Patient Forms

New Patients

Download, print, fill out, and bring the Patient Information Form and the Medical History Form for the child’s first visit or if there is any change in your information such as change of address or any change of medical insurance information.

Records Release

Download, print and fill out the Record Release Form if you would like our office to forward your medical records to another provider. This form can be delivered to the office in person, by mail, or via fax at (973) 258-4030.

Auto Insurance

Download, print, fill out, and bring with you to the visit the Car Insurance Information Form if your visit will be covered under an auto policy. This information is needed in order to see your child. Also if this is your child’s first visit to our office download, print, fill out, and bring with you the Patient Information Form and the Medical History Form

Proxy Consent

Download, print and fill out the Proxy Consent to Treat Minors Form if you would like to authorize an individual to accompany your child to an office visit if the parent or legal guardian is unable to attend. The form can be delivered to the office in person, by mail, via fax at (973) 258-4030, or scanned and emailed to cfobilling@verizon.net.

Office Policies

Insurance

Please make every effort to understand your insurance policy prior to your visit. It is ultimately the parents’ responsibility to comply with the provisions of their policy. A very good resource for explanation of you insurance plan provisions would be to call the membership services line generally listed on the back of your insurance card. Feel free to contact us if you have any questions and we will be happy to assist you any way we can.

We are happy to accept most major insurance plans, which include but are not limited to:


Aetna
BlueCross/BlueShield
Cigna
MagnaCare
United Healthcare

It is your responsibility to make sure we participate in your insurance plan if you wish to be seen by our office in-network. This list above is incomplete and is subject to change so it is best to check with your insurance company to see if Children First Orthopedics, LLC or Dr. Frank J. Liggio is a participating member of your plan. You can also contact our office if you need assistance.

All referrals are needed at the time of the visit and your child will not be seen without one if it is required by your insurance plan. Referrals are obtained from your primary care provider such as the child’s Pediatrician or Family Medicine doctor. You will need to contact your primary care provider and obtain the referral in person or have it faxed to our office so our office has it at the time of the visit. If you are not sure whether you need a referral, check your insurance card or call your insurance carrier.

If your child’s visit is being billed to an auto insurance there is specific information we need regarding the insurance policy and accident to see your child. The form listing the information needed can be downloaded from the patient forms section of the website. Please bring this information with you at the time of the office appointment.

Caring for Minors When Parent or Legal Guardian Cannot Be Present

Children First Orthopedics will evaluate and provide treatment to unaccompanied minors in the following situations:
  • We highly recommend that a parent or legal guardian accompany their child to all visits.
  • In the event that a parent or legal guardian is not available to accompany the child to the visit, the parent or legal guardian may authorize an individual 18 years of age or older to act as the parent’s or legal guardian’s proxy for the visit as long as a valid Proxy Consent to Treat Minors Form is in the child’s medical chart.
  • The Proxy Consent to Treat Minors Form is available to download using the link provided on this webpage. The parent or legal guardian can also call our office and request the form be mailed or faxed to a provided address or fax number. To be valid the form must be signed by a parent or legal guardian and be hand delivered, faxed, mailed, or emailed to the office using the address cfobilling@verizon.net. Authorization forms are valid for one year.
  • Seeing a child without a parent or legal guardian in the office is at the discretion of the office/physician and is considered on a case by case basis.

Billing

All office visit co-pays required by your insurance plan are due at the time of your visit. There may be co-pays for other services performed during the visit, which you may be billed for after we receive your EOB.

Payment for any services or products not covered by your insurance plan, such as waterproof cast material, is due at the time of the visit.

Payment for self-pay patients is due at the time of the visit.

Your child’s visit will generate a bill for the services rendered by this office. You may be responsible for all or part of this bill in the form of co-pays, co-insurance, deductible, or non-covered services as determined by your insurance company depending on your insurance plan. This bill is the result of the contract between you and your insurance company. Please pay any bills you receive from this office in a timely manner. For your convenience the bills can be paid online, over the phone or by mail. Insurance bills can be confusing so if you have questions, please contact our biller in the office for clarification. The biller can also help with payment arrangements if needed. The billing number for use during office hours is (973) 258-1010.

