This sample document was adapted from an original document created by St. Cloud Medical Group, PA, and provides patients and families with education about billing for health care services, why there might be more than one co-pay, etc. It is provided only as a reference for practices developing their own materials and may be adapted to local needs. This document does not represent official American Academy of Pediatrics (AAP) policy or guidelines and the AAP is not responsible for its use. You should consult an attorney who is knowledgeable about the laws of the jurisdiction in which you practice before creating or using any legal documents.
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The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. This content is for informational purposes only. It is not intended to constitute financial or legal advice. A financial advisor or attorney should be consulted if financial or legal advice is desired.