Welcome to Small Town Pediatrics

Here you will find important information about our practice and being a Small Town Pediatrics family. Most items listed here can also be found on our website, in our communications, and on handouts you will receive at registration and your first visit. Consider this any easy access summary and please do not hesitate to reach out with any questions.

Silverton appointment hours:
Monday 9-noon, 1-5
Tuesday 9- noon, 1-5
Wednesday, 9- noon
Thursday 9-noon, 1-5
Friday 9- noon

Monmouth appointment hours:
Monday 9-noon, 1-5
Tuesday 9 -noon
Wednesday 9-noon, 1-5
Thursday 9- noon, 1-5
Friday 9-noon

You can reach a clinician when you need us regardless of the day or time.


Need urgent care advice? If you are considering an Emergency Room or Urgent care visit, or your child has worrying symptoms. Text or Call 503 400-3852 and press ‘2’ for the clinical line.

Need care advice that can wait a few hours? “My Kid’s Chart” portal messages are the quickest, most secure and direct way to reach Dr. Mark or Kourtney. We strive to answer within 12-24 hours. If you have not heard from us promptly, please text 503 400 3852.

Follow the link for information and instructions of the resources and information available to you in My Kid’s Chart- plus instructions to download a shortcut to your phone.

  • Please arrive 10 minutes early for your appointment.
  • If you need to reschedule, please do so 24 or more hours in advance.
  • Please bring a valid insurance card and if applicable a form of payment to each visit.
  • Children under the age of 14 must be accompanied by a custodial parent for well child exams.
  • To minimize the spread of germs please bring a toy or book to entertain your child.
  • For visits with vaccines, please bring an age appropriate distraction for your child – toy, video, bottle.

Office Policies

 Well Child Exams are Required

At Small Town Pediatrics, we are dedicated to helping your child(ren) reach their highest health and development potential. We follow the American Academy of Pediatrics recommended schedule for preventive health care as follows:

✔ Newborn ✔ 6 months ✔ 24 months

✔ 10-14 days ✔ 9 months ✔ 30 months

✔ 1 month ✔ 12 months ✔ 3+ years – annually

✔ 2 months ✔ 15 months

✔ 4 months ✔ 18 months

We request the primary caregivers bring children in for well child exams.  Failure to bring children for Preventive care visits does not adhere to Small Town Pediatrics’ policies, and may result in discharge from the practice.

 Mutual Respect of Time

We do our best to run on time. You can help by:

  1. Arriving 10 minutes early for your appointment. 
  2. Inform us of all concerns to be addressed when scheduling to allow enough time.
  3. If you are running late, text or call the office. Arrival 10 or more minutes after the appointment time may result in needing to reschedule.

Vaccines Protect Our Community

Small Town Pediatrics’ vaccine policy exists to protect my child(ren) and our community of infants, medically fragile children and pregnant women. I agree that my child(ren) at a minimum will be vaccinated on time against Whooping Cough, Measles, Mumps, Rubella, and Chicken Pox.

Financial Policy

Personal Responsibility

At each visit, parents must identify who is responsible for the costs of their child(ren)’s healthcare. This person or party is named as the account guarantor.  Any person bringing the child to the office should always bring a form of payment to each visit, have current proof of enrollment in a Medicaid program with a contract with Small Town Pediatrics, or the guarantor must participate in our credit card on file option.

Accurate Updated Insurance

I agree to provide Small Town Pediatrics complete and accurate insurance information and timely updates on any changes in coverage. I will promptly answer questions regarding insurance coverage and if requested, communicate with the child’s insurance plan to facilitate payment for services provided by Small Town Pediatrics. Failure to maintain coverage or provide complete information which leads to a need to reprocess insurance claims may result in a $50 per transaction administrative fee.

Insurance Contracting and Personal Responsibility

I understand that my child(ren)’s insurance plan – not Small Town Pediatrics – determines what is and is not covered, and who pays the costs.  My insurance plan specifies copays, coinsurance, deductibles, non-covered charges, and other charges that may be personal responsibility. Insurance plans require Small Town Pediatrics to bill for all services as defined by Current Procedural Terminology (CPT) codes.  We must consistently bill insurance plans for office visits, telemedicine (phone, video, email/portal), home visits as well as for vaccines, screening tools and other defined administrative work. Small Town Pediatrics must comply with the contractual coverage determinations, including collection of personal responsibility defined by the insurance plan.  Small Town Pediatrics reserves the right to charge patient families directly for additional, non-covered services and administrative charges, including requests for forms, letters, and fees. I am personally responsible for these charges.

