Greg Krenek, M.D., P.A.
503 Medical Center Blvd., Suite 140
Conroe, TX 77304
936-756-0668
Patient Confidentiality Statement
Patients of Greg Krenek, M.D., P.A., have the right of patient confidentiality
on all medical information and laboratory results. All information shall be
held in confidence and shall not be disclosed to any persons, except upon the
expressed consent of the patient or by the guidelines of his/her insurance
company. All biopsy, laboratory results or any other medical information
will only be released to the patient unless otherwise noted below. If the
patient is a minor, all information will be explained to the parents or legal
guardian.
______________________________
______________________________ _________________________ Other person(s) who may receive my Patient name printed
medical information, biopsy and
laboratory results.
______________________________ _________________________ Date Signature
(Parent or legal guardian if patient is
a minor)