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 for form completion can be submitted in-person, via email at mguhpeds@medstar.net, or by fax to 877-680-5502. 

  All completed forms will be sent electronically to the email address provided. If you prefer to pick up the original copy, please indicate this preference at the time of submission. Otherwise, the original document will be securely 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)

  • FMLA/Complex Disability Forms: $45

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

• To request copies of your medical records, please complete our Medical Records Release Form here. Submit the completed form via:

  • Email: mguhpeds@medstar.net

  • Fax: 877-680-5502

  If you would like to speak with an associate concerning your medical records, please call 202-243-3400, opt. 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