Athena Women’s Institute for Pelvic Health

151 Fries Mill Road, Suite 301

Turnersville, NJ 08012

Phone: 856-374-1377 Fax: 856-374-2177

Please read, complete and sign the following before arriving to your appointment:

  • Partners in Health Agreement
  • Patient Registration Form
  • Mission Statement Receipt
  • Financial Policy
  • Insurance Authorization
  • Consent for Treatment
  • HIPAA / Authorization regarding Medical Information
  • Bladder Diary
  • Patient History
  • Complete ALL questionnaires that apply

The staff at Athena Women’s Institute for Pelvic Health

looks forward to being involved in your care.

Timothy B McKinney, MD 151 Fries Mill Road ● Suite 301

Elizabeth Babin, MD Turnersville ● NJ ● 08012

Linda Narcisi APN ph: (856) 374-1377

fx: (856) 374-2177

Welcome to our family!

Dear Patient,

We intend to provide you with the care and service that you expect and deserve. Achieving yourbest possible health

requires a partnership between you and your doctor. As our partner in health, we ask you to help usin the following ways:

Be sure your referral paperwork is here the day before your initial appointment:

To avoid being responsible for the entire cost of my visit, I understand that I am responsible for checking with my primary care physician or insurance company to find out whether or not a referral is necessary for my visit. I will also be sure to check my

insurance card to verify whether or not a copay will be due at the time of my visit. I realize that I am coming to a “specialist office”

and the copay may differ from regular “office visits.”

Keep follow-up appointments and reschedule missed appointments:

I understand that my doctor will want to know how my condition progresses after I leave the office. Returning to my

doctor on time gives him or her the chance to check my condition and my response to treatment. During a follow-up appointment,

my doctor might order tests, refer me to a specialist, prescribe medication, or even discover and treat a serioushealth condition.

If I miss an appointment and don’t reschedule, I run the risk that my physician will not be able to detectand treat a serious health condition. I will make every effort to reschedule missed appointments as soon as possible.

Call the office when I do not hear the results of Labs and other tests:

I understand that my physician’s goal is to report my lab and test results to me as soon as possible. However, if I do not hear

from my physician’s office within 2 weeks, I will call the office for my test results. No news is exactly that, I will not assume that

if I do not hear from you that my results are normal.

Inform my doctor if I decide not to follow his or her recommended treatment plan:

I understand that after my examination, my doctor may make certain recommendations based on what he or she feels is best

formy health. For the same reasons it is important to come to my follow up appointments, it is important for me to follow my

treatment plan. I understand that not following my treatment plan can have serious negativeeffects on my health. I will let my

doctor know whenever I decide not to follow his or her recommendation so that he or she mayfully inform me of any risks

associated with my decision to delay or refuse treatment. Finally, I understand the importance ofproviding a full and complete

medical history. All conditions and symptoms of which I am aware will be disclosed in my medicalhistory questionnaire.

Consent for Off-Label Use of Medication:

Many medications are prescribed routinely for “off-label” used. This means that the medication (or device) is FDA approved,

but the use for which it is being prescribed is not specifically in the package labeling on the Physician’s Desk Reference. Such prescriptions are extremely common and considered appropriate in the medical profession by the FDA and off-label uses are

part of routine medical practice. I understand that my physician may prescribe an approved medication for an off-label use when

the potential benefits to me outweigh any potential risks, and that any significant risks or alternatives will be explained to me.

Patient Signature______Date______

Patient Name Printed______

Timothy B McKinney, MD 151 Fries Mill Road ● Suite 301

Elizabeth Babin, MD Turnersville ● NJ ● 08012

Linda Narcisi APN ph: (856) 374-1377

fx: (856) 374-2177

DIRECTIONS TO OUR OFFICE

FROM ROUTE 42 SOUTH:

Follow Rt. 42 South until the fork in the road (to the left is Atlantic City Expressway to the right is where 42 merges with the Black Horse Pike) stay to the right (which is actually straight on) and follow the Black Horse Pike. Follow the Black Horse Pike and Fries Mill Road will be on the right hand side. (You can only turn right at this light) Slight right onto Fries Mill Road and our complex is right before Able Imaging on the right hand side.

FROM WEST BLACK HORSE PIKE:

Head East on Black Horse Pike, follow until Watson Road (there is a Target & a Lowes at this light) make a left. Follow until the end of the road (Fries Mill Road) Make a right onto Fries Mill Road. The University Executive Campus is down on the left hand side right after Able Imaging.

FROM ATLANTIC CITY EXPRESSWAY (toward Camden/Philadelphia):

Take the CR-689 exit, EXIT 41, toward Berlin/Cross Keys/Gloucester Twp/Winslow Twp. Turn left at light onto Berlin Cross Keys Rd/Cross Keys Rd. Berlin Cross Keys Rd/Cross Keys Rd becomes Cross Keys-Berlin Rd. Cross Keys-Berlin Rd becomes Cross Keys Byp. Turn right onto Hurffville-Crosskeys Rd. If you reach Oak Ridge Ln you've gone too far. Take the 1st right onto Fries Mill Rd. The University Executive Campus is down on the left hand side right after Able Imaging.

