Notice of Privacy Practices
Effective Date January 1, 2021
THE NOTICE OF PRIVACY PRACTICES DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
If you have any questions about this Notice of Privacy Practices, please contact 1-877-BMH-TIPS and choose Option 3 during regular business hours. If necessary, your question may be directed to the Privacy and Security Officer, or their designee, at the hospital, clinic, doctor’s office, or other health care entity to which your question refers. The BMG Family Physicians Group HIPAA Privacy Officer may be contacted at 901-751-5528. You may also contact the Corporate Privacy and Security Department at Baptist Memorial Health Care Corporation, 350 N. Humphreys Blvd., Memphis, TN 38120.
Efectivo el 1 de Enero de 2021
EL AVISO DE PRIVACIDAD DESCRIBE CÓMO SE PUEDE UTILIZAR Y DIVULGAR LA INFORMACIÓN MÉDICA SOBRE USTED Y CÓMO USTED PUEDE TENER ACCESO A ESTA INFORMACIÓN. POR FAVOR REVISARLO DETENIDAMENTE.
Si tiene alguna pregunta sobre este Aviso de privacidad, comuníquese con 1-877-BMH-TIPS y elija la opción 3 durante el horario comercial habitual. Si es necesario, su pregunta puede dirigirse al Oficial de Privacidad y Seguridad, o su designado, en el hospital, clínica, consultorio médico u otra entidad de atención médica a la que se refiere su pregunta. Puede comunicarse con el oficial de privacidad de BMG Family Physicians Group HIPAA en 901-751-5528. También puede comunicarse con el Departamento de Seguridad y Privacidad Corporativa al Baptist Memorial Health Care Corporation, 350 N. Humphreys Blvd., Memphis, TN 38120.
NEW PATIENT FORMS
In order to save time when arriving for your first appointment, we have made available all of the standard forms that The Family Physicians Group will need to establish your medical record, and bill your insurance.
Each patient being seen will require one copy of the following forms filled out to place in your medical record. In addition, please bring with you a copy of your latest INSURANCE CARD and a PHOTO ID for identification purposes. For parents bringing in minor children under the age of 16, we will need your photo ID and consent to treat your child.
These forms require Adobe Acrobat Reader v9.0 or equivalent application to read and print.