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Phone & Fax Numbers for All Locations
Phone: 703-924-2100 | Fax: 703-922-6067

Inova Healthplex Office
6355 Walker Lane, Ste 401, Alexandria, VA 22310
Potomac Yard Office
3600 S. Glebe Rd., Ste 150, Arlington, VA 22202

OPEN 7 DAYS A WEEK!

Inova Healthplex: Mon-Thu: 6am-8pm | Fri: 6am-6pm | Sat: 8am-12pm | Sun: closed

Potomac Yard: Mon-Thu: 6am-8pm | Fri: 6am-6pm | Sat: closed | Sun: 8am-12pm

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Escuela, Campamento, Formularios de Guardería

Formas: escuela, campamento o guardería

Pediatric Associates of Alexandria ha hecho que nuestros formularios de escuela, campamento y guardería sean un proceso completamente electrónico para nuestros pacientes a través de DocuSign. DocuSign es seguro y cumple con HIPAA. Cuando se complete el formulario, se le enviará directamente por correo electrónico. Este proceso permite un envío más fácil, una finalización más fácil y un seguimiento confiable de sus formularios. DocuSign también le permitirá elegir entre muchos idiomas diferentes en la configuración de DocuSign.

Tenga en cuenta que si envía varios formularios para un niño o para varios niños, es posible que los reciba en momentos distintos o incluso en días distintos. Todos sus formularios están en la cola para ser completados.

• Tarifa estándar (entrega en 7 días hábiles): $15 por formulario*

• Tarifa acelerada (entrega en 1 día hábil): $50 por formulario*

• Gratuito cuando se trae a las citas de control de salud

* El día hábil no incluye sábado, domingo, cierre de la oficina debido a circunstancias imprevistas (ejemplo: mal tiempo) y días festivos cuando la oficina está cerrada (Año Nuevo, Día de los Caídos, Día de la Independencia, Día del Trabajo, Acción de Gracias y Navidad).

Ejemplo: si se envía un formulario acelerado a nuestra oficina un viernes a las 5:30 p. m., se completará al final del día hábil de PAA el lunes, siempre que el lunes no sea feriado o esté cerrado por otros motivos mencionados anteriormente.

La tarifa del formulario se cobrará en línea antes de enviarlo a la oficina.

Direcciones

1. Desplácese por la lista de formularios a continuación. También puede obtener una vista previa del formulario para ver si es el correcto que solicita su escuela, campamento o guardería. PAA ha actualizado nuestra lista de formularios, revísela por completo antes de hacer una selección. PAA no es responsable si se envía el formulario incorrecto.

2. ¿No ve el formulario que necesita? Desplácese hasta la parte inferior para encontrar "¿Su formulario no está en nuestra lista?" para cargar una copia del formulario que está solicitando.

3. Haga clic en "Formulario estándar" o "Formulario acelerado" para iniciar el proceso para enviarlo a nuestra oficina. El formulario estándar cuesta $15 y se entregará en 7 días hábiles. El formulario acelerado cuesta $ 50 y se entrega en 1 día hábil.

4. Complete todas las partes obligatorias y opcionales del formulario del que es responsable el padre/tutor.

5. Cuando haya terminado de completar todas las partes del formulario y haga clic en "Finalizar", se le pedirá la información de su tarjeta de crédito/débito. Su tarjeta solo se cargará si el proveedor completa el formulario y se lo envía por correo electrónico.

6. Tenga en cuenta: si una enfermera o un proveedor rechaza su formulario, se le notificará a través del portal del paciente.


Virginia Forms


Commonwealth of Virginia School Health Form

Standard Form

Expedited Form

Preview Form


Virginia Athletic Participation Form

Standard Form

Expedited Form

Preview Form


Virginia Asthma Action Plan

Standard Form

Expedited Form

Preview Form


Fairfax County Public Schools


Fairfax County Middle School Sports Form

Standard Form

Expedited Form

Preview Form


Fairfax County Public School Authorization for Anaphylaxis Action Plan

Standard Form

Expedited Form

Preview Form


Fairfax County Public School Medication Authorization

Standard Form

Expedited Form

Preview Form


Arlington County Public Schools


Arlington County Medication Authorization

Standard Form

Expedited Form

Preview Form


Arlington County Allergy Action Plan

Standard Form

Expedited Form

Preview Form


Arlington County Tuberculosis Screening

Standard Form

Expedited Form

Preview Form


Prince William County Public Schools


Prince William County Epinephrine Permission Form

Standard Form

Expedited Form

Preview Form


Prince William County Medication Form

Standard Form

Expedited Form

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Prince William County Middle School Athletic Form

Standard Form

Expedited Form

Preview Form


Alexandria City Public Schools


Alexandria City Public School Medication Authorization

Standard Form

Expedited Form

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Alexandria City Public School Epinephrine Authorization