Please Note:

We are the 2nd right turn once in the complex. We are the last building on the left Suite 301.

Timothy B McKinney, MD 151 Fries Mill Road ● Suite 301

Elizabeth Babin, MD Turnersville ● NJ ● 08012

Linda Narcisi APN ph: (856) 374-1377

fx: (856) 374-2177

Office Policies

Office visits:

•For your first visit, we recommend that you arrive 30 minutes prior to your scheduled appointment. This will allow for completion of paper work, insurance verification, and a timely start with your practitioner.

•Follow up visitsit is recommended that you arrive 15 minutes prior to your visit for the same reasoning.

•We will do our best at providing you with timely medical care. As a specialist, emergencies do occur, which can affect the flow of your visit.We will do our best to keep you informed of how this may affect your visit. If we run more than one hour behind in appointments or if we need to be out of the office, you will be notified as soon as possible and given the opportunity to reschedule your appointment.

•In addition, we try to give you our undivided attention during your scheduled time. We also want to make sure you are satisfied with your medical care. Sometimes this might make your appointment run over into someone else’s session. We try to keep this to a minimum. Please be patient if your time is affected because you too will be given the same opportunity. If your visit is more complicated and requires more time than scheduled you may be asked to schedule another appointment to address all of your concerns in a timely manner without affecting another patient’s time.

Routine Care, Simple Bladder Infections:

We are a specialist office treating complicated pelvic conditions. We highly recommend that you have a Primary Health Care Practitioner/Family Doctor, who will schedule and perform routine testing, lab work, and yearly physical exams. Let your Primary Physician determine at which point you will need to follow up with a specialist such as our Practitioners. Please follow this policy unless otherwise notified by our office.

IF HOWEVER YOU ARE A PATIENT WHO SUFFERS FROM CHRONIC OR RECCURING UTI’S, PLEASE CALL OUR OFFICE WITH QUESTIONS AND DROP OFF A URINE SAMPLE FOR CULTURE ANYTIME SYMPTOMS ARISE.

Late, Cancellations or No Shows:

Because of the number of patients that need to be seen, please be courteous and let us know as soon as possible if you need to cancel or reschedule your appointment.

Late: If you are more than 15 minutes late for an appointment you will be asked to reschedule your appointment. Repetitive tardiness may be grounds for dismissal from the practice with 30 days notification.

Cancellations & No Shows:Repetitive cancellations and no shows will be grounds for dismissal from the practice with 30 days notification.

If you cancel with less than 24 hour notification or no show for your scheduled appointment you will be charged to following fees:

Biofeedback/Physical Therapy$ 25.00

Office Visits & Consultations$ 75.00

Testing such as Urodynamic & Cystoscopy $150.00

IF YOU CANCEL ANY PROCEDURE TAKING PLACE AT THE HOSPITAL OR SURGICAL CENTER WITH LESS THAN A WEEKS (7 days) NOTICE YOU WILL BE RESPONSIBLE FOR A $250.00 FEE REQUIRED BY OUR OFFICE.

Hours of Operation:

Hours are by appointments only. The general office hours are Monday – Friday 8:00am-5:00pm. We do not accept walk-in patients. Hours may change based on physician availability, surgical schedules, and holidays. For details, please call and speak to our staff.

Appointments are scheduled for evaluations, consultations, testing, treatments and surgery. Please be advised that all questions and concern should be addressed during your scheduled time.

Phone Call Policy:

Our staff will do their best to address any questions or concerns you may have over the phone. Please make an appointment to review your concerns in person. Lab results can be given over the phone by a member of our staff with the approval of a practitioner. However, detailed review of these findings requires an office visit. Prescriptions and refills will only be addressed during normal business hours.

We reserve the right to charge for phone calls to our office. If your insurance does not cover this, you will be responsible for this charge. The amount will be due before your next office visit.

Timothy B McKinney, MD 151 Fries Mill Road ● Suite 301

Elizabeth Babin, MD Turnersville ● NJ ● 08012

Linda Narcisi APN ph: (856) 374-1377

fx: (856) 374-2177

Mission Statement: (See also the receipt of this Mission Statement)

The staff and practitioners at Athena Women’s Institute for Pelvic Health are dedicated to providing you with the most up-to-date treatment options for your female healthcare needs. We are a “group” medical practice which means we work as a team to provide excellent care. In our team approach, your appointments will be scheduled at your convenience. We will strive to have you meet as many of our practitioners as possible. However, we cannot guarantee that you will have the same practitioner at every appointment, but please be aware that every practitioner is aware of your care and has full access to your medical records.

