Nemours Children's Clinic, Philadelphia Patient Appointment Form
Nemours Children's Clinic, Philadelphia Patient Appointment Form
Nemours Children's Clinic, Philadelphia Patient Appointment Form
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
<strong>Nemours</strong> Children’s <strong>Clinic</strong>, <strong>Philadelphia</strong> <strong>Patient</strong> <strong>Appointment</strong> <strong>Form</strong><br />
OFFICE HOURS BOTH LOCATIONS: MONDAY-FRIDAY, 8:30 A.M. – 5:00 P.M.<br />
833 Chestnut Street, Suite 300 | <strong>Philadelphia</strong>, PA 19107<br />
Ph: 215-861-8830 | Fax: 215-861-8833<br />
Pediatric specialists listed below are available at the two <strong>Nemours</strong> Children’s <strong>Clinic</strong> offices on Chestnut Street in <strong>Philadelphia</strong>, PA.<br />
<strong>Appointment</strong> availability varies by specialist. All of <strong>Nemours</strong>/Alfred I. duPont Hospital for Children specialists are available in Wilmington, DE.<br />
<strong>Patient</strong>: _____________________________________________________________________________________<br />
Reason for Referral: (diagnosis code/comment)______________________________________________________________<br />
Referring Physician:_______________________________Physician’s Phone Number:___________________________<br />
Date:__________ Time: __________Specialist Name: __________________________________________________<br />
For appointments with specialists at 833 Chestnut Street, Suite 300: CALL 215-861-8830 For appointments with specialists<br />
Allergy & Immunology<br />
Stephen J. McGeady, MD<br />
Ejaz Yousef, MD<br />
Cardiology<br />
Paul C. Anisman, MD<br />
Bradley W. Robinson, MD<br />
Takeshi Tsuda, MD<br />
Endocrinology<br />
Gary Carpenter, MD<br />
Judith L. Ross, MD<br />
Martha Zeger Bardsley, MD<br />
Infectious Diseases<br />
Stephen Eppes, MD<br />
Abigail Freedman, MD<br />
Neurology<br />
Charles Brill, MD<br />
Christian Stanley, APN<br />
Neurosurgery<br />
Jeffrey W. Campbell, MD<br />
Pulmonology<br />
Robert Heinle, MD<br />
Rehabilitation Medicine<br />
Rochelle Haas, MD<br />
Surgery<br />
Barry Hicks, MD<br />
Urology<br />
T. Ernesto Figueroa, MD<br />
Susan Myers, APN<br />
Please arrive 15 minutes prior to your appointment to allow for registration. You are asked to bring any pertinent data such as medical records or X-ray films that may be helpful.<br />
Insurance information such as claim forms, insurance cards, co-pays, HMO referral forms, etc., must be presented at the time of registration.<br />
Directions to both <strong>Nemours</strong> Children’s <strong>Clinic</strong> locations on Chestnut Street<br />
Trouble finding us? Call 215-861-8830<br />
For more information:<br />
<strong>Nemours</strong>/Alfred I. duPont Hospital for Children, main number: 302-651-4000<br />
<strong>Nemours</strong>/Alfred I. duPont Hospital for Children, admissions: 302-651-4199<br />
<strong>Nemours</strong>.org<br />
__________________<br />
__________________<br />
__________________<br />
FROM POINTS NORTH AND WEST OF PHILADELPHIA:<br />
Take Exit 24 (Valley Forge) from Pennsylvania Turnpike. Take Route 76 East and follow signs for Exit 38 (I-676/US 30<br />
East, Central <strong>Philadelphia</strong>/Broad St.). Take Exit 38 to Vine St. and follow Vine St. to 8th St. Turn right onto 8th St. and<br />
continue to Market St. Cross over Market Street and the Central Parking System lot is on the right-hand side on Market<br />
St. between 8th and 9th Sts. When exiting the lot, walk out the 9th St. gate, turn left and walk towards Chestnut St.<br />
FROM DELAWARE, THE WALT WHITMAN BRIDGE AND POINTS SOUTH OF PHILADELPHIA:<br />
Take I-95 North, passing the Naval Base, stadiums, and Columbus Blvd. exits. Exit I-95 Northbound on the left hand<br />
side of the expressway at the I-676/Callowhill exit ramp (Exit #22). Stay in the middle lane on Callowhill St. and<br />
continue to 8th Street. Turn left on 8th St. and continue to Market St. Cross over Market St. and make a right turn into<br />
Central Parking System Lot. Central Parking System lot is between 8th and 9th Sts. on Market. When exiting the lot,<br />
walk out the 9th St. gate and turn left and walk towards Chestnut St.<br />
FROM THE BEN FRANKLIN BRIDGE:<br />
After crossing the bridge, stay in left lane. You will see a sign indicating 8th St. South, Chinatown. Make a left onto 8th<br />
St. and continue to Market St. Cross over Market Street and the Central Parking System lot is on the right-hand side on<br />
Market St. between 8th and 9th Sts. When exiting lot, walk out the 9th St. gate, turn left and walk towards Chestnut St.<br />
1015 Chestnut Street, Suite 601 | <strong>Philadelphia</strong>, PA 19107<br />
Phone: 215-861-9100 | Fax: 215-861-9090<br />
at 1015 Chestnut Street, Suite 601:<br />
CALL THE NUMBER LISTED BELOW<br />
Diagnostic Referral Service 215-861-9095<br />
Deborah Consolini, MD<br />
Jeffrey Malatack, MD<br />
Gastroenterology 215-861-9100<br />
Sheeja K. Abraham, MD<br />
Joan S. DiPalma, MD<br />
Neonatology 215-955-6974<br />
Shobhana A. Desai, MD<br />
Marcy B. Gringlas, MD<br />
1015 CHESTNUT 833 CHESTNUT<br />
5/10
Write down any questions you have about your child’s diagnosis. Items printed below may help you think of what you<br />
want to discuss during your visit with our <strong>Nemours</strong> team.<br />
My current concerns are:<br />
New medications for my child:<br />
My child has experienced these new symptoms:<br />
Are there other symptoms that I should be looking for?<br />
Please write down any additional questions you have for our <strong>Nemours</strong> team during your child’s visit.<br />
_______________________________________________________________________________________________________________________________________<br />
_______________________________________________________________________________________________________________________________________<br />
_______________________________________________________________________________________________________________________________________<br />
_______________________________________________________________________________________________________________________________________<br />
_______________________________________________________________________________________________________________________________________<br />
_______________________________________________________________________________________________________________________________________<br />
_______________________________________________________________________________________________________________________________________<br />
_______________________________________________________________________________________________________________________________________<br />
_______________________________________________________________________________________________________________________________________<br />
_______________________________________________________________________________________________________________________________________<br />
_______________________________________________________________________________________________________________________________________<br />
_______________________________________________________________________________________________________________________________________<br />
Advanced pediatric specialty care, here in your community.<br />
What is the next step in treating my child?<br />
What else can I do at home to help my child?<br />
Are there any activities or foods my child should avoid?<br />
Ask the name of the diagnosis/condition.<br />
Learn more at <strong>Nemours</strong>’ www.kidshealth.org. Information on our award-winning<br />
site is reviewed by our <strong>Nemours</strong> physicians specifically for parents, teens and kids.<br />
<strong>Nemours</strong> Children’s <strong>Clinic</strong>, <strong>Philadelphia</strong><br />
©2010. The <strong>Nemours</strong> Foundation. <strong>Nemours</strong> is a registered trademark of the <strong>Nemours</strong> Foundation.