PANDAS/PANS Provider Survey
Please provide the following information regarding your current practice. This information will be used by Health New England to assess adequate network access to pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS) treatment for our covered members pursuant to Massachusetts Division of Insurance Bulletin 2021-06.
Name
First Name
Last Name
Provider Type (Select all that apply):
Pediatrician
Pediatric Allergist
Pediatric Immunologist
Pediatric Infectious Disease
Other
Location of Practice
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
NPI
Are you currently accepting new patients?
Yes
No
Do you provide treatment for PANDAS/PANS?
Yes
No
If yes, please provide your phone number.
Please enter a valid phone number.
Format: (000) 000-0000.
Can we refer patients to your practice for PANDAS/PANS treatment or diagnosis?
Yes
No
Please indicate when your next available appointment for an urgent situation for an existing patient would be:
Within 48 hours
Within 72 hours
In more than 72 hours
Please indicate when your next available appointment for a routine follow up visit for an existing patient would be:
Within 10 business days
Within 14 business days
In more than 14 business days
Please indicate when your next available appointment for a routine visit for a new patient would be:
Within 10 business days
Within 14 business days
In more than 14 business days
Submit
Should be Empty: