We are excited to have you as part of our practice.

We know that paperwork can be time-consuming so we ask that patients arrive at least 15 minutes before their appointment so that any needed paperwork can be completed and insurance/demographics can be verified. Our hope is that this can make your experience smoother. We also offer an online option to complete most of the needed paperwork. Please go to the "Forms" to find the appropriate paperwork.

Our practice makes every effort to run on-time with appointments, as we believe everyone’s time is equally valuable. Our front office staff does its best to schedule sufficient time for the patient's anticipated needs. We sometimes run into situations that require additional time to be spent with a patient or family. We promise to do our best to let you know if the provider is running behind. 

Patients arriving 10 minutes late to their appointment will be asked to reschedule either to a later appointment that day (if available) or on another day.

We ask that any appointment cancellations happen at least 24 hours in advance. This allows us to offer that time slot to a patient in-need. Late cancellations or no shows may incur a fee. If a family incurs 3 late cancellations or no-shows, they may be dismissed from the practice. 

At Centennial Pediatrics of Spokane, we aim to provide the highest quality of service to you and your family. This requires a team approach – our office plus your family. As part of our commitment to providing quality care to your family and others, we do ask that everyone in the office follow certain conduct guidelines.

• We will provide an environment that is clean, safe and welcoming.

• We will treat your child and you with respect, courtesy and kindness.

We ask that our patients and families do the same. We reserve the right to dismiss a patient/family if any of the following occur:

• Disruptive or rude behavior (physical or verbal) towards any employee or other patient(s) in the clinic;

• Destructive behavior that damages clinic property;

• Taking photos or videos while in the office without the consent of the staff member or provider;

• Bringing weapons into the office;

• Non-payment of responsible charges;

• Misrepresentation of any medical history, insurance information, contact information or identity of the patient or parent/guardian;

• Non-compliance regarding major health issues/care; or

• Violation of any office policy.

In the case of a parental separation/divorce/custody concern, our main focus is to provide the best care for the patient.

• We will assume that the parent who accompanies the patient to the office has full or joint legal custody allowing full medical decision-making, unless we have legal documentation stating otherwise.

• If one parent or guardian is unable to attend an appointment, we ask that the attending parent share all relevant information from the visit with the other parent.

• At the time of the visit, we are happy to provide an additional copy of the After Visit Summary upon request.

• To ensure our providers can remain focused on patient care, they are not able to take follow-up phone calls to review details of a visit with a non-attending parent. If additional information is needed, you may request your child’s medical records by completing a Release of Information form or make another appointment. The Release of Information form is available on our website or can be obtained by contacting our front desk.

• If the parental dynamics become disruptive to our office, staff or other patients in our practice, or if there is non-compliance with this policy, we reserve the right to dismiss the family from the practice.

Please be aware that the decision to dismiss a patient/family is not one that we come to lightly. We appreciate your help in maintaining a safe, supportive and welcoming environment.

The following details are updated policies as of September 15th, 2025.

Copays and Returned Checks:  

Copays are required at the time of service. A $10 service fee for copays not paid on the service date will apply. You can avoid this charge by adding a card on file to ensure the copay is paid for on the service date. There is a $25 charge for any payments returned for non-payment. These fees may be waived at the discretion of the practice or based on insurance contracts. 

After Hours Advice: 

Our providers and trained staff provide medical advice during business hours. When we are closed, we contract with a third-party after-hours triage service to assist with this. If you choose to utilize this service, there is a $20 fee per call.  Most insurance companies have their own nurse triage line that can be utilized at no cost. The number is usually on the back of your insurance card.  Please refer to our website under Office Info & Forms for additional information about contacting someone after hours and on weekends/holidays.

Missed Appointment or Late Cancellation: 

Missed appointments or late cancellations affect not just our providers and staff but, most importantly, access to appointments for other patients. If you fail to show for an appointment or provide less than 1 business day’s notice to cancel or reschedule, there will be a fee of $50 for each appointment missed. If you are more than 10 minutes late for a scheduled well check, you will be asked to reschedule and be charged a $50 fee.  Upon the family’s 3rd appointment missed or cancelled with less than 1 business day’s notice, the office reserves the right to dismiss the family. We do not take dismissals of patients lightly. If you miss or late cancel a circumcision appointment, there will be a $150 fee. These fees may be waived at the discretion of the practice or based on insurance contracts. 

