Patient Information


New Patient Paperwork

Please print out all pages of the the paperwork packets!

[accordions]
[accordion title=”New Pregnancy Patient Paperwork”]

Financial Policy 1

Financial Policy 2

Financial Policy 3

New Patient Obstetrical Medical History 1

New Patient Obstetrical Medical History 2

New Patient Obstetrical Medical History 3

Patient Information

Power of Attorney

Privacy Policy

Release of Information

Ultrasound Waiver

[/accordion]

[accordion title=”New Gynecology Patient Paperwork”]

Financial Policy 1

Financial Policy 2

Financial Policy 3

New Patient Medical History 1

New Patient Medical History 2

Patient Information

Power of Attorney

Privacy Policy

Release of Information

[/accordion]

[accordion title=”Yearly Update Paperwork”]

Financial Policy 1

Financial Policy 2

Financial Policy 3

Patient Information

Release of Information

[/accordion]

[/accordions]

Insurance

Desert Rose OB/GYN prides itself in providing care to as many members of the community as possible. Therefore, we work very hard at keeping up with contracting with all insurance plans. Please call our office for information about specific plans.

  • Aetna (all plans)
  • AHCCCS plans, see specific plan name
  • Ambetter through Healthnet from Arizona Complete Health
  • Allwell from Healthnet
  • Arizona Benefit Options (Schaller Anderson/CHW)
  • Arizona Foundation for Medical Care
  • Arizona Medical Network (AMN)
  • Arizona Complete Health (AHCCCS)
  • Blue Cross and Blue Shield (Blue advantage, Blue Choice HMO, Blue Cross Indemnity, Blue Preferred PPO, Blue Select HMO, Federal Employee Program, Blue Anthem) **EXCEPT NEIGHBORHOOD NETWORK**
  • Beech Street
  • Benesight
  • Care 1st (AHCCCS)
  • CCN
  • Cigna (all plans, Senior Care) **EXCEPT LOCAL PLUS**
  • Community Connection (AHCCCS)
  • Definity Healthcare (UHC)
  • Emergency Services (AHCCCS)
  • Healthnet of Arizona
  • Humana PPO Choice Care (not HMO)
  • Medicare
  • MediSun
  • The Mega Life
  • Mercy Care Plan (AHCCCS) **EXCEPT MERCY CARE RBHA**
  • Multiplan
  • PHCS (Private Healthcare Systems)
  • Principal Financial
  • Prudential
  • South West Service Administrators
  • Starmark
  • United Healthcare (all plans)
  • UHC APIPA (AHCCCS)
  • UMR
  • University Family Care (AHCCCS)
  • WEB-TPA
  • Western Growers
  • Zenith Administrators
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