These policies are subject to change without notice.

Inclement Weather Protocol


During the fall and winter months, inclement weather poses problems for some employees and patients in traveling to the Clinic.  In those instances, the Clinic will follow the following guidelines:

  1. The Clinic will follow the inclement weather closures for AISD i.e. if delayed opening at 10 am, the Clinic will open at 10 am.
  2. If ASID is closed all day due to weather, the Clinic will have the option to open at 12 noon if a provider requests to come in to see their patients.
  3. When conducting reminder calls, the staff will inform patients that we follow the AISD inclement weather closures.
  4. A posting will be placed on the website to inform patients of our inclement weather plan
  5. A voicemail will be placed on our phone system for our inclement weather plan

Phone Calls

We make an effort to return phone calls and voicemail messages within 24 hours. Our triage nurse will return phone calls within 2 hours. Messages left after business hours will be returned the following business day.

Main Phone: (512) 472-6134

Fax Number: (512) 472-2928

After Hours calls: (512) 406-3112


If you are having an emergency please contact 9-1-1 or go to the nearest hospital emergency room.


After Hours Contact

To contact the physician on call after business hours or on weekends or holidays please call (512) 406-3112 (Medical Exchange).

Appointment Policies

Office visits are by appointment only. We see patients Monday through Thursday 8:00 am to 5 pm and Friday 8:00 to 4:30 pm. You may make an appointment during office hours at (512) 472-6134 or request an appointment online.

If you are a new patient or your insurance has changed since your last visit, please arrive 15 minutes early. If this is your first visit, please make sure that your referring physician has provided us with all the pertinent medical records prior to your scheduled appointment. Please note that a photo ID and your insurance card will also be required for your appointment.

We have scheduled specific time to see you on your appointment date. We make every effort to keep our scheduled appointments. We strive to keep wait times within reasonable limits, but an appointment may run longer than expected or an emergency may arise. We try to accommodate late patients within reason, but we may ask you to reschedule the appointment if we are unable to work you back into the schedule.

Appointments are triaged and scheduled accordingly. If you feel that your child needs to be seen in an urgent manner, we will have you speak to our triage nurse or ask that your referring physician call our office to speak to our triage staff or an available physician.

Cancellation and No Show Policy

If you are unable to make your scheduled appointment we require 24 hours notice. If you are going to be late, call to see if we can still accommodate your appointment. If we are unable to do so you may be asked to reschedule. Appointments must be canceled by phone. Patients who fail to show up for an appointment, or fail to give a 24-hour notice of cancellation may be billed a charge of $25.00 per missed appointment. Please contact the Practice Manager at (512) 472-6134 if you have any questions.


Billing Phone: (512) 472-6134


We are dedicated to providing the best possible care and service to you and regard your complete understanding of your financial responsibilities as an essential element of your care and treatment.

To reduce confusion and misunderstanding between our patients and Children’s Urology, we have adopted the following financial policies. If you have any questions regarding these policies, please discuss them with our Practice Manager at (512) 472-6134.


Unless other arrangements have been made in advance by either you or your health insurance carrier, PAYMENT IS DUE IN FULL AT THE TIME OF SERVICE. Payment may be made by check, cash, or credit card. We accept the following credit cards: Visa, MasterCard, and Discover.

To insure proper credit for your payment please include your account number and invoice number on all payments including electronic checks. Co-payments are due at the time of service. Payment is due in full by the due date shown on the front of your statement. If you cannot make a payment you must contact Children’s Urology’s billing department before the due date to arrange for a payment plan.



We have made prior arrangements with many insurers and health plans to accept an assignment of benefits. This means that we will bill those plans for which we have an agreement and will only require you to pay the authorized co-payment, deductible and/or co-insurance at the time of service. This office’s policy is to collect this co-payment when you arrive for your appointment.

It is the responsibility of the guarantor to know the benefits associated with their insurance plan or coverage and to obtain all referrals and authorizations from the primary care physician, when applicable. If you do not have a current referral or authorization on file, you may be asked to reschedule your appointment.

If child has secondary insurance this information must be given to our office on the date of services. We will not accept the secondary insurance after this date.

It is the guarantor’s responsibility to know where their insurance company requires them to obtain any labs, x-rays, any other ancillary services. Please let your doctor’s medical assistant or nurse know so that they may schedule things accordingly.

In the event that your health plan determines a service to be “not covered,” you will be responsible for the complete charge. Payment is due upon receipt of a statement from our office.

If we do NOT participate with your insurance company, you will be considered a self-pay patient. The protocol for self-pay patients, as seen below, will apply. As a courtesy, we can submit a claim to your insurance company on your behalf, and your insurance company can reimburse you.



