- Pediatric Patient Packet[pdf version] (Adobe Acrobat Reader), Click here for MS Word Version ( Word 97 or greater)
- Adult Patient Packet[pdf version] (Adobe Acrobat Reader), Click here for MS Word Version ( Word 97 or greater)
- In order to better serve our patients in the office, Dr Dajani is not available for telephone consultation. If you have medical concerns you would like to discuss, please make an appointment. You can request an appointment at anytime by phone (623) 748-4700 or email (email@example.com).
- Dr. Dajani Offers appointments for diagnosis and treatment of Endocrine Disorders in people age 40 years and younger.
- We offer appointments, Monday through Thursday from 8:00AM to 4:00 PM.
- We work our best to reduce wait times. Nevertheless, the appointment in total, wait time included, may last far longer than you might expect. At minium set aside 1-2 hours for the entire visit.
- For Endocrinology appointments, we recommend that you leave yourself plenty of time for the entire visit. Especially if you will also be seeing the diabetes educator or nutritionists.
- We recommend that you do not schedule anything right after the appointment to ensure you get the most out of your appointment. For example, if you have a meeting, you may not want to schedule an endocrine appointment beforehand.
- Dr. Dajani reviews your medical history from your patient packet at the first visit. You may print this paperwork from our patient forms page. Complete it at home and bring it to your appointment. If you do not have internet access or are unable to print the forms, please arrive thirty minutes early for your first visit or stop by the office prior to your appointment so that you can get the blank forms.
- Download the Patient Packet (You will need Adobe Acrobat Reader), [Click here for MS Word Version]
- Then send it to us by secure email, mail or fax.
- We will contact you to schedule an appointment.
- If a physician referral is required, our appointment staff will advise you.
- Some insurers require referrals, or may have additional requirements for certain medical care. Appointments are prioritized on the basis of medical need.
- You will be asked for your insurance card(s), so please bring it along with your co-payment if you have one.
- Please bring your driver’s license or a government issued photo ID with you to your appointment. This is necessary for you to bring so that we can help reduce the risk of identity theft.
- Bring copies of recent lab tests results, x-ray reports, etc., if applicable
- Your appointment is time set aside for your care. The practice is booked far in advance with a waiting list. Cancellations less than 24-48 hours in advance prevents other patients the opportunity to receive timely care.
- If you are unable to keep your appointment or are going to be late, please call our office as soon as possible. This courtesy allows us to be of service to other patients.
- If we do not receive a cancellation call at least one business day in advance, you will be considered a no-show for your appointment and a $35 fee will apply. Also, if you call the same day as your appointment to cancel and/or reschedule the $35 fee will apply.
- If you miss three appointments, we will ask you to obtain medical services from a different provider.
MEDICAL RECORDS REQUEST
You can request a copy of your health information by completing a the medical records release form in the patient packet.
REFERRALS AND AUTHORIZATIONS
- Some plans require PCP (Primary Care Physicians) referrals and/or plan authorizations in order for services to be covered.
- A PCP referral serves as a mechanism for coordinating a patient’s care and communicating with the specialty care provider. If your health plan requires a referral, your primary care physician (PCP) completes and forwards a referral form to the health plan and specialty provider authorizing the member’s care. A PCP referral is a common requirement with Health Maintenance Organizations (HMO) and Point of Service (POS) type plans. If your plan requires a referral, your primary care physician (PCP) must provide the referral prior to services being rendered. If you arrive for services without a referral in place, you may be asked to sign a waiver that holds you financially responsible for the services you receive
- A formal process requiring a provider to obtain prior approval from the patient’s health plan before providing a particular service or procedure. It is a process in which the plan determines whether the service is medically appropriate prior to the provision of care. Plan authorization (sometimes called authorization, prior authorization, pre-certification, or certification) is required for any medical service that requires clinical review such as inpatient admissions, certain outpatient surgeries, diagnostics, and therapies. Unlike PCP referrals which are required by only certain products, plan authorization is required by all managed care plans including HMOs, PPOs, and POS products.
ACCEPTED INSURANCE PLANS
- Aetna, APIPA, Arizona Foundation
- Banner, BCBS, Care 1st
- Cigna, Healthnet, Humana, Mercy Care
- Pacific Care, Tricare, United HealthCare
- We accept most other insurance plans.
AFTER HOURS SICK DAYS AND EMERGENCIES
Dr. Dajani is available on-call 24 hours a day to offer help to patients in emergency situations. If you have an urgent problem, after hours or on a holiday, please call. Prescriptions refill requests require 48 hours in advance and there is a $50 fee after-hours non-urgent prescription calls and after-hours requests for pharmacies that are closed. In case of an urgent prescription request after-hours, please have pharmacy call our office.
RELEASE OF MEDICAL RECORDS
Patients may at times need a copy of their medical records for themselves or for a third party.
- The “Authorization for Use and Disclosure of Protected Health Information” form is available for you to print. Please read and complete the form carefully so we know exactly what medical information needs to be released and to whom it should be sent to. The form can be mailed to us at the address listed on the bottom of the form.
- We use a printing/copy service that may process your request for medical records. There is a fee for the copies which includes an administrative fee plus a fee for each page copied. The copy service will send you an invoice, and after they receive payment, the copies will be sent out to the person and/or place designated on the Release of Medical Records Form. The fewer copies you request, the lower the cost, so please be specific when requesting which records you need copied.