Form Request Information and Guidelines

Forms include any document that needs to be reviewed by a medical provider and signed

Pediatric Form Request Guidelines

We are now processing and providing all forms to parents in electronic form using MyChart with limited exceptions.   If requesting a non-standard special form to be processed, this can also be uploaded to the child’s MyChart account:

  • Requested turnaround time for all form requests is a minimum of 48 business hours.
    • This time can be extended to 72 business hours during peak times when the demand for forms is higher – especially summer and fall.
    • Special requests for expedited processing can be accommodated only on a limited basis in an emergency and is dependent upon the current volume to be processed for any given day.
  • Your child MUST be current on their annual health supervision exam for all forms being submitted for review and signature.
  • All forms MUST have the child’s name and date of birth on all pages.
  • All forms submitted via MyChart or email should be in PDF format.  DO NOT submit photographs of forms.

Printout of all vaccines that are part of the patient record for:

  • Daycares  
  • School
  • College
  • Personal use

The printout of your child’s vaccine record  is available through MyChart.   The document can be found under the Resources Menu option, or type “immunizations” in the search bar.   Select “printable immunization record”.

Because EPIC syncs directly with the Colorado Immunization Information system (CIIS) it is the same information record in both systems.  It can be downloaded/saved for your use and provided to other facilities as needed.  A signature is not required on this form.

The General Health Appraisal form is automatically generated at each physical exam appointment and is available through MyChart under the Resources Menu Option – Letters.

  • We only complete the State Approved General Health Appraisal form provided by Children’s Hospital Colorado for our office.
  • We do not manually complete any other daycare form.

The Colorado High School Athletic Association (CHSAA) sport form is completed at the annual physical exam and is available through MyChart under Resources – Letters.

If a different form is needed, please submit the specific form with all parent required sections completed before submitting for processing.  These can be uploaded through your child’s MyChart account.

Sports Questionnaire – Required for ALL Sport/Camp Forms

School Athletics The CHSAA form will be completed unless a specific form required for the individual school is provided.
Scout Related Camps
  • Girls Scouts – Please submit specific form to be completed with all parent portions completed prior to request
  • Boy Scouts – Please submit all Parts – A, B, C, and D with parent portions completed prior to request
Other Summer/Day Camps Please submit the specific form for the organization with parent portions completed before submitting.

  • It is our policy not to sign for over-the-counter medications unless needed to treat a specific illness/problem for a limited period of time.
    • If for an overnight trip when your child will be away from home, the form required by the organization can be considered for completion.
  • Please complete all portions of the medication form before submitting, including:
    • medication name,
    • dose,
    • administration route,
    • and any specific dose instructions.

This helps us ensure that parents understand the medications they are administering to their children, as well as the instructions for use.

  • DO NOT include multiple medications on a form that is designed for a single medication.  If multiple medications are needed, separate forms should be completed for each medication with dosing instructions.

Any forms that do not fall into the above categories, for example:

  • FMLA / FAMLI – all required information completed before submitting for review

To submit forms to be completed, or for questions about forms – email fax@parkerpediatrics.com

  • Be sure your email request includes your name, contact information, and your child’s name and date of birth.

Forms may also be submitted via your child’s MyChart account.  These should also be in PDF format with all parent portions completed before submiting.