Forms To Fill Out(For New Patients Only)

Please print from your computer, fill out and bring to your visit. Doing so will reduce the wait time to see Dr. Albornoz on the day of the visit

First Visit Policies

Change of Health Insuranceor New Primary Care Physician

  • Please notify staff of any change in your insurance or primary care physician
  • If your insurance is not accurate you will likely be billed for the total cost of the visit

Appointment Policy

  • Arrive 15 minutes prior to your visit
  • Bring a list of your medications or place all of your medicines, prescription and over-the-counter in a bag
  • If required by your insurance, remember to bring a referral and confirm that it has not expired.
  • Obtaining and verifying that your referral is in order is the sole responsibility of the patient. Regretfully, due to contractual agreements, you will not be seen without a referral.
  • Our office will call you 48 hours prior to your visit. Please provide the phone number that will give us the greatest opportunity of reaching you.
  • Co-pays
    • Payment is expected at the time of service.
    • Acceptable forms of payment include cash, check or Visa/MasterCard/AMEX/Discover.
    • Physicians have a contractual obligation to collect co-pays. Doing otherwise can result in significant administrative and financial penalties for the practice.

Appointment Checklist


  • We fully understand that at some point you may have to cancel an appointment. However, if you do not call to cancel, your time slot cannot be used by the many patients on our cancellation list. Remember, it takes only 30-60 seconds to call and notify you will be cancelling. Please be considerate.
  • Cancelling 24 hours prior to your visit will not incur a charge
  • Same day cancellation will incur a $50 charge

Cancellation List

  • On most days there will be an opening due to a cancellation. If not, you will be placed on cancellation list.
  • Priority to see Dr. Albornoz will be assigned to those on the cancellation list. Therefore, we encourage you to call--the earlier, the better.
  • Every effort is made to accommodate patient requests. Your feedback is always encouraged

Insurances We Do Not Accept

  • Keystone First
  • Keystone Connect
  • Keystone VIP Choice
  • Medicaid
  • Humana
  • Coventry
  • United Healthcare Compass
  • Gateway
  • Health America
  • Health Partners

Languages Spoken by Dr. Albornoz

  • Spanish: Fluent
  • French & Italian: Conversant
  • Portuguese: Basic

Office Policies

  • Rheumatology Medical Specialists strictly adheres to all federal cybersecurity Personal Health Information (PHI) regulations. We have taken numerous measures to protect your privacy, including, but not limited to, multi-tier password protection of Electronic Medical Records (EMR), staff education and regular EHR security upgrades. Patient confidentiality is one the pillars of a fruitful long-term Patient-Physician relationship.
  • We suggest arriving 15 minutes prior to your visit. Arriving late will likely result in a longer wait time to see Dr Albornoz or the need to be rescheduled
  • $50 Administrative Fee
  • No charge for simple excuse from work or jury letter, physician signature and basic office information (eg, address, phone number)
  • Fees for 1 page: $10
  • Fees for 2 pages: $ 20
  • Fees for > 3 pages: $30
  • Pennsylvania has put a computerized system in place that requires all physicians to provide the name, dosage and number of narcotics and sedatives prescribed to each patient on every visit.
  • Barring an urgent medical event, narcotics and sedatives must be obtained ONLY from the physician who is principally in charge of pain management.
  • Non-adherence to narcotic and sedative policy, either on the part of the physician or patient, can result in significant sanctions to the prescribing physician. Accordingly, infractions of this policy on the part of the patient cannot be tolerated and may ultimately result in dismissal from the practice.

No-Show for Scheduled Visit Policy

  • Explanation about what a No-Show means:
    • Failing to appear to your visit without calling our office to cancel or reschedule an appointment.
  • Consequence of New Patient No-Show:
    • Due to the busy nature of the practice, we reserve the right to not reschedule your appointment.
  • Follow-up Patient No-Show:
    • If you fail to keep your appointment without notifying our office more than 2 times in one year you will be permanently retired from the practice. A certified letter will be sent to you with an explanation of our actions and your right and options

Office Address

Riddle Memorial Hospital Office (Main Office)
1088 W. Baltimore Pike. Suite 2105 Health Center II
Media, PA 19063

Phone # (610) 565-2415
Fax # (484) 444-0111

Mercy Fitzgerald Hospital Office
1503 Lansdowne Ave. Suite 3010
Darby, PA 19023

Phone # (610) 237-5801
Fax # (610) 237-5802