Crescent Clinic
Clinical Excellence, Compassionate Care
Accepting New patients and walk ins
Phone : 832-437-2427
23211 Red River Drive, Katy, Texas, 77494
FORMS
ADVANCE DIRECTIVES
An advance directive is a legal document that tells your family, friends and healthcare professionals the care you would like to have if you become unable to make medical decisions. Through advance directives, you can make legally valid decisions about your future medical treatment.
You do not need a lawyer to complete your advance directives. However, you should be aware that each state has its own laws for creating advance directives.
There are three advance directives recognized in Texas:
· The Texas Medical Power of Attorney appoints someone to speak for you any time you are unable to make your own medical decisions, not only at the end of life. Your attending physician must certify in writing that you are unable to make health care decisions and file the certification in your medical record.
· A living will, officially known in Texas as the Directive to Physicians and Family or Surrogates, describes the kind of medical treatments or life-sustaining treatments you would want if you were seriously or terminally ill. A living will should be signed, dated and witnessed by two people, preferably individuals who know you well but are not related to you and are not your potential heirs or your health care providers.
· The Out-of-Hospital Do Not Resuscitate (DNR) order provides you with the right to withhold or withdraw cardiopulmonary resuscitation (CPR) or other treatments such as defibrillation and artificial ventilation.
By creating an advance directive, you are making your preferences about medical care known before you're faced with a serious injury or illness. This will spare your loved ones the stress of making decisions about your care while you are sick. Any person 18 years of age or older can prepare an advance directive.
In order to make your directive legally binding, you must sign it, or direct another to sign it, in the presence of two witnesses who must also sign the document.
RELEASE OF RECORDS
Request Medical Records
How Can I Obtain A Copy of My Medical Record?
Patients can complete:
· Patient Right to Access: Request for Medical Records form - English
· Patient Right to Access: Request for Medical Records form - Spanish
Crescent Clinic will respond to your request within 15 days. A cost-based fee, including only the cost of labor for the production of the information requested and supplies for creating the information, along with possible postage, may be assessed.
How Can My Medical Records Be Transferred To Another Health Care Provider?
For physicians or health care facilities not affiliated with Crescent Clinic, you can request that we transfer your medical records by completing the form below and faxing it back to the Release of Information Department.
· Patient Request To Have Medical Records Transferred To Another Health Care Provider - English
· Patient Request To Have Medical Records Transferred To Another Health Care Provider - Spanish
In addition, your physician can also ask that your medical records be sent to their office by requesting your medical records on his office letterhead and faxing back to the Release of Information Department.
I am the medical power of attorney. How do I request copies of medical records?
When requesting medical records acting as the medical power of attorney, we will ask that you supply a copy of the medical power of attorney as well as the physician statement citing that the patient is unable to make medical decisions for oneself.
Can I Request an Amendment To My Medical Records?
A patient has the right to request an amendment to information contained within their medical record. Complete the form: Request to Amendment of Protected Health Information.