While you are welcome and encouraged to pay for services at the time of delivery, we bill your child(ren)’s insurance as a benefit to you.  The insurance plan will send an explanation of benefits (EOB) specifying the insurance plan coverage and payments and the amount (if any) of your personal responsibility.  For commercial insurance plans, personal responsibility due will be billed to you. 

 

Self-pay accounts/Out of Network Insurance

For families without insurance and for those preferring to pay for services at the time of a visit, a time of service discount will be applied to the bill if settled in full on the day the service is billed.  If Small Town Pediatrics does not participate in your commercial insurance plan, payment in full is expected at the time of your visit.  We will supply a detailed receipt for submission to your insurance plan for reimbursement.  We cannot provide services to Medicaid patients covered by out of state Medicaid plans or Coordinated Care Organizations which are not contracted with Small Town Pediatrics. 

Missed/No Show Appointments

Missed appointments prevent other patients the opportunity for care and cause administrative burdens.  Appointments not canceled/rescheduled 24 hours in advance may incur a $50 “no show” fee.  Repeated missed appointments is a violation of Small Town Pediatrics policies and may lead to discharge from the practice or appointment scheduling limitations.

 

 Timely Payment

If your insurance requires one, a co-payment must be paid at the time a service is delivered.  When any balance is owed to Small Town Pediatrics, we will bill the responsible party on file. Payment is due within 30 days from the date of the bill.  If there is no request for a payment plan or the payment cannot be processed (card declined/check returned)  the account may be charged a re-billing fee of $30 for each monthly cycle.  Small Town Pediatrics reserves the right to send any balance outstanding over 90 days to a collections agency or to make a claim for judgment in court.  If the account is sent to collections, a 50% of balance collection fee will be charged.  

As a convenience to you, and to help avoid past due balances, Small Town Pediatrics offers families the option to maintain a credit card on file (see Credit Card on File policy).   A valid credit card on file relieves patient families of the risk of fees or collections.  

Please bring your insurance card to every visit.

Credit Card on File Policy

Families are encouraged to maintain a credit card on file with Small Town Pediatrics.  A credit card can be used to pay co-payments, payments for services on the day of service, or account balances.   Credit card on file information will be securely stored with our card payment processor, Payment Pros.

It is your responsibility to ensure that the credit card on file is active and up to date.  A rejected transaction can result in fees/penalties as described in the Timely Payment section of the  Small Town Pediatrics financial policy.

Payments may be made to any credit card at any time through the patient portal/My Kids Chart.  Unless specific charges are authorized by you, a stored credit card will only be used to satisfy account balances due beyond 30 days. By opting in to the credit card on file service and signing this form you authorize Small Town Pediatrics to charge unpaid account balances beyond 30 days to the credit card on file. A notification text will be sent to you before a charge is made. Any time your card is charged, a receipt will be sent to you by email.

You have the right to appeal any charge made to your credit card.  Should you feel we charged your card in error, or if there is a dispute regarding the insurance coverage decision, please contact our office. If a charge was made in error, Small Town Pediatrics will reverse the erroneous charges.  Please note:  questions regarding insurance coverage and/or personal responsibility should be directed first to your insurance plan(s).

 

If you are considering an Emergency Room or Urgent care visit, or your child has worrying symptoms. Text or Call 503 400-3852 and press ‘2’ for the clinical line.

“My Kid’s Chart” portal messages are the quickest, most secure and direct way to reach Dr. Mark or Kourtney. We strive to answer within 12-24 hours. If you have not heard from us promptly, please text 503 400 3852 .

Your Small Town Pediatrics team is made up of an administrative team, medical assistants, and clinicians. Each team member is involved in the coordination of your child(ren)’s care.

Administrative Team
Our administrative team (Nicole and Melissa) can help you with registering, scheduling, patient records, and payments. You can reach them by text, portal message, or dialing (503) 400-3852 option 1.

This team can also answer some billing questions or help you get answers from our billing consultant, Susan. We do recommend contacting your insurance payer first as they determine your billed charges. Nicole and Melissa can also answer status questions about referrals that are already in progress. For billing or referral questions please text, portal message or dial (503) 400 – 3852 and leave a message.

Medical Assistants

Our medical assistants (Vanessa and Kate) help you during office visits by taking your child(ren)’s vitals, distributing health screens and safely administering vaccines., Contact them for sick visit appointments and they will coordinate with your clinician. Medical assistants also retrieve your lab and imaging results for your clinician’s review and may communicate results to you. You may also speak with our medical assistants when you need care advice and your clinician is caring for another patient. They can send you clinician written educational materials and make sure your questions reach your clinician. You can reach them by text, portal message or dialing (503) 400 – 3852 option 2.

