Patient Information



Patient and Parent

Code of Conduct

To our patients.

Noe Valley Pediatrics is dedicated to offering quality care to our patients.

We will strive to be courteous, considerate and respectful

We will safeguard your information and respect your privacy

We will strive to offer timely response to requests for services, inquiries and complaints

In order to have a mutually satisfying relationship, we ask the following from you

Please become familiar with office policies such as turnaround time for forms/ fees/ no show policy.

We see patients by appointment only. Dropping into the office without an appointment is highly discouraged and it is unlikely that they can be accommodated

In an effort to stay on time, If you are more than 15 mins late for a well child exam, you will likely not be seen. We will have to reschedule and you will be billed.

We reserve the right to dismiss patient from the practice for any of the following causes:

Inappropriate behavior in the office as well as on the phone.

3 or more no shows/late cancellations

Overdue balance greater than 90 days without responding to communication from billing department.

Dismissal will be done with a certified letter. We will continue to care for your child for 30 days from the date of the letter to allow you time to find a new physician.



How To Join Our Practice

If you are an expectant parent, Congratulations!

Due to space and time limitations we do need to actively control the number of new patients coming into the practice. We have a huge demand for spots and more people than we can possibly accommodate.

With this in mind, we have instituted a lottery system.

If you are interested in joining our practice, we will need your name, contact information, due date and insurance. We will put you on our list of prospective patients. Names are randomly pulled from the list to be invited to one of our new patient information sessions for expectant couples.

Currently we are accepting newborns only.  We offer group information sessions once or twice a month that will give you an opportunity to learn more about the practice and ask any questions that you might have. If your name is chosen, you will be contacted and welcomed to become one of our Noe Valley Pediatrics families. You will have the opportunity to come hear about the practice and see if we are a good fit for you. Your chances to be selected will remain active until your due date has past (calling early gives a distinct advantage).

Due to the busy schedule, the doctors are not currently making individual appointments to meet prospective patients. Being available to give excellent and timely care to our existing patients is our primary goal.

Please plan in advance…

*** If you would like to be in the lottery for a group pregnancy information session, please call the front desk 415-641-1019 to get on the list.

After Hours



Telephone advice: from specially trained nurses: there is currently no fee for this service. The nurses can help you decide if something warrants an appointment, a trip to the ER or can wait until we open the next day.

Evening and weekend office visits: your child can be seen by appointment at the PERG office located at 3490 California Street, Suite 200. Telephone: 415-387-9293 Appointments can be made between 6:00 pm -9:30 pm Monday through Friday, and from 8:30am -9:30pm Saturday, Sunday and holidays. Weeknight pediatricians are made up of participating private pediatricians, including our doctors. Weekend doctors are fully trained and board certified pediatricians who are not yet established in a private practice.

As of April 2016, our patients have new after-hours options that might be closer. Pediatrics After Hours Care at St Lukes Hopital is now open 7 days a week.

Monday-Friday 5:00pm-10:00pm

Saturday-Sunday 8:30am-10:00pm


1580 Valencia Street, 7th Floor #701

San Francisco, CA 94110

Phone: 866-961-8588

This service does not currently have an advice nurse

Continuity of care: Reports of all the telephone advice and after hours visits will be faxed to our office for review.

If the advice nurse can not be reached you can call our answering service at 415-753-4697 to have the on call doctor paged.

Please leave a message on our voicemail system at 415-641-1019 to schedule appointment, cancel appointments or messages to be answered during the next business day.

Prescriptions: please request refills from your pharmacy during regular business hours. PERG will NOT okay refills. All new prescriptions require an office visit.



VACCINATION WAIVER SIGNATURE: If your child is over the age of two years and is not up to date with standard vaccines, we will require parents or legal guardians to sign a vaccine waiver form acknowledging that they have been counseled about risks of not following the ACIP approved vaccination schedule.

 No Show Fee: If your child is scheduled for a well child exam, we have set aside up to 45 minutes of time for you child. If you fail to cancel the appointment less than 24 hours in advance, fail to show up, or arrive more than 15 minutes late, you will be charged a $50 no show fee.