Appointments

All appointments are made with the receptionist. We will do our very best to accommodate urgent visits and see all patients in a timely fashion.

We provide appointment reminders via email or text message at your discretion. You can confirm or cancel an appointment with this service. If you cancel an appointment and want to reschedule you will then need to call us during normal office hours. You will have the option to sign up for this reminder service at the time of your initial visit.

We strongly urge that at least one parent accompany your child to the visit, especially an initial visit, to ensure better understanding of the diagnosis and treatment for your child. We understand how busy everyone is and if there is no way a parent can come to the visit let us know. We will require written consent from a parent consenting for someone else to bring the child to the office and that person must be at least 18 years of age.

Please call to let us know as early as possible if you need to cancel your appointment. We will not reschedule an appointment if you have repeated cancellations without notifying our office.

Privacy

Your privacy is your right and something we take very seriously. Access to your child’s medical record is restricted to the office staff for medical and office related functions.

When you come for a visit you will sign a Notice of Privacy. This gives our office permission to release your child’s medical records from the present and future examinations to your primary physician, your referring physician, and any other health provider you stipulate by filling out our Record Release Form. The records may be transmitted via standard or electronic means. You also agree to allow us to release your child’s medical records to your insurance carrier in any situation we feel it is necessary and in your child’s best interest.

Any complaint about health information privacy can be made to the Department of Health and Human Services via email to ocrcomplaint@hhs.gov

Frequently Asked Questions

My child just got hurt; what should I do?

If your child gets hurt, it is always safe to follow the RICE protocol - Rest, Ice, Compression, and Elevate. Your child should stay off the affected leg or not use the affected arm. You should place ice on the affected area for approximately 15-20 minutes on and leave it off for 15-20 minutes and then repeat to decrease swelling. Sometimes an ace bandage wrapped loosely around the affected area can give support and decrease swelling. You should also elevate the arm or leg, aiming to get the affected area around the level of the child’s heart.

When do I need to bring my child in to the office?

Whenever your child’s complaints are causing a problem, we suggest you bring them in for a visit. A problem could be any decreased ability to participate in sports, dance, or regular activities. Significant pain, limited motion and any deformity also require evaluation.

How do I know if it is broken?

You may not know if something is broken without an x-ray. Certainly, if an injured area has a lot of swelling, tenderness or any deformity, a break or fracture is more likely and the injury should be evaluated.

How do I know if my child needs an MRI?

It is best to allow the treating physician to determine when an MRI is needed. Taking a good history and physical are the best tools a physician has to decide if advanced imaging such as an MRI is needed. Most conditions are diagnosed without an MRI, but a MRI can be particularly helpful if someone’s diagnosis is not clear of if a treatment prescribed is not working. Once an MRI is ordered, our office will call your insurance company to obtain pre-authorization for the test. If pre-authorization is required by your insurance plan, you will not be able to make an appointment for the MRI at an imaging facility without it. Please allow three to five days for pre-authorization to be obtained.

What is an EOB?

EOB stands for explanation of benefits. Your insurance company generates it after we submit our bill. It states the amount your insurance plan allows for services provided, how much the insurance company pays our office and any charges that you are responsible to pay our office. You will be billed for the amount you are responsible for.

I brought my child in for a fracture and my EOB mentions something about surgery; why?

Our office bills your insurance company for our services using a series of codes called CPT codes. All insurance companies consider the treatment of any fracture to be a “surgical procedure”.

We submit a certain CPT code called a global code to your insurance company for any fracture treatment. The global code includes the initial evaluation for the injury, the initial immobilization for the injury, such as a splint or cast performed at that initial visit, and all follow up visits for that fracture for the 90-day period after the initial visit. Co-pays are not collected for follow up office visits during the 90-day period after the initial visit. The global code does not include any x-rays performed at any time during the treatment of the fracture and any subsequent splint or cast placed for treatment of the fracture. These services are billed separately and may result in co-insurance, deductibles, or co-pays, for which you are then responsible.