Patient Information & Forms

We've included important patient information and forms pertaining to care at Partners in Women's Healthcare, P.C. We look forward to making your experience as nice and friendly as possible.

Call 717-737-4511 

and schedule your

appointment today.

Privacy Policy Overview



Effective: May 1, 2017


Partners in Women’s Healthcare is required by law to maintain the privacy of its patients’ protected health information (“PHI”) and to provide each patient with notice of our legal duties and privacy practices with respect to PHI under the federal Health Insurance Portability and Accountability Act of 1996, as amended (“HIPAA”), and the HIPAA Privacy and Security regulations.

The terms of this Notice of Privacy Practices (“Notice”) apply to Partners in Women’s Healthcare, and the employees, staff, volunteers, and other personnel whose work is under direct control of Partners in Women’s Healthcare. All Partners in Women’s Healthcare personnel may share certain information with each other for treatment, payment or health care operations, as described in this Notice. Partners in Women’s Healthcare is required to abide by the terms of this Notice.

Partners in Women’s Healthcare will be referred to as “we”, “us” or “our” in this Notice. More...

New Patient Information

Welcome to our practice! We look forward to meeting you on your scheduled appointment at one of our four locations.

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.


You have health insurance. But insurance benefit plans are complicated. How do you know what will be covered, and what does it mean when you receive a bill?

 The following information is intended to help you better understand the elements of your insurance plan, and circumstances under which you may be responsible for a portion of the cost of your healthcare.

What does it mean for a service to be a “covered benefit”?

A “covered benefit” means that your insurance company believes that the service is medically appropriate care for you, and your employer has agreed to include that service on your benefit plan. More...


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) infertility. 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 medications 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.


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 co-pays be paid at time of service. If we do NOT participate with your medical insurance, office visits must be paid at time of service.


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


As you probably already know, Partners in Women’s Healthcare, P.C. 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 Women’s Healthcare, P.C. have 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, P.C. 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 in our office 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!


Robert delRosario, MD

Corporate President

Circumstances may arise that requires a patient to transfer their medical care to another physician. Such reasons may include moving out of the area or a change of medical insurance that Partners in Women's Healthcare, P.C. is not a participating provider. In order for the patient to obtain a copy of their healthcare information, an authorization form from our office must be accurately completed.

Please make certain the form is completed in its entirety with special attention made to authorizing the release of information regarding the four specially protected areas: substance abuse, mental health, HIV and sexual abuse. In order for this authorization to be valid, the patient’s signature must be witnessed.

Be aware there may be costs associated to the photocopying of the medical record. Usually it is not necessary to request the entire medical record, but only the pertinent or more recent health information (past three years). We request two weeks advance notice to prepare the medical records.

Primarily for security reasons, but also to reduce costs; we request the patient pick-up their medical records from our office. Photo identification is required at the time of pick-up. If there are any questions regarding this process, please, do not hesitate to call our office at 717-737-4511.