CoPays: should be paid at the time of the visit. There will be a $10 fee added on if we need to bill for them

Form Fees:

There is no charge for forms filled out at the time of an exam. All other forms have a $10 fee and a one week turn around time (We try to get to them sooner but there are no promises.) Rush forms  will be done within 48 business hours. There is an additional fee for this.

Release of Records: We believe it is in the best interest for your child to have one primary care physician, therefore we do not share patients with other practices. If you are leaving Noe Valley Pediatrics to transfer care to another practice, we will furnish the new doctor with a complimentary detailed Health summary, growth charts and vaccination records.

A records release signals that you are no longer an active patient of Noe Valley Pediatrics. Return to the practice is not guaranteed. Readmission is contingent on the physician’s approval.

Dismissal from practice: Our office reserves the right to dismiss patients for any reason. In those rare situations, the family will be notified by certified letter. Except for unusual circumstances, we will continue to take care of acute health issues for 30 days after receipt of the letter.


Our staff understands that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a medical record that details the care and services you receive. We refer to this as protected health information (PHI). We need that record in order to provide you with quality care and to comply with certain legal requirements. This notice applies to any medical records generated by our office. While we may sometimes care for you during a hospital stay the hospital may have different policies and/or procedures and a separate notice about your medical information.

TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS: The most common reason why we use or disclose your health information is for treatment, payment or health care operations. Examples of how we use or disclose information for treatment purposes are: setting up an appointment for you; performing a physical examination; performing therapeutic or diagnostic tests; referring you to another doctor or clinic for additional or specialist services; or getting copies of your health information from another professional that you may have seen before us. Examples of how we use or disclose your health information for payment purposes are: asking you about your health insurance coverage or other sources of payment; preparing and sending bills or claims; and collecting unpaid amounts (either ourselves or through a collection agency or attorney). “Health care operations” mean those administrative and managerial functions that we have to do in order to run the Practice or the Center more efficiently and make sure that all of our patients receive quality care. Examples of how we use or disclose your health information for health care operations are: financial or billing audits; internal quality assurance; reviewing our treatment and services to evaluate the performance of our staff; participation in managed care plans; defense of legal matters; business planning; and outside storage of our records.

In order to maintain the communications that allow for quick, effective, and high quality health care, we may release medical information about you to a family member or friend who accompanies you to your appointment unless you tell us not to.

Under most circumstances, we are not required to obtain a signed consent for Treatment, Payment, or Operations. However, we will ask you to sign an authorization for certain purposes such as release of PHI to a referring provider or for claims payment in order to comply with regulations.

We routinely use your health information inside the Practice and/or the Center for these purposes without any special permission. We will ask for special written permission in the following situations: research, legal requests, and marketing. We will also ask for your written authorization before we disclose PHI that pertains to HIV, AIDS, mental health treatment or substance abuse.

USES AND DISCLOSURES FOR OTHER REASONS WITHOUT PERMISSION: In some limited situations, the law allows or requires us to use or disclose your health information without your permission. Not all of these situations will apply to us; some may never come up at our office or Center at all. Such uses or disclosures are:

  • When a state or federal law mandates that certain health information be reported for a specific purpose;
  • For public health purposes, such as contagious disease reporting, investigation or surveillance; and notices to and from the Federal Food and Drug Administration regarding drugs or medical devices;
  • Disclosures to governmental authorities about victims of suspected abuse, neglect or domestic violence;
  • Uses and disclosures for health oversight activities, such as for the licensing of doctors; for audits by Medicare or Medicaid; or for investigation of possible violations of health care laws;
  • We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
  • Disclosures for judicial and administrative proceedings, such as in response to subpoenas or orders of courts or administrative agencies;Disclosures for law enforcement purposes, such as to provide information about someone who is or is suspected to be a victim of a crime; to provide information about a crime at the Center; or to report a crime that happened somewhere else;Disclosure to a correctional institution or law enforcement officials if you are an inmate or under the custody of a law enforcement official;Disclosure to a medical examiner to identify a dead person or to determine the cause of death; or to funeral directors to aid in burial; or to organizations that handle organ or tissue donations;
  • Uses or disclosures for health related research;
  • Uses and disclosures to prevent a serious threat to health or safety;
  • Uses or disclosures for specialized government functions, such as for the protection of the president or high ranking government officials; for lawful national intelligence activities; for military purposes; or for the evaluation and health of members of the foreign service;

Disclosures of de-identified information: Disclosures of a “limited data set” for research, public health, or health care operations;

Incidental disclosures that are an unavoidable by-product of permitted uses or disclosures;

Disclosures to “business associates” who perform health care operations for us and who commit to respect the privacy of your health information.

