MedStar Health: Pediatrics at Tenleytown

The department of Pediatrics has implemented several new policies to ensure that your health-related school/camp form submission is timely and accurate. To this end, we ask that you please review our new policies mentioned below:

• Requests to complete forms can be dropped off in-person, emailed to the clinic (mguhpeds@medstar.net), or faxed to 877-680-5502. Completed forms will either be emailed to the address provided or held for pick up by a parent or legal guardian. All original copies will be held for 30 days. After 30 days, the original copy will be discarded.

• The demographic section of the form must be completed by parent or legal guardian and signed at the time of submission in order for us to process your request. We will attempt to contact the parent or guardian regarding fax requests that are illegible. If we cannot reach the requestor, we will be unable to process your request. Given that we use the contact information we have on file, please ensure that all information submitted is current.

• As in the past, we require that your child have had a well-child exam within the last 12 months in order for us to complete his/her form. If your child has not had a well-child exam within the last year, you will be asked to schedule this appointment with our office prior to our staff accepting and completing the form. We will be able to provide a shot record at your request, regardless of the last visit date.

• There will be a charge for each form submitted. We ask that you pay in full at the time of your request.

• Please see the fee scheduled below:

  • Standard: $15 ($15 for each additional child)

  • Expedited: $45, 2-3 business days ($15 for each additional child)

  • FMLA/Complex Disability Forms: $45

  • No Charge: Asthma Action Plan, immunization, medication authorization

• There is no charge for the following forms:

  • Asthma action plans

  • Shot records

  • Medication authorization forms

• To request medical records please click here for release form and instructions. To request copies of outpatient medical records please call  202-243-3400 option #8.

Pediatric downloadable health forms

• D.C. Health Certificate School Form

• D.C. Medication Form

• Maryland State Department of Education Health Inventory Form

• Maryland Medication Form

• Virginia School Health Form