 

Clinicians

Our clinicians (Dr. Mark and Kourtney) provide chronic, acute, and well child care. You can expect anticipatory guidance at all stages of your child(ren)’s development. Diagnosis, referrals, prescriptions, and care advice ALWAYS comes from your clinician even if another team member helps with communication. Dr. Mark and Kourtney share call responsibilities outside of regular office hours. Please see Contact your Clinician for the best ways to reach Dr. Mark and Kourtney.

The easy phone tree can help direct you to the right service. We also encourage you to send portal messages to My Kid’s Chart.

Description of Patients Rights

NOTICE OF PRIVACY PRACTICES for SMALL TOWN PEDIATRICS

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. (Revision 8/1/2023)

If you have any questions about this notice, please contact the Privacy Officer of our office at 503-400-3852.

WHO WILL FOLLOW THIS NOTICE. This notice describes our practices and that of (1) any healthcare professional authorized to enter information into your medical record that we maintain at this office; and (2) all employees, staff, and other healthcare personnel.

YOUR CHILD(REN)’S MEDICAL INFORMATION. We create a record of the care and services your child(ren) receive at this office. We need this record to provide you with quality service and to comply with certain legal requirements. This notice applies to all of the records about your child(children) maintained by this office. Other physicians or healthcare providers that you use may have different policies or notices regarding the use and disclosure of your medical information. This notice will tell you about the ways in which we may use and disclose medical information about your child(ren). We also describe your rights and certain obligations we have regarding the use and disclosure of medical information. We are required by law to (1) make sure that medical information that identifies your child(ren) is kept private; (2) give you this notice of our legal duties and privacy practices with respect to medical information about your child(ren); and (3) follow the terms of the notice that is currently in effect.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOUR CHILD(REN). The following categories describe different ways that we use and disclose medical information. “Use” is what we do with your child(ren)’s information in this office. “Disclose” means sharing your child(ren)’s information with others outside this office. All of our permitted uses and disclosures of information fall within one of the categories.

  • For Treatment. We may use medical information about your child(ren) to provide your child(ren) with medical treatment or services. We may disclose medical information about your child(ren) to doctors, nurses, technicians, office staff, or other personnel who are involved in your child(ren)’s care.
    ● For Payment. We may use and disclose medical information about your child(ren) so that the treatment and services your child(ren) receive at this office may be billed to and payment may be collected from you, an insurance company, or a third party.
    ● For Health Care Operations. We may use and disclose medical information about your child(ren) as reasonably necessary. These uses and disclosures are necessary to run the office and make sure that all of our patients receive quality care.
    ● To the Department of Health and Human Services (HHS). We must disclose your medical information when requested by HHS when it is undertaking a compliance investigation, review, or enforcement action.
    ● To You. We must disclose your child(ren)’s medical information, except information explicitly protected for adolescents, to you when you request it as described below. We may disclose your child(ren)’s medical information to you in other situations.
    ● Opportunity to Agree or Object. We may disclose your child(ren)’s medical information in front of others with your informal permission when you are present. If you are not present or otherwise unable to give permission, we may disclose your child(ren)’s medical information to others if, in a healthcare provider’s professional judgment, disclosure is determined to be in your child(ren)’s best interest. This includes telling family or friends involved in your child(ren)’s care about your child(ren)’s current medical condition.
    ● For Appointment Reminders. We may use medical information about your child(ren) to remind you about appointments using phone calls, emails, or text messages. This also allows us to leave appointment reminders and messages with limited information on your voicemail and answering machine.
    ● Incidental Use. Although we try to limit communications of your child(ren)’s medical information to the minimum necessary, we can disclose information that is incidental to an otherwise permissible use.
    ● Valid Authorization. We may disclose your child(ren)’s medical information pursuant to your written authorization. For authorization to be valid, you must sign a form containing certain statements.
    ● Public Interest and Benefit Activities. We may disclose medical information about your child(ren) for 12 national priority purposes, including when required by law, such as statute or court order; for public health activities, such as providing immunization records to a school with a parent’s permission; to government agencies regarding victims of abuse; to health oversight agencies to carry out legally authorized audits and investigations; pursuant to court orders and subpoenas that meet certain requirements; to law enforcement as described below; to a coroner or medical examiner; as necessary to facilitate organ or tissue donation and transplantation; for research purposes under certain circumstances; to prevent a serious threat to your health and safety or the health and safety of the public or another person; for certain essential government functions; and for workers’ compensation or similar programs.
    ● Law Enforcement. We may disclose your child(ren)’s health information if asked to do so by a law enforcement official (1) in response to a court order, subpoena, warrant, summons, or similar process; (2) about a death we believe may be the result of criminal conduct; (3) about criminal conduct at the office; or (4) in emergency circumstances, in order to report a crime, the location of the crime or
    victims, or the identity, description, or location of the person who committed the crime.
    ● Limited Data Set. In certain situations we may disclose your child(ren)’s medical information within a limited data set for research, healthcare operations, and public health purposes. A limited data set is medical information about your child(ren) from which certain identifying information about your child(ren), your child(ren)’s relatives, household members, and employers has been removed.