Standard Form

Expedited Form

Preview Form


Loudoun County Public Schools


Loudoun County Allergy Action Plan

Standard Form

Expedited Form

Preview Form


Loudoun County Asthma Action Plan

Standard Form

Expedited Form

Preview Form


Loudoun County Medication Authorization

Standard Form

Expedited Form

Preview Form


Loudoun County Tuberculosis Screening

Standard Form

Expedited Form

Preview Form


Catholic School Forms


Bishop O'Connell Immunization Certificate

Standard Form

Expedited Form

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Bishop O'Connell Sports Form

Standard Form

Expedited Form

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Office of Catholic Schools Food Allergy Action Plan

Standard Form

Expedited Form

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Office of Catholic Schools Inhaler or Nebulizer Authorization

Standard Form

Expedited Form

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Office of Catholic Schools Epinephrine Authorization

Standard Form

Expedited Form

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Office of Catholic Schools Medication Form

Standard Form

Expedited Form

Preview Form


St. Stephens St. Agnes Immunization & Physical Form

Standard Form

Expedited Form


Maryland Forms


Maryland School Form + Lead Test Certificate

Standard Form

Expedited Form

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Maryland Lead Test Certificate

Standard Form

Expedited Form

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Maryland State Department of Education Medication Authorization

Standard Form

Expedited Form

Preview Form


Maryland State Department of Education Allergy and Anaphylaxis Medication Administration Authorization Plan

Standard Form

Expedited Form

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Maryland Asthma Action Plan

Standard Form

Expedited Form

Preview Form


Maryland Department of Health Immuniziation Certificate

Standard Form

Expedited Form

Preview Form


Prince George County Public Schools


Prince George County Epinephrine Form

Standard Form

Expedited Form

Preview Form


Prince George County Health Form

Standard Form

Expedited Form

Preview Form


Prince George County Inhaler/Nebulizer Form

Standard Form

Expedited Form

Preview Form


Prince George County Medication Form

Standard Form

Expedited Form

Preview Form


Montgomery County Public Schools


Montgomery County Public Schools Anaphylaxis Management

Standard Form

Expedited Form

Preview Form


Montgomery County Public Schools Physical Examination Form

Standard Form

Expedited Form

Preview Form


Montgomery County Public Schools Medication Authorization

Standard Form

Expedited Form

Preview Form


Montgomery County Public School Pre-Participation Athletic Form

Standard Form

Expedited Form

Preview Form


Washington D.C. Forms


DC Universal Health Form

Standard Form

Expedited Form

Preview Form


Washington DC Medication and Medical Procedure Authorization

Standard Form

Expedited Form

Preview Form


DC Anaphylaxis Action Plan

Standard Form

Expedited Form

Preview Form


District of Columbia Medication Authorization

Standard Form

Expedited Form

Preview Form


Miscellaneous Forms (Various Camp, Daycare, Medication Forms)


Preparticipation History and Physical Evaluation

Standard Form

Expedited Form

Preview Form


Boy Scout Physical Form

Standard Form

Expedited Form

Preview Form


Food Allergy and Anaphylaxis (FARE) Action Plan

Standard Form

Expedited Form

Preview Form


Medication Authorization Form

Standard Form

Expedited Form

Preview Form


Written Medication Consent Form

Standard Form

Expedited Form

Preview Form


Tuberculosis Screening Form

Standard Form

Expedited Form

Preview Form


Bright Horizons Allergy Health Care Plan

Standard Form

Expedited Form

Preview Form


Bright Horizons Asthma Health Care Plan

Standard Form

Expedited Form

Preview Form


Crystal City Children's Center Health Statement

Standard Form

Expedited Form


Government Forms (Local, State, Federal)


Child, Youth, and School Services Health Assessment/Sports Physical

Standard Form

Expedited Form

Preview Form


WIC Infant Form - No Fee for This Form

Standard Form

Preview Form


WIC Child Form - No Fee for This Form

Standard Form

Preview Form


DMV Disabled Parking Placard or License Plate Application

Standard Form

Expedited Form

Preview Form


Family Member Medical Summary (DD 2792)

Standard Form

Expedited Form

Preview Form


Medical, Dental, Educational Suitability Screening (1300-1)

Standard Form

Expedited Form

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Overseas Screening Assignment (CG 1300B)

Standard Form

Expedited Form

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Report of Medical History (DD 2807-1)

Standard Form

Expedited Form

Preview Form


Department of State Medical History and Exam (DS 1622)

Standard Form

Expedited Form

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Department of State Medical History and Exam (DS 1843)

Standard Form

Expedited Form

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College Forms


University of Virginia Health Form

Standard Form

Expedited Form

Preview Form


University of Mary Washington Immunization and Tuberculosis Screening

Standard Form

Expedited Form

Preview Form


James Madison University Immunization Form

Standard Form

Expedited Form

Preview Form


George Mason Immunization Form

Standard Form

Expedited Form

Preview Form


Virginia Commonwealth University Certificate of Immunization

Standard Form

Expedited Form

Preview Form


Virginia Tech Immunization Form

Standard Form

Expedited Form

Preview Form


Other Forms


Is your form not in our list?

1. Please ensure your form is not in list of forms above.

2. Pre-op forms must be completed during an office appointment.

Standard Form

Expedited Form