this rule is in the case of a life threatening incident or an accident.
Forms/Medical Record Copies
We ask that all forms be brought to your appointment for completion. If you are unable to bring the form with you, please plan on
leaving the form for a minimum of 3 days. A charge may be made if you need the form immediately.
A medical record authorization must be completed prior to Hamblen Pediatric releasing copies of medical records. In accordance with
Tennessee law, a $20.00 charge is made for up to 40 pages. After 40 pages, there is a charge of $ .25 per page to have copies.
If you wish for your medical record to be transferred directly to another physician, there will not be a charge. Medical records will be
copied within 10 days of receipt of request.
If a former patient requests a copy of their medical record or any part of their record and it is not in the active charts, there will be a
$10.00 retrieval fee to get the chart out of storage in addition to any other fee that may be charged.

Get Well Here!
What to Bring?