APPOINTMENT REMINDERS: We may call, write, or email to remind you of scheduled appointment that it is time to make a routine appointment or to follow up after a procedure. We may also call or write to notify you of other treatments or services available at our Center that might help you. Unless you object, this contact may be on an answering machine or other method, which could (potentially) be received or intercepted by others. This call or message may be to a home or work number. In writing, you can ask us to use other methods and we will consider your request and determine our ability to comply.

OTHER USES AND DISCLOSURES: We will not make any other uses or disclosures of your health information unless you sign a written “authorization form.” Federal law determines the content of an “authorization form”. Sometimes, we may initiate the authorization process if the use or disclosure is our idea. Sometimes, you may initiate the process if it is your idea for us to send your information to someone else. Typically, in this situation you will give us a properly completed authorization form or you can use one of ours.

If we initiate the process and ask you to sign an authorization form, you do not have to sign it. If you do not sign the authorization, we cannot make the use or disclosure. If you do sign the authorization, you may revoke it at any time unless we have already acted in reliance upon it. Revocations must be in writing. Send them to the contact person named at the beginning of this Notice.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION: The law gives you many rights regarding your health information.

Restrictions: You can ask us to restrict our uses and disclosures for purposes of treatment (except emergency treatment), payment or health care operations. We do not have to agree to do this, but if we agree, we must honor the restrictions that you want. To ask for a restriction, send a written request to the contact person at the address shown at the beginning of this Notice.

Communications: You can ask us to communicate with you in a confidential way, such as phoning you at work rather than at home, by mailing health information to a different address, or, at some point in the future, we may be able to email to your personal email address. We will accommodate these requests if they are reasonable and if you pay us for any extra cost. If you want to ask for confidential communications, send a written request to the contact person at the address shown at the beginning of this Notice.

Photocopies: You can ask to see or to get photocopies of your health information. By law, there are a few limited situations in which we can refuse to permit access or receiving a copy of your health information. For the most part, however, you will be able to review or receive a copy of your health information within 30 days of asking us (or sixty days if the information is stored off-site). You will be asked to pay a reasonable charge in advance for such access or copies. If we deny your request, we will send you a written explanation and instructions about how to get an impartial review of our denial if one is legally available. By law, we can have one 30-day extension of the time for us to give you access or photocopies if we send you a written notice of extension. If you want to review or get photocopies of your health information, send a written request to the contact person at the address shown at the beginning of this notice.

Amendments: You can ask us to amend your health information if you think that it is incorrect or incomplete. If we agree, we will amend the information within 60 days from when you ask us. We will send the corrected information to persons who we know got the wrong information and others that you specify. If we do not agree, you can write a statement of your position and we will include it with your health information along with any rebuttal statement that we may write. Once your statement of position and/or rebuttal is included in your health information, we will send it along whenever we make a permitted disclosure of your health information. By law, we can have on 30-day extension of time to consider a request for amendment if we notify you in writing of the extension. If you want to ask us to amend your health information, send a written request, including your reasons for the amendment, to the office contact person at the address shown at the beginning of this Notice.

Disclosures: You can get a list of the disclosures that we have made of your health information within the past six years (or a shorter period if you want). By law, the list will not include: disclosures for purposes of treatment, payment, or health care operations; disclosures that were made with your authorization; incidental disclosures; disclosures required by law; and some other limited disclosures. You are entitled to one such list per year without charge. If you want more frequent lists, you will have to pay for them in advance. We will usually respond to your request within 60 days of receiving it, but by law we can have one 30-day extension of time if we notify you of the extension in writing. If you want a list, send a written request to the contact person at the address shown at the beginning of this Notice.

Notice: You can get additional paper copies of this Notice of Privacy Practices upon request. It does not matter whether you got one electronically or in paper form already. If you want additional paper copies, send a written request to the contact person at the address shown at the beginning of this Notice.

