Policy on Divorce, Separation and Custody Agreements

The Youth Clinic and Pediatric Urgent Care of Northern Colorado are dedicated to the health and well-being of our patients. Due to the fact our patients are children and young adolescents; we rely on parents and other supportive adults to assist us in their care. Divorce and separation can present our practice with unique challenges; therefore it is important to articulate our practice philosophy to avoid
misunderstandings going forward.

1. In general, we ask that parents NOT place our office in the middle of family disagreements. If parents become disruptive to our organization or there is non-compliance with this policy, we may choose to terminate the patient/provider relationship so care can be transferred to another practice.

2. Either parent or legal guardian can schedule an appointment for their child, be present for a visit and obtain copies of medical records unless a COURT ORDER has been presented to our office RESTRICTING a parent’s right. If you have a court order, please produce a copy to our staff immediately. If court orders change at any point, please make sure we have a current copy at all time.

3. The parent or legal guardian that brings the child in for an appointment is responsible for co- pays or insurance deductibles at the time of service, even if the other parent is responsible for the medical insurance. We will not mediate financial disputes between parents. Any disputes about reimbursement for medical expense need to be settled between parents.

4. If a step-parent, or other adult, should bring your child in, we must have a “Consent for Treatment” on file with that adult’s name within the past year. In circumstances when it is unclear whether or not the attending adult has the right to consent to treat, we will call you to obtain a one-time authorization.

5. Additionally, we will NOT:

  • Call the other parent for consent prior to treatment or inform the other parent
    whenever visits are scheduled.
  • Restrict either parent’s/legal guardian’s involvement in your child(ren)’s care, unless
    authorized by law.
  • Tolerate appointment scheduling/cancelling patterns of behavior between parents.
  • Routinely call the non-attending parent following visits. It is either parents or legal guardian’s responsibility to communicate with each other about the patients care and any relevant information regarding care of the child.