DISCLOSURES THAT REQUIRE AUTHORIZATION FROM YOU.

  • Psychotherapy Notes, Marketing, and Sales of Protected Health Information. Most uses and disclosures of psychotherapy notes, protected health information for marketing purposes, and that constitute a sale of protected health information require authorization.
    ● Other. Other uses and disclosures not described in this notice will be made only with your authorization.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOUR CHILD(REN) You have the following rights regarding medical information we maintain about your child(ren):

  • Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your child(ren)’s care. Usually, this includes prescriptions and billing records. To inspect and copy medical information that may be used to make decisions about your child(ren), you may be required to submit your request in writing to the Privacy Officer. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. We will select a licensed healthcare professional to review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
    ● Right to Amend. If you feel that medical information we have about your child(ren) is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for this office.
    To request an amendment, complete and submit an AMENDMENT REQUEST form to the Privacy Officer.
    We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that (1) was not created by us, unless the person or entity that created the information is no longer available to make the amendment; (2) is not part of the medical information kept by or for the office; (3) is not part of the information which you would be permitted to inspect and copy; or (4) is accurate and complete.
    ● Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of certain disclosures we made of medical information about your child(ren). To request this list or accounting of disclosures, you must submit your request in writing to the Privacy Officer. Your request must
    state a time period which may not be longer than six years. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at the
    time before any costs are incurred.
    ● Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about your child(ren) for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about your child(ren) to someone who is involved in your child(ren)’s care or the payment for your child(ren)’s care, like a family member or friend. We are not required to agree to your request unless (1) the disclosure is for the purposes of carrying out payment or healthcare operations, and (2) the protected health information pertains to an item or service which you, or another person other than your health insurance, have paid for in full. If we do agree, we will comply with your request unless the information is needed to provide your child(ren) emergency treatment.
    To request restrictions, you may complete and submit the REQUEST FOR LIMITATION AND RESTRICTION OF PROTECTED HEALTH INFORMATION to the Privacy Officer. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted.
    ● Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. To request confidential communications, you may complete and submit the PATIENT’S REQUEST TO LIMIT CONFIDENTIAL COMMUNICATIONS to the Privacy Officer. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted.
    ● Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. To obtain a paper copy of this notice, contact the Privacy Officer.
    ● Right to Receive Notice of Breach. You will receive notification of breaches of your child(ren)’s unsecured protected health information unless we determine there is a low probability your PHI was compromised.

CHANGES TO THIS NOTICE. We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about your child(ren) as well as any information we receive in the future. We will post a summary of the current notice in the office. The summary will contain, in the top right-hand corner the effective date. You are entitled to a copy of the current notice in effect.

COMPLAINTS. If you believe your child(ren)’s privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with the office, contact the Privacy Officer. You will not be penalized for filing a complaint.

OTHER USES OF MEDICAL INFORMATION. Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about your child(ren), you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about your child(ren) for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to your child(ren.)

 

 

  • Right to Be Treated With Respect.
  • Right to Obtain Your Medical Records.
  • Right to Privacy of Your Medical Records.
  • Right to Informed Consent.
  • Right to Receive and Question Itemized Bills for Medical Services.

Small Town Pediatrics does not discriminate against anyone (patients, families or our team) on the basis of age (except our patients are kiddos), ancestry, disability, race, color, citizenship, national origin, creed, political or religious affiliation, sex (including pregnancy-related conditions), familial or marital status, sexual orientation, gender identity or expression, marital status. military status,  unfavorable discharge from the military, status as a protected veteran, or other groups protected by law.

If you have a concern please send a portal message to My Kid’s Chart to Dr. Mark. You will receive a phone call in response. If you wish to speak your concern instead of typing it, please send a portal message to My Kid’s Chart to Dr. Mark that states you have a concern and request a call back.