Athena Women’s Institute for Pelvic Health is a practice specializing in female pelvic medicine, urogynecology, reconstructive surgery and advanced gynecology. We are considered specialists; therefore this may affect your insurance co-payments and need for referrals. We highly recommend that you have a primary health care physician for your routine needs.

Emergency Policy:

•A practitioner will be on call 24 hours a day for emergencies. Though difficult to fully explain in this small area what constitutes an emergency, the easiest rule of thumb is to evaluate anything you may consider going to the emergency room or calling 9-1-1 for. If your concern falls into this category, please call our practitioners or seek appropriate care.

•There is a $25.00 fee for non-emergent after hours phone calls. Please call us during normal business hours. Monday through Friday 8am to 5pm.

•Outside of this definition, if your concern can wait until normal business hours, then please address these concerns when the office is open.

•Surgical patients will be given specific post-operative instructions indicating if and when they should call for emergencies. Please refer to this paperwork.

•Emergency calls will be returned as soon as possible. If you do not hear from one of our practitioners within one hour, please call the answering service back, call 9-1-1 or go to the nearest emergency room.

•When calling, PLEASE REMOVE CALL BLOCK FROM YOUR PHONE. IF THIS IS NOT REMOVED OUR PRACTIONERS WILL NOT BE ABLE TO CALL YOU BACK.

•When calling, please be available to speak to the doctor. The doctor may have questions for you that a family member will not be capable of answering.

•If you are instructed to go to the emergency room, please do so. We do not make these decisions lightly. Failure to follow such directions may result in severe consequences to your health.

•When going to an emergency room, have available all current medications and be able to provide a list of medical conditions and past surgeries. It is also helpful to have your pharmacy phone number for any prescription needs. The emergency room physician will be the doctor who will evaluate you. If need be they will contact your practitioner for added instructions, consultations, and interventions. Please be aware that going to the emergency room or hospital does not guarantee that your practitioner will be there to see you. Your practitioner will be called into the hospital when medically appropriate.

Concerns that do not meet emergency criteria include but are not limited to:

  • Prescription refills
  • Appointments cancellations and scheduling
  • Lab results
  • Birth control
  • Sexual Disorders
  • Constipation in non-surgical patients
  • Temperature less than 100.4
  • Pessary fitting or falling out
  • Bladder infections
  • Vaginal infections

Once again we would like to welcome you to our family. Please feel free to contact us with any further questions or concerns.

You may need to be scheduled for a:

The Urodynamic studyis the name given to a number of tests designed to show how your bladder functions. The main test is called cystometry, which measures your bladder’s ability to store and pass urine.

Why are Urodynamics performed?

Urinary problems, especially incontinence, may affect women of any age. Problems such as these usually increase with age, pregnancy, childbirth and the onset of menopause.

Your symptoms may include:

  • Loss of urine while coughing, sneezing, laughing or exercising
  • Sudden and/or frequent urge to pass urine
  • Getting up at night frequently to pass urine
  • Difficulty in emptying your bladder
  • Recurrent bladder infections

Results from urodynamic tests allow your doctor to demonstrate the reason why you have the symptoms you have, and so offer you the best treatment for your problems.

How is the test performed?

There are several slightly different ways that the Urodynamic testing can be performed, but the principles are the same.

  • You may first be asked to do a series of exercises with a full bladder to see how bad your leakage is. This is called a pad test. Don’t worry, you will not be expected to do anything which you are not normally able to do easily.
  • You will then be asked to pass urine into a special toilet to measure how quickly your bladder is able to empty. You may have a bladder scan immediately after you havepassed urine to assess how well your bladder has emptied.
  • Following this, a small plastic tube called a catheter will be inserted into your bladder so it can be filled with fluid. Two fine soft catheters (sensors) will also be inserted, one into the bladder and the other into the vagina or rectum. These lines will record pressures measured in your bladder and abdomen. The information contained in this brochure is intended to be used for educational purposes only. It is not intended to be used for the diagnosis or treatment of any specific medical condition, which should only be done by a qualified physician or other health care professional.
  • During the procedure you will be asked questions about the sensations in your bladder. You will also be asked to do some of the things which might trigger the problem you have (e.g. cough, strain, jog, stand up, or listen to the sound of running water). Let the person doing the test know when your bladder feels full.
  • Finally, you will be asked to empty your bladder again, with the two fine sensors still in place. The sensors are then removed and the procedure is complete, and you can get dressed.

Are there any alternatives to Urodynamics?

Not everyone with bladder symptoms will need to have Urodynamics. If simple conservative management such as altering your fluid intake, exercises and/or medicine fails, then Urodynamics is the best way that your bladder function can be properly measured, and treatment tailored to your particular problem.

Are there any risks?

No matter how carefully the test is performed urine infections can sometimes occur after it. You should drink more water than usual for a day or two to flush out any bacteria. You may be advised to take tablets of antibiotics for a short period of time after the test to prevent infection.

What to expect afterwards?

Passing urine may sting a little for a day after the test, but if you think that you have developed a urine infection please let your doctor know.