We respect your time and want to make your visit with us as pleasant and efficient as possible. We hope the following information will be of some help to you and will also assist us in your care.

MEDICAL INFORMATION
In order for our providers to perform a comprehensive examination, we request that you bring the following items to your first appointment:

1. A completed Patient Information Form along with the appropriate Health History Forms (a) gynecological, (b) obstetrical or (c) inferfility. This assists us in maintaining an accurate record of personal and insurance information.
2. All medical reports related to this condition, if applicable
3. Please provide all medication you are taking including the strength and dosage
4. All insurance information
   ***If you were involved in a motor vehicle accident, please have the claim number and address of where the claim should be sent.

MEDICAL INSURANCE
If we participate with your medical insurance we will file the claim with your insurance company based upon the information you provide us. We request, however, that you also bring all insurance identification cards with you to your visit to ensure accurate and prompt submission of charges incurred. We require all insurance copays be paid at time of service. If we do NOT participate with your medical insurance office visits must be paid at time of service.

CANCELLATION
Our appointments are made on a limited basis. Please notify us as early as possible if you are unable to keep your appointment.

CONFIDENTIALITY OF PROTECTED HEALTH INFORMATION
As you probably already know, Partners in Womens Healthcare is required by law to maintain the privacy of your health information (“protected health information”) and to provide you with notice of our legal duties and privacy practices with respect to your protected healthcare information. Partners in Womens Healthcare has always been very conscientious about the confidentiality of our patients’ health information. Our Notice of Privacy is included on our web site. It is also our policy to inform each patient or power of attorney (POA) of the existence of the Notice of Privacy Practices and request each patient (or POA) to sign our Acknowledgment Form . Furthermore, Partners in Women’s Healthcare will not routinely release any of your health information to anyone including family members unless the patient is a minor or unless you as the patient sign the appropriate form authorizing release of healthcare information to a designated individual/s. Please complete an Authorization Form if you wish to designate another individual/s access to your protected health information.

If you have any questions regarding the above information or if we may be of further assistance, please do not hesitate to call us. Again, we look forward to meeting you!

Sincerely,

Russell R. Janson, M.D.
Corporate President