FHP Geriatrics - Registration Information 

11007 Northpointe Blvd                                         Phone: 832-599-8336

Tomball, TX 77375                                                 Fax: 888-840-6973 

www.fhpgeriatrics.com                                                     Email: admin@fhpgeriatrics.com

Physicians Collaborative Network 

Do not select boxes below if you have specialists and do not need visiting specialists.  We have a unique network of specialists, exclusive to FHP Geriatrics, who can bring care to where the patient lives, without the stress of transportation or sitting in a doctors office.  In some cases the specialist may not be able to visit, but we can facilitate the appointment, within weeks rather than months.

Our specialists communicate with us and with each other to solve problems. This is uncommon in healthcare.  They help provide more knowledge and more options.  They are able to help prevent hospitalizations.  They also understand when quality of life is preferred over a more aggressive approach.   It may be helpful to have specialist input to reduce medications, or for more accurate prognosis.  

Select any of our mobile specialists that may be needed now or in the near future. After we review, we will send the referral.  From there, the specialist will call or the patient or family is responsible for calling the specialist office to confirm the appointment. Make sure to mention visiting service requested.  Remember, each specialist is unique in their own workflow challenges, and ability to accommodate the unique solutions to providing visiting services. There will be times when waiting for a visit, a problem becomes more serious and more urgent, and the patient must be brought to their office, or to the hospital. 

Please select boxes below if you would like to request a specialist.

Requests are reviewed and sent once per month.  If it has been more than a month and you haven't heard from specialist, please notify us.

Hospice/Palliative Care: Please contact us to discuss further if you feel your family member is at the point where hospitalization is likely to cause more stress, suffering, and they are unlikely to recover to a reasonable quality of life.  Problems and infections are still treated, but we will focus on comfort rather than hospitalization if they continue to worsen.  Hospice can be revoked at any time.  Dr. Valdez is one of few who are also Board-Certified in Hospice and Palliative Care.  We will only continue as primary care for company he is associated as medical director.   If another company is involved, they may have an excellent director, but it is similar to having to great chefs for one recipe.  If things go wrong, we are not familiar with the other company's team or director, and we cannot properly address problems.  If a patient or family chooses another company, Dr. Valdez will turn over all care to that company’s medical director to avoid any confusion in care.  As medical director, he receives a flat fee, and there is no financial incentive to refer patients.  When working with his team, he has clearer communication with the care team members, as well as closer oversight of quality of care.

Treatment Policy

Please be aware that we collect estimated insurance portions at each visit. Your insurance policy is a contract between you and your insurance company. You are responsible for any unpaid balances, regardless of the original estimate of the insurance benefit. As a courtesy to you, we will file your claims with your insurance company. Insurance payments are usually received within 30-45 days. Any unpaid balances after 60 days are your responsibility and are due at that time. All deductibles and co-payments are due at the time of service.  A copy of your insurance card will need to be kept on file in our office.  You are providing consent to services provided in person or via a secure telehealth platform.  Patients with chronic conditions are enrolled in Chronic Care Management and Remote Patient Monitoring program to provide more comprehensive care and anticipate worsening.  You may discontinue at any time, but it has proven beneficial in making better-informed decisions and preventing complications.  A care plan is created and available for review. The care plan includes the patient’s problem list, expected outcome, treatment goals, symptom management, planned interventions, medication management, social services if ordered, and periodic revision of the care plan.  We try to answer any questions you may have about your insurance company, however, you may need to contact your insurance company for additional information. If your insurance changes, it is your responsibility to provide updated information to our office.  Please be aware of your insurance policy regarding a deductible.  The deductible is usually required at the beginning of each calendar year which is payable before benefits are covered.      

Assignment of Benefit

Please read and sign to have our office file your insurance: I authorize the release of information and understand that I am responsible for all costs of medical treatment. I hereby authorize payment directly to George Valdez, MD of the insurance benefits otherwise payable to me.

HIPAA Consent and Acknowledgment

Notice of Privacy Practices. I acknowledge that I have received the practice’s Notice of Privacy Practices, which describes the ways in which the practice may use and disclose my healthcare information for its treatment, payment, healthcare operations and other described and permitted uses and disclosures, I understand that I may contact the Privacy Officer designated on the notice if I have a question or complaint. To the extent permitted by law, I consent to the use and disclosure of my information for the purposes described in the practice’s Notice of Privacy Practices.

Release of Information. I hereby permit practice and the physicians or other health professionals involved in the inpatient or outpatient care to release healthcare information for purposes of treatment, payment, or healthcare operations. Healthcare information may be released to any person or entity liable for payment on the Patient’s behalf in order to verify coverage or payment questions, or for any other purpose related to benefit payment. If I am covered by Medicare or Medicaid, I authorize the release of healthcare information to the Social Security Administration or its intermediaries or carriers for payment of a Medicare claim or to the appropriate state agency for payment of a Medicaid claim. This information may include, without limitation, history and physical, emergency records, laboratory reports, operative reports, physician progress notes, nurse’s notes, consultations, psychological and/or psychiatric reports, drug and alcohol treatment and discharge summary. Federal and state laws may permit this facility to participate in organizations with other healthcare providers, insurers, and/or other health care industry participants and their subcontractors in order for these individuals and entities to share my health information with one another to accomplish goals that may include but not be limited to: improving the accuracy and increasing the availability of my health records; decreasing the time needed to access my information; aggregating and comparing my information for quality improvement purposes; and such other purposes as may be permitted by law. I understand that this facility may be a member of one or more such organizations.

Authorization To Obtain/Release Medical Information

Disregard this section and click 'Submit' if there are no relevant medical records to request.

Please complete this section if you would like to give permission for us to request or send information to other physicians who are or have been involved in the patient's care.

Conditions Of Authorization

I may revoke this authorization in writing. If I do, it will not affect any previous actions already taken in reliance upon my authorization. I may not be able to revoke this authorization if its purpose was to obtain records. I may revoke this authorization by writing a letter and mailing it certified, return receipt requested, to the Privacy Officer at the health provider listed above.   Information used or disclosed pursuant to the authorization may be subject to re-disclosure by the recipient and longer protected by Federal Privacy Regulations. 

This authorization is valid for the release of information as indicated above. Only records from this facility can be legally released. Any record for other physicians must be obtained from them.