| 1. CHILDREN (under age
18 or still in high school)
1.1 Parents please complete and provide to our
office:
1.2 Provide copies—no originals please:
- All report cards from kindergarten to present. If
you do not have these obtain them from your child's
school
- Reports of any standardized school testing such
as the WASL, Metropolitan Achievement Test, or Iowa
Test of Basic Skills
- Reports of any testing done by school psychologists,
occupational, language or physical therapists
- Reports of any previous evaluations by physicians,
psychologists or psychiatrists
1.3 Obtain completed Teacher
Evaluation Form (66k PDF file) from all current
teachers and tutors
1.4 We strongly recommend reading one of the
following books before your appointment.
Parents of boys: Daredevils
and Daydreamers by Barbara Ingersoll
Parents of girls: Understanding
Girls with AD/HD, by Kathleen Nadeau, Ellen Littman,
and Patricia Quinn
1.5 Send all completed forms to: Puget Sound
Behavioral Medicine, 2553 76th Avenue SE, Mercer Island,
WA 98040. If you wish to specify a preferred physician
please indicate your preference.
1.6 When all materials are received and reviewed
you will be contacted to set up appointments.
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2. ADULTS (over age 18
and not in high school)
2.1 Please complete and return to us:
2.2 Copies—no originals—of all report
cards from kindergarten through college
2.3 Copies of reports of previous tests or evaluations
2.4 If parents are still living ask them to complete
the Child
History Form (601k PDF file) based on their recollections
of your childhood behavior.
2.5 We strongly recommend reading the book
Driven
to Distraction by Edward Hallowell and John Ratey.
Women may also want to consider reading either Understanding
Women with AD/HD by Kathleen Nadeau and Patricia Quinn
or Women
with Attention Deficit Disorder by Sari Solden.
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3. PREVIOUSLY DIAGNOSED
PATIENTS
3.1 Please complete and return to us:
- Registration
Form (17k PDF file)
- Release
Form (118k PDF file) for each of the following:
- current physician
- current or previous psychiatrist or therapist
- any other professionals you have consulted
3.2 Provide copies of any previous evaluations.
3.3 Parents of previously diagnosed children
or teens need to obtain Teacher
Evaluation Form (66k PDF file) from all of their
child's teachers and tutors.
After Dr. Mandelkorn or Dr. Woolley review the above
information, our office will contact you and either
set up an initial appointment or ask you to complete
our questionnaire for further information. The usual
two hour-long appointments may not be necessary for
you or your child. We will let you know whether the
doctor needs one or two hours for your consultation.
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4. SERVICES AND FEES
All services at Puget Sound Behavioral Medicine, P.S.
including office visits and phone consultations will
be payable at the time of service either by credit card
or check. We do not bill insurance companies or accept
medical coupons. We provide receipts for patients to
submit to their insurance for reimbursement. If office
notes are needed for submission by your insurance, a
release will need to be signed by the patient or family
in order for us to communicate with the insurance company.
Some insurance companies will reimburse for the office
charges, but it has been our experience that most insurance
carriers either deny coverage of charges or greatly
reduce charges for the evaluation and treatment. We
feel that it is important for you to be aware of this
before undertaking an evaluation. We encourage you to
check with your insurance provider in advance if you
have questions regarding coverage. For your convenience
we have provided the Visit Codes for each type of visit
that we schedule. Your insurance carrier should be able
to tell you what if anything your insurance benefits
will pay for these visits. For a current fee schedule
for these visits contact our office.
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5. APPOINTMENT
SCHEDULING
The scheduling at this office consists of the following:
5.1 For newly diagnosed child patients:
Two one-hour appointments. Both parents should come
if at all possible. It can be helpful to bring a tape
recorder and tape to record the information provided.
- First one hour visit (Visit Code 90801)
- Review of questionnaire, teacher forms, other
professional evaluations and history with patient/family
- Review of diagnosis, modalities of treatment
- Second one hour visit (Visit Code 99215)
- Review of diagnosis and treatment recommendations
- Discussion of accommodations needed if applicable
- Explanation of phone consultation
- Start medication if indicated
- Follow-up visits (Visit Code 99214)
- Review of medication benefits and side effects
and adjust as needed
- Evaluate social, family, and academic/workplace
progress
- Nurse phone consultation (Visit Code 99371)
- Monitor progress and treatment effectiveness
between office visits
5.2 For newly diagnosed adult patients: (Visit
Code 90801)
- One one-hour appointment is needed
- Follow-up and Nurse phone consultations as above
5.3 For previously diagnosed patients who wish
to transfer care:
- After review of information provided, the physician
will determine what visits are needed
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