Forms/Specialty Letters:  

We encourage you to get forms that are needed for school or camp participation completed at the time of your appointment.  If these forms need to be completed outside of the appointment, they will incur a charge that is not reimbursable by insurance companies. 

Forms include but are not limited to Sports/Activity Clearance, Camp Clearance, Asthma Plans, Allergy Plans, Digestive Plans, and School Medication forms. 

Our staff/providers are happy to complete your form(s) during your visit. Forms must have your portion completed and presented to staff either before the appointment date, at check-in, or when taken back to the exam room for them to be processed at your appointment. Forms are uploaded to the patient portal if you have a staff member scan them before leaving. Please make sure this is done to avoid a future fee for re-completing the form. 

Requests for forms outside of a visit will be completed within 3 business days, excluding weekends and holidays. Expedited processing is 1 business day, excluding weekends and holidays, and is the form fee plus a $20 rush processing fee. 

Form/letter fees are as follows per patient, and payment is due at the time of the submission/request. 

• One Form: $10

• Two Forms: $15

• 3+ Forms: $25

There is no charge for notes provided to school, work or daycare for illness-related visits when completed at the time of the appointment.

For forms to be completed, your child's well visit with us must have been done within the last 12 months for those over the age of 3 years. Patients under 3 years of age need to be current on their visits according to the AAP’s recommended well child check schedule. These fees may be waived at the discretion of the practice or based on insurance contracts.

FMLA/Disabled Parking Permits:

FMLA/Disability Paperwork is $30, and due to the complexity, a minimum of 3 days for completion is required. Rush processing is not an option. Often to complete the paperwork, the provider may need to have a visit in order to gather needed information.

There is no charge to complete a disabled parking permit form. However, we require 3 business days to process this request. These fees may be waived at the discretion of the practice or based on insurance contracts.

There is also no charge to complete the Washington Paid Family and Medical Leave (PFML) form.

Immunization Forms: 

A record of administered immunizations is available on your child’s patient portal (accessed via our website or mobile app).

If you need an official Certificate of Immunization Status (CIS), which most schools and daycares in Washington State require for enrollment, please follow the set-up process for MyIR on their website, myirmobile.com. 

You may send us a request via phone or portal message so we can retrieve the CIS for you. Allow 3 business days for processing. If you need it sooner, there is a $10 administrative fee per patient per request. These fees may be waived at the discretion of the practice or based on insurance contracts.

As medical professionals, we feel very strongly that vaccinating children on schedule with currently-available vaccines is absolutely the right thing to do for all children and young adults. We are making you aware of these facts not to scare you or coerce you but to emphasize the importance of vaccinating your child. We are more than willing to discuss any questions you may have about vaccines and provide information about the vaccines but do require patients in our practice to adhere to the vaccination schedule endorsed by the American Academy of Pediatrics (AAP) unless medically contraindicated.

• We believe in the effectiveness of vaccines to prevent serious illness and to save lives.

• We believe in the safety of vaccines.

• We believe that all children and young adults should receive all of the recommended vaccines according to the schedule published by the American Academy of Pediatrics  (AAP).

• We believe that vaccinating children and young adults may be the single most important health promoting intervention we perform as health care providers, and that you can support as parents/caregivers.

The recommended vaccines and the schedule of administration are the results of years and years of scientific study and data-gathering on millions of children by thousands of our brightest scientists and physicians.

As a pediatric office, we will not uncommonly have patients or family members who are immunosuppressed or unable for medical reasons to receive certain vaccinations. It is our job to take the best care of all of our patients, and for this reason, we ask that patients who can receive vaccinations do so to protect those around them. For these reasons, we require our patients to commit to receiving the recommended vaccinations and, if needed, schedule catch-up vaccinations. We will work to create a schedule to bring your child up-to-date within 6 months. In this case, we can utilize vaccine-only visits which, depending on your child's insurance, could incur additional copays. 

