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Office & Patient Information

Hospital Affiliations | Your First Appointment | Patient Forms
PracticeOne Access | Insurance and Payment Information | Privacy Practices

Hospital Affiliations

Our office currently utilizes hospitalists at various facilities for inpatient care.

Your First Appointment

Please arrive early so that we can complete your initial paperwork. Also, please bring the following:

• Patient's insurance card
• List of current prescriptions and/or over-the-counter medication, including dose and frequency
• Information about patient's medical and surgical history
• Recent test results, x-rays, or relevant records
• Be sure to have read our office policies
• The patient forms below

Patient Forms

• Authorization to release health information [PDF]
• Acknowledgment of receipt of privacy policies [PDF]
• Financial policies [PDF]
• Patient registration [PDF]
• Health history questionnaire [PDF]

PracticeOne Patient Access Portal

Click here to go to the PracticeOne Patient Access Portal. Once there you will need to know our enterprise number: 337, and you will have to register for an account.

Insurance and Payment Information

Currently contracted major insurance carriers:

• AETNA
• AZ FOUNDATION
• BCBS of AZ (including TRICARE)
• BANNER
• BEECH STREET
• CIGNA
• GREAT WEST
• HEALTHNET
• HUMANA
• MEDICARE
• MULTIPLAN
• PHCS (only certain networks)
• PACIFICARE (excluding HMO)
• UNITED HEALHCARE

You are responsible for co-payments or charges that are not covered by your insurance. If you have questions regarding billing or which insurance plans we accept, please contact us. Questions regarding insurance coverage and benefits should be directed to your employer or insurance company.

Download our financial policies [PDF]

Privacy Practices

Our Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information. It is given to all new patients, and a copy is available upon request.

What's New?

September 24, 2009 Dr. Chan is now a provider for Signature MD Rejenesis, PLLC.