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ARIZONA STATE UROLOGICAL INSTITUTE The Center for Comprehensive Urological Care

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New Patient Center Page

First Visit Forms New Patient – Male New Patient – Female Follow-up Patient – Male Follow-up Patient – Female Medical Records Release Form Pre-surgical Instructions Health Surveys Bladder Satisfaction Survey for OAB AUA Symptom Score (AUASS) Sexual Health Inventory for Men (SHIM) Female Bladder Questionnaire IPSS – Spanish Office Procedures BCG Treatment Biofeedback Cystoscopy Prostate […]

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About Us

Your Health Information Although your health record is the physical property of the health care practitioner or facility that compiled it, the information belongs to you. You have the right to: Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522 Obtain a paper copy of the notice

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Responsibilities

This organization is required to: Maintain the privacy of your health information Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you Abide by the terms of this notice Notify you if we are unable to agree to a requested restriction Accommodate

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Privacy Practices

Notice of Health Information Privacy Practices   This notice describes how information about you may be used and disclosed and how you can get access to this information. Please review it carefully: Notice of Privacy Practices (PDF) Non-Discrimination Disclosure (PDF) Understanding Your Health Record/Information Each time you visit a hospital, physician, or other health care

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Contact Us

Phone: 480-394-0200Main Fax: 480-394-0202 Locations are closed on the following holidays: New Year’s Day Memorial Day 4th of July Labor Day Thanksgiving Day Friday after Thanksgiving Christmas Eve (half day) Christmas Day New Year’s Eve (half day) Urology Office Hours Monday – Thursday 8:00 AM to 5:30 PM (Last appt at 4:30) Friday 7:30 AM

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Patient Center

First Visit Forms New Patient – Male New Patient – Female Follow-up Patient – Male Follow-up Patient – Female Medical Records Release Form Pre-surgical Instructions Health Surveys Bladder Satisfaction Survey for OAB AUA Symptom Score (AUASS) Sexual Health Inventory for Men (SHIM) Female Bladder Questionnaire IPSS – Spanish Office Procedures BCG Treatment Biofeedback Cystoscopy Prostate

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Insurance

Insurance Plans that ASUI accepts are as follows: Aetna PPO, HMO, POS Arizona Care Network/Bright Health Intel Connect Care Bright Health MA Bright Health AHCCCS Arizona Foundation HMO PPO WC Arizona Priority Care (AzPCP) Medicare Advantage Banner Health Network (BPHO) United Medicare Complete Blue Medicare Advantage United Commercial BHN | Aetna Narrow Ntwk Banner |

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