As a practice, we will not sign vaccine exemption forms for personal or philosophical reasons. The state of Washington requires all children who are 4 years or older enterrng into daycare/preschool to be up to date with the MMR vaccine.

We work hard to not overuse antibiotics.

Not all illnesses require antibiotics, and in some cases, antibiotics can even result in more side effects or issues. We take the time to educate families about whether or not an illness requires antibiotics and prescribe them appropriately. 

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOUR CHILD MAY BE USED AND DISCLOSED BY CENTENNIAL PEDIATRICS OF SPOKANE, PLLC AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Under the HIPAA Privacy regulations, Centennial Pediatrics of Spokane and all similar health care clinicians are required by federal law to maintain the privacy of your child’s protected health information (PHI) and will abide by the terms in the Privacy Notice.

This notice of Privacy Practices describes how we may use and disclose your child’s protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your child’s protected health information. “Protected health information” is information about your child, including demographic information, that may identify you or your child (children) and that

relates to you or your child’s past, present or future physical or mental health or condition and related health care services.

We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices. You may call the office and request that a revised copy be sent to you in the mail, ask for one at the time of your next appointment, or access our website at www.centennialpedspokane.com. The terms of this notice apply to health information created or received by Centennial Pediatrics of Spokane and is effective as of 06/12/2025.

1. Uses and Disclosures of Protected Health Information

The following categories describe different ways that we use and disclose medical information, which do not require your written authorization.

Treatment: We will use and disclose your child’s protected health information to provide, coordinate, or manage your child’s health care and any related services. For example, your child’s health information will be disclosed to the Centennial Pediatrics of Spokane clinical staff (medical assistants and nurses) who participate in your child’s care. We may disclose your child’s health information to another physician for the purpose of a consultation. We may also disclose your child’s health information to another healthcare clinician to be sure those parties have all the information necessary to diagnose and treat your child.

Payment: Your child’s protected health information will be used, as needed, to obtain payment for your child’s health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for your child such as: making a determination of eligibility or coverage for insurance benefits, reviewing services provided to your child for medical necessity, and undertaking utilization review activities. For example, obtaining approval for an imaging study may require that your child’s relevant protected health information be disclosed to the health plan to obtain approval for the imaging. With your permission, we may share your health information with pharmaceutical company patient assistance programs and patient support organizations in order to assist you in obtaining payment for your care or payment for certain parts of your care.

Healthcare Operations: We may use or disclose, as-needed, your child’s protected health information in order to support the business activities of your child’s clinicians’ practice. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, and conducting or arranging for other business activities. For example, we may disclose your child’s protected health information to medical school students that see patients at our office. We may also call your child by name in the waiting room when the clinician is ready to see your child. We may use or disclose your child’s protected health information, as necessary, to contact you to remind you of your child’s appointment.

Business Associates: We will share your child’s protected health information with third party “business associates” that perform various activities (e.g., billing, transcription services) for the practice. For example, we may use another company to perform medical billing services.

Whenever an arrangement between our office and a business associate involves the use or disclosure of your child’s protected health information, we will have a written contract that contains terms that will protect the privacy of your child’s protected health information.

Health-Related Benefits and Services: We may use and disclose your child’s protected health information to inform you of health-related benefits or services that may be of interest to you.

Others Involved in Your Child’s Healthcare: If you agree to the use or disclosure and in certain other situations, we may make the following uses and disclosures of your child’s health information. We may disclose to a family member, close personal friend, or anyone else whom you give permission to do so. If you would like us to refrain from releasing your health information to a family member or friend, please notify Centennial Pediatrics of Spokane at 509-352-3777. We may also make these disclosures after your child’s death, unless doing so is inconsistent with any prior expressed preference made by you that is known to us.

Research: As authorized by applicable state and federal law, we may use and disclose your child’s health information for certain limited research purposes without your authorization. For certain research activities, an Institutional Review Board (IRB) or Privacy Board may approve uses and disclosures of your child’s health information without your authorization.

Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization, or Opportunity to Object

We may use or disclose your child’s protected health information in the following situations, to the extent permitted by applicable state and federal law, without your authorization. These situations include:

Required By Law: We may use or disclose your child’s protected health information for public health information to the extent that the use or disclosure is required by federal, state or local law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.