OUR NOTICE OF PRIVACY PRACTICES: By law, we must abide by the terms of this Notice of Privacy Practices. We reserve the right to change this notice at any time as allowed by law. If we change this Notice, the new privacy practices will apply to your health information that we already have as well as to such information that we may generate in the future. If we change our Notice of Privacy Practices, we will post the new notice in our Center, have copies available in our office and post it on our website.

COMPLAINTS: If you think that we have not properly respected the privacy of your health information, you are free to complain to us or to the U.S. Department of Health and Human Services, Office for Civil Rights. We will not retaliate against you if you make a complaint. If you want to complain to us, send a written complaint to the contact person at the address shown at the beginning of this Notice. If you prefer, you can discuss your complaint in person or by phone.

FOR MORE INFORMATION: If you want more information about our privacy practices, call or visit the contact person at the address or phone number shown at the beginning of this Notice.

Web Site Privacy Policy – Effective Date: April 14, 2010

Our Commitment to Privacy: Noe Valley Pediatrics is committed to maintaining the privacy of those who use our Web site. This Web Site Privacy Policy is designed to assist you in understanding how we collect and use the personal information you provide to us and to assist you in making informed decisions when using our Web site.  Additionally, our Web site is hosted by MedFusion, which has its own Web Site Privacy Policy posted at

Information We Collect: When you visit our Web site, you may provide us with two types of information: 1) personal information you knowingly choose to disclose and 2) Web site use information.

How We Use Information: Noe Valley Pediatrics uses the personal information that you submit to us via our Web site to administer our business activities and to respond to your inquiries. We will not sell, lease, rent, or license your personal information to a third party, unless you authorize us to do so. We may provide your personal information to entities involved in providing health care to you, such as, for example, your health plan and/or medical group. In such cases, Noe Valley Pediatrics will disclose personal information in compliance with all applicable laws and regulations.

Personal information is any information you’ve provided us through our Web site that uniquely identifies you, such as name, social security number, health plan ID number, medical record number, date of birth, telephone number, address, or email address, to name a few.

Web site use information is information that is gathered automatically by Noe Valley Pediatrics to track Web site activity, including the number of users and the pages visited. Web site use information includes, but is not limited to, internet protocol (IP) addresses, browser type, internet service provider (ISP), referring/exit pages, operating system, and date/time stamp. Web site use information does not identify individual users.

To access the secure services on our Web site, “cookies” must be enabled. Cookies are pieces of information stored on a user’s computer which allow us to recognize repeat users, track usage patterns and better serve you when you return to our site.

Our Commitment to Security: The security of your personal information is important to Noe Valley Pediatrics. To prevent unauthorized access, maintain data security, and ensure the correct use of information, Noe Valley Pediatrics has adopted stringent security standards. These standards include physical, electronic, and procedural safeguards to protect and secure the information that we collect from you. While we follow generally accepted industry standards to protect the personal information submitted to us, no method of transmission over the Internet is 100% secure. We, therefore, cannot guarantee absolute security. If you wish, you may contact us, instead, via telephone at (415) 641-1019.

Health Information on Our Web Site: The health information provided on this Web site is intended to provide general information only. This information is not intended to substitute for the exercise of a physician’s professional judgment, or the consultation with an expert physician.

Links to Other Web Sites: This Web site contains links to other Web sites that are not owned or controlled by Noe Valley Pediatrics. Please be aware that Noe Valley Pediatrics is not responsible for the privacy practices, content or accuracy of such other Web sites.

Noe Valley Pediatrics encourages you to be aware when you leave our Web site and to read the privacy policies of every Web site that collects your personal information.

Changes to Our Web Site Privacy Policy: Noe Valley Pediatrics reserves the right to change this Web Site Privacy Policy at any time without advance notice to our users.

Contact Us: If you have questions regarding our Web Site Privacy Policy, your personal information maintained by Noe Valley Pediatrics, or other general questions, please contact us at:

Noe Valley Pediatrics

Office Phone Number: (415) 641-1019

Office Fax Number:     (415) 826-1308

Effective 8-1-2016,  a service charge of 1.5% per month will be added to patient balances beyond 60 days