Dallas-Fort Worth Patient Forms

MRI Registration

X-Ray Registration

CT Registration

Ultrasound Registration

Mammo Registration

Bone Densiy Registration

This Privacy Notice is being provided to you as a requirement of a federal law, the Health Insurance Portability and Accountability Act (HIPAA). This Privacy Notice describes how we may use and disclose your protected health information to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law. It also describes your right to access and control your protected health information. Your “protected health information” means any written or oral information about you, including demographic data that can be used to identify you, created or received by your health care provider, which relates to your past, present, or future physical or mental health or condition.

Federal law requires that we maintain the privacy of your protected health information, provide you with notice of our legal duties and privacy practices with respect to protected health information, and notify you following a breach of your unsecured protected health information.