Surgery deposits are due 5 business days prior to surgery. If for any reason surgery needs to be canceled it must be done 10 business days prior to the surgery date or a $100.00 cancellation fee may be charged. You may call in surgery payment to (512) 472-6134.


Self-Pay Patients

If you do not have insurance you will be considered a self-pay patient, which means that upon arrival before seeing the doctor you will need to make a deposit of $100.00. You will also need to make payment arrangements at CHECK-OUT to pay the balance in full within 12 months. We accept Visa, MasterCard, Discover, cash and checks.


Minor Patients

For all services rendered to minor patients, we will look to the adult accompanying the patient and the parent or guardian with custody for payment.

Medical Records

Children’s Urology cannot see patients without their referring provider’s medical records on file in our office. Please ensure that your referring physician has provided us with all the pertinent medical records prior to your scheduled appointment or else you may be asked to reschedule. Fax records to 512-472-2928.

Children’s Urology abides by federal HIPPA guidelines, in that all patient care information is strictly confidential and will not be released to any person or organization without the consent of the patient or the patient’s legally authorized representative (unless authorized by law). This includes verbal information.

To receive a copy of your child’s medical health information, an authorized release of medical information must be signed and dated by the parent or legal guardian.

Requests for medical information must include the following:

  • Patient name and address
  • Patient date of birth
  • Name of person to whom information is to be disclosed and relationship to patient
  • Address of person to whom information is to be disclosed
  • Specific health information to be disclosed
  • Purpose for the release of information

A fee of $25.00 will be assessed to cover the cost of copying and for sending your records. If the records are being faxed or mailed to another medical facility, there is no charge.

Requests for forms completed by physician or staff (example: Disability forms, FMLA forms, etc.) will be charged a $25.00 fee. A $50.00 fee will be charged for immigration forms/letters.  Please allow 2 weeks for processing. Excuses for school or work are free of charge. Please contact our Practice Manager at (512) 472-6134 if you have any questions.

Please use the Medical Records Release Form (Liberacion de Historia Medica)

Medication refills

Prescriptions and refills are handled during business hours or at a scheduled appointment.

The quickest way to request a refill for a current prescription is to ask your pharmacy to contact our office. Please allow 24 to 48 hours for a refill request to be completed with your pharmacy. If your pharmacy cannot initiate the request, please contact us.

To expedite the refill request please have the following information available:

  • patient’s name
  • medication name
  • pharmacy name
  • pharmacy phone number


Referrals to our office are either initiated by a healthcare provider or by self referral.

Health Care Professionals

Healthcare providers may refer a patient by calling our office 512-472-6134 and asking to speak with our triage nurse, who can begin the intake process.


Self-referrals can be made by parents or patients by calling to make an appointment at 512-472-6134.  In order to schedule you in the best manner you may be asked to speak to our triage nurse. You will be asked to send us medical records and insurance information. Please ensure that we have received your medical records prior to your appointment or else your appointment may need to be rescheduled. In some situations medical records may need to be reviewed prior to scheduling an appointment.

Download Referral Form

Privacy Policies

HIPAA NOTICE of Privacy Practices

Effective Date: September 20, 2013

This notice can be downloaded in PDF format: FORMS – HIPAA NOTICE of Privacy Practices


This Notice is provided to you pursuant to the Health Insurance Portability and Accessibility Act of 1996 and its implementation regulations (“HIPAA”). It is designed to tell you how we may, under federal law, use or disclose your Health Information. It has been updated to the HITECH Omnibus Rule requirements.


I. Your Rights.

You have the right to request restrictions on the uses and disclosures of your Health Information. However, we are not required to comply with all requests. You are allowed to restrict transmittal of health care charges to your insurance carrier if you pay for those services, in full, by other means.

You have the right to receive your Health Information through confidential means and in a manner that is reasonably convenient for you and us.

You have the right to inspect and copy your Health Information. You may request your records in digital format and have your records sent digitally to another provider with written authorization.

You have a right to request that we amend your Health Information that is incorrect or incomplete. We are not required to change your Health Information and will provide you with information about our denial and how you can disagree with the denial.

You have a right to receive an accounting of disclosures of your Health Information made by us, except that we do not have to account for disclosures: authorized by you; made for treatment, payment, health care operations; provided to you; provided in response to an Authorization; made in order to notify and communicate with approved family members; and/or for certain government functions, to name a few.

You have been provided with a paper copy of this Notice of Privacy Practices. If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, please contact our HIPAA Compliance Officer at 512-472-6134.


