Dr. Sonia Gidwani, MD, PLLC
135 W. 70th Street
(Between Broadway and Columbus)
New York, NY 10023
Tel: 212 496 KIDS (5437)
(Between Broadway and Columbus)
New York, NY 10023
Tel: 212 496 KIDS (5437)
Our Location X
Forms
- Assignment of Medical Care
This form is to be used when another person other than a parent or legal guardian will be bringing your child to our office for a scheduled appointment. - Car Seat Standards
This is an informational fact sheet regarding car seat safety issues. - CDC Growth Charts for Boys
CDC statistical data on growth v height v weight and other information. In addition, you may visit the CDC website for more information. - CDC Growth Charts for Girls
CDC statistical data on growth v height v weight and other information. In addition, you may visit the CDC website for more information. - CDC Growth Charts or the CDC Web Site
CDC statistical data on growth v height v weight and other information. In addition, you may visit the CDC website for more information. - Confidential Medical Record
New York City Department of Health and Mental Hygiene Bureau of day care Children’s Medical Record - Immunizations and Visit Schedule
This is the standard immunization schedule followed by our office. - Medical/Family History Questionnaire
This form is a detailed list of all medical problems in your family and your child´s past medical history. It is confidential and is filed in your child’s chart. - Multi-use Medication Form
Authorization for Administration of Medication to Students for the School Year - New Admission Examination Form
- New Admission Record
- Notice of Privacy Practices
As Required by the Privacy Regulations Created as a Result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A PATIENT OF THIS PRACTICE) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION. - Office Policies
This form is a printable version of our office policies. They may also be accessed online by clicking here. - Parent Delegation Form
This form authorizes us to give immunizations or medical care to a minor in the absence of a parent or legal quardian, but in the presence of your designated adult. - Parent's Questionnaire
These are standard parent checklists which help us understand your perception of your child´s behavior. - Parental Information
This form should be completed prior to your prenatal interview. It includes all vital information regarding your pregnancy and informs us of any expected health problems. - Patient Information & Benefits Record Release
This is the main patient information and insurance data sheet. It needs to be updated yearly and when your address, telephone, or insurance information changes. - Records Release Authorization
This form authorizes another medical institution or doctor’s office to forward your child´s medical records to our practice. - Teacher Questionnaire
These are standard teacher behavioral checklists used by the school system to assess your child´s behavior while in the classroom. - Tuberculosis Risk Assessment
This is another simple questionnaire assessing your child´s risk of tuberculosis exposure. It is usually completed prior to the 12 month and five year visit. - Vaccination Consent Form For FluMist, Influenza Virus Vaccine, Intranasal
FluMist should only be administered to children and adolescents 5-17 years old and adults 18-49 years old who are healthy. Certain people must not receive FluMist. You must answer each question on this form, and have the answers reviewed by the health care professional to ensure you are eligible to receive FluMist. The health care professional will keep the questionnaire, and any information collected in a confidential manner.