PATIENT FORMS

At your initial appointment, you will need to bring your insurance cards, picture I.D., and the new patient paperwork. This paperwork includes a signed and completed New Patient Information Packet and the Acknowledgement Receipt of Privacy Practices form. Also included on this page is the Medical Records Release Form which will allow you to transfer your medical records from your old primary care physician to us.

Privacy Information and Documents

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is federal legislation which has created a national standard for protecting the privacy of a patient's private health information. Germantown Minor Medical has always been careful to protect a patient's privacy and will continue to strive to do so. This page provides helpful information about your privacy rights and certain key forms that you can use in exercising these rights.

Notice of Privacy Practices

HIPAA requires that every healthcare provider create and distribute a Notice of Privacy Practices. This document describes what the provider may do with your Private Healthcare Information and what rights you have regarding these practices.

 Germantown Minor Medicalís Notice of Privacy Practices

Authorization for the Release of Medical Records

One key element in maintaining the privacy of a patient's personal health information is having them authorize the release of information for certain purposes prior to any release occurring. The types of releases that do and do not need authorization are reviewed in the Notice of Privacy Practices mentioned above. We are providing the authorization here so you can download it to fill out at your convenience. This form can be used to transfer your medical records from providers you have seen in the past to our office.

 Germantown Minor Medicalís Medical Records Release Form

For More Information

Many of the elements concerning your privacy can be confusing and no printed document can start to answer all of the questions that might arise. For further information, or to discuss any privacy issue you may have, please call The Privacy Officer at 901-754-8880 or write to:

Germantown Minor Medical
2018 Germantown Road South
Germantown, Tennessee 38138
Monday - Thursday- 8 AM to 7:30 PM
Friday- 8 AM to 5:30 PM
Saturday - Sunday- 8 AM to 3.30 PM

Germantown Minor Medical
2018 Germantown Road South
Germantown, Tennessee 38138

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