Public Health: We may disclose your child’s protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. Other public health information activities in which we may disclose your child’s health information include the following:

• To report births or deaths;

• To report child abuse or neglect;

• To report adverse events, product defects or problems;

• Activities related to the quality, safety or effectiveness of FDA-regulated products; and

• To notify a person who may have been exposed to a communicable disease or may be at risk for contracting or spreading a disease or condition.

Health Oversight: We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.

Data Breach Notification Purposes: We may disclose protected health information to provide legally required notices of unauthorized access to or disclosure of your child’s health information. We will notify you in writing if we discover a breach of your child’s unsecured health information, unless we determine that notification is not required by applicable law. You will be notified without unreasonable delay. Such notification will include information about what happened and what has been done or can be done to mitigate any harm to your child as a result of such breach.

Legal Proceedings: We may disclose your child’s health information in response to a court or administrative order. We may also release your child’s health information in response to a subpoena, discovery request, or other lawful process, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested, and only if authorized by applicable state and federal law.

Coroners, Funeral Directors, and Organ Donation: We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death. Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.

Criminal Activity/Serious Threat to Health or Safety: Consistent with applicable federal and state laws, we may disclose your child’s protected health information, if we believe that the use or disclosure in necessary to prevent or lessen serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual, as authorized by applicable state and federal law.

Workers’ Compensation: Your child’s protected health information may be disclosed by us as authorized to comply with workers’ compensation laws and other similar legally-established programs that provide benefits for work-related injuries or illness.

Law Enforcement: Your child’s protected health information may be disclosed for law enforcement purposes or with a law enforcement official.

Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500et.seq.

Uses and Disclosures of Protected Health Information Based upon Your Written Authorization

Other uses and disclosures of your child’s protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in writing, except to the extent that your child’s clinician or the practice has taken an action in reliance on the use or disclosure indicated in the initial authorization.

Marketing: Your written authorization is required for us to use or disclose your child’s medical information for marketing purposes.

Sale of Medical Information: Your written authorization is required for any use or disclosure which is considered a sale of your child’s medical information. Any authorization for the sale of medical information will state that the disclosure will result in payment to us.

Psychotherapy Notes: We usually do not maintain psychotherapy notes about your child. If we do, we will only use and disclose them with your written authorization except in limited situations.

HIV-Related Information: We will not disclose your child’s HIV-related information without your written authorization.

Substance Abuse Information: We will not disclose your child’s alcohol and other drug abuse information without your written authorization.

Mental Health Information: We will not disclose any of your child’s information relating to mental health treatment without your written authorization.

If you authorize us to use or disclose your health information, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose your health information as specified by the revoked authorization, except to the extent that we have taken action in reliance on your authorization.

Other Permitted and Required Uses and Disclosures That May Be Made with Your Consent, Authorization or Opportunity to Object

We may use and disclose your child’s protected health information in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your child’s protected health information. If you are not present or able to agree or object to the use or disclosure of the protected health information, then your child’s clinician may, using professional judgment, determine whether the disclosure is in your child’s best interest. In this case, only the protected health information that is relevant to your child’s health care will be disclosed.

Emergencies: We may use or disclose your child’s protected health information in an emergency treatment situation.

Communication Barriers: We may use and disclose your child’s protected health information if your child’s clinician or another clinician in the practice attempts to obtain consent from you but is unable to do so due to substantial communication barriers and the clinician determines, using professional judgment that you intend to consent to use or disclosure under the circumstances.

2. Your Rights

Following is a statement of your rights with respect to your child’s protected health information and a brief description of how you may exercise these rights.