II. We May Use or Disclose Your Health Information for Purposes of Treatment, Payment or Healthcare Operations without Obtaining Your Prior Authorization and Here is One Example of Each: 

We may provide your Health Information to other health care professionals — including doctors, nurses and technicians — for purposes of providing you with care.

Our billing department may access your information — and send relevant parts to insurance companies to allow us to be paid for the services we render to you.

We may access or send your information to our attorneys or accountants in the event we need the information in order to address one of our own business functions. Our attorneys and accountants are required to maintain confidentiality when they receive patient information.


III. We May Also Use or Disclose Your Health Information Under Certain Circumstances without Obtaining Your Prior Authorization. However, in general, we will attempt to ensure that you have been made aware of the use or disclosure of your Health Information prior to providing it to another person. Some instances where we may need to disclose information include but are not limited to:

To Notify and/or Communicate with Your Family. We will only communicate with family members that we are authorized to communicate with based on your completion of the Authorization to Disclose Health Information to Family and Friends form.

As Required By Law.

For Health Oversight Activities. We may use or disclose your Health Information to health oversight agencies during the course of audits, investigations, certification and other proceedings.

In Response to Civil Subpoenas or for Judicial Administrative Proceedings. We may use or disclose your Health Information, as directed, in the course of any civil administrative or judicial proceeding.

To Law Enforcement Personnel. We may use or disclose your Health Information to a law enforcement official to comply with a court order or grand jury subpoena and other law enforcement purposes.

For Purposes of Organ Donation. We may use or disclose your Health Information for purposes of communicating to organizations involved in procuring, banking or transplanting organs and tissues.

For Worker’s Compensation. We may use or disclose your Health Information as necessary to comply with worker’s compensation laws.


IV. For All Other Circumstances, We May Only Use or Disclose Your Health Information After You Have Signed an Authorization. If you authorize us to use or disclose your Health Information for another purpose, you may revoke your authorization in writing at any time. 

• Fundraising. Should our practice use patient information for fund raising we will inform individuals that they have the right to opt out of fundraising solicitations and explain that process. You do have the capability to opt back in with written notice.

• Marketing. Should our practice use patient information for marketing purposes we will first obtain your written authorization and fully explain the uses and disclosures of PHI for marketing purposes, and disclosures that constitute a sale of PHI will require a separate  written authorization.

• Use or Disclosure of Psychotherapy Notes. Written authorization is required if our practice intends to use or disclose psychotherapy notes.

• Breach Notice. All patients will be informed if there is a breach, as defined by federal rules, of their unsecured protected health information as required by the HIPAA regulations.

Right to Request Restrictions for Disclosures Related to Self-Payment. Our practice is required to comply with a request not to disclose health information to a health plan for treatment when the individual has paid in full out-of-pocket for a health care item or service and signed our “Do Not File Insurance Form”.


V. You Should Be Advised that We May Also Use or Disclose Your Health Information for the Following Purposes:

Appointment Reminders. We may use your Health Information in order to contact you to provide appointment reminders or to give information about other treatments or health-related benefits and services that may be of interest to you.

Change of Ownership. In the event that our Business is sold or merged with another organization, your Health Information/record will become the property of the new owner.

Electronic Exchange. Your information may be shared with other providers, labs and radiology groups through our EMR/EHR system as listed below:

1) Strictly Pediatrics Surgery Center

2) Dell Childrens Medical Center

3) Seton Northwest

4) Clinical Pathology Labs

5) Austin Radiological Clinic

6) Any medical facility we provide services



VI. Our Duties.

We are required by law to maintain the privacy of your Health Information and to provide you with a copy of this Notice.

We are also required to abide by the terms of this Notice.

We reserve the right to amend this Notice at any time in the future and to make the new Notice provisions applicable to all your Health Information — even if it was created prior to the change in the Notice. If any such amendment is made that materially changes this Notice, we will send you another copy.


VII. Complaints to our Practice and the Government.

You may make complaints to our HIPAA Privacy Officer or the Secretary of the Department of Health and Human Services (“DHHS”) if you believe your rights have been violated.

We will review all complaints in a professional manner and keep you informed of your rights as our patient.

We promise not to retaliate against you for any complaint you make about our privacy practices.

VIII. Contact Information.

You may contact us about our privacy practices or file a complaint by calling our Privacy Officer: Office Manager at (512) 472-6134.

You may contact the DHHS at: The U.S. Department of Health and Human Services, 200 Independence Avenue, S. W., Washington, D.C. 20201, Telephone: 202-619-0257,  Toll Free: 1-877-696-6775