You have the right to inspect and obtain a copy of your child’s protected health information (“PHI”). This means you may inspect and obtain a copy of protected health information about your child that is contained in a designated record set for as long as we maintain the protected health information, except in limited circumstances. To inspect and copy your health information, you must make your request in writing. You may request access to your health information in a certain electronic form and format and access may be granted in that requested form and format if it is readily producible, or, if not readily producible, in a mutually agreeable form and format. Further, you may request in writing that we transmit a copy of your health information to any person or entity you designate. Your written, signed request must clearly identify such designated person or entity and where you would like us to send the copy. If you request a copy of your child’s health information, we may charge a cost-based fee for the labor, supplies, and postage required to meet your request. We may deny your request to inspect and copy in certain very limited circumstances. Under state and federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed by a licensed health care professional chosen by us. Please contact our office if you have any questions about access to your child’s medical record.

You have the right to request a restriction of your child’s protected health information. This means you may ask us not to use or disclose any part of your child’s protected health information for the purposes of treatment, payment, or healthcare operations. You may also request that any part of your child’s protected health information not be disclosed to family members or friends who may be involved in your child’s care or for notification purposes as described in this Notice or Privacy Practices. Your written request must state the specific restriction requested and to whom you want the restriction to apply.

In most circumstances, your child’s clinician is not required to agree to a restriction that you may request. If the clinician believes it is in your child’s best interest to permit use and disclosure of your child’s protected health information, your child’s protected health information will not be restricted. If your child’s clinician does agree to the requested restriction, we may not use or disclose your child’s protected health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your child’s clinician. You may request a restriction by writing to one of our managers.

You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Practice Administrator.

You may have the right to have your clinician amend your child’s protected health information. This means you may request an amendment of protected health information about your child in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Practice Administrator to determine if you have questions about amending your child’s medical report.

You have the right to receive an accounting of certain disclosures we have made, if any, of your child’s protected health information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, to family members or friends involved in your child’s care, or for notification purposes. Your request must state a time period which may not be longer than six years, and which may not include dates before December 1, 2022. The first accounting you request within a 12-month period will be free. For additional accountings, we may charge you for the costs of providing the accounting. We will notify you of the costs involved and give you an opportunity to withdraw or modify your request before any costs have been incurred. The right to receive this information is subject to certain exceptions, restrictions and limitations.

You have the right to request a specific item or service not be disclosed to a health plan for purposes of payment or health care operations. If you have paid out-of-pocket (or in other words, you have requested that we not bill your child’s health plan) in full for a specific item or service, you have the right to ask that your child’s PHI with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations. Centennial Pediatrics of Spokane may not use or disclose your child’s PHI in violation of that restriction unless it is necessary for treatment purposes or in the event the disclosure is required by law.

You have the right to request an electronic copy of your child’s electronic medical record. This means you may request an electronic copy of your child’s electronic medical record be given to you or transmitted to another individual or entity. We will make every effort to provide access to your child’s PHI in the form or format you request, if it is readily producible in such form or format. If the PHI is not readily producible in the form or format you requested, your child’s record will be provided in a readable hard copy form. We may charge you a reasonable fee for the labor associated with transmitting the electronic medical record.

You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.

3. Complaints

You may complain to us or to the Secretary of Health and Human Services if you believe your child’s privacy rights have been violated by us. You may file a complaint with us by notifying our privacy contact of your complaint. We will not retaliate against you or penalize you for filing a complaint.

You may contact our Privacy Officer and Practice Administrator, Kina Hunt, at kinahunt@centennialpedspokane.com with any concerns.

Changes to this Notice

We reserve the right to change the terms of this Notice at any time. We reserve the right to make the new Notice provisions effective for all health information we currently maintain, as well as any health information we receive in the future. If we make material or important changes to our privacy practices, we will promptly revise our Notice. We will post a copy of the current Notice in all Waiting Areas. Each version of the Notice will have an effective date listed on the first page.

• Our website has some useful resources and information to address commonly-asked questions and concerns.

• Our providers are incorporating AI technology into capturing what is discussed in the visit. We use a HIPAA-compliant platform that does not store patient recordings. Patients are always welcome to opt-out of this feature.

• We also have a patient portal through our electronic medical record. This allows our patients' families to communicate with us about non-urgent medical issues through a virtual platform. Parents find this especially helpful to send photos of rashes, etc. We encourage all of our families to get registered for the portal as this is a great way to communicate.

• Additionally, we offer telemedicine appointments. If a telemedicine appointment is appropriate for your child's concern, our front office will get you all the information you need.