Fort Worth Dermatology Associates, РА
Fort Worth Dermatology Associates uses electronic communications, such as phone calls, email and text/SMS messaging to communicate with patients. This Electronic Communication Informed Consent form ("Consent Form") is used to explain what kinds of electronic communications we intend to send you, memorialize your consent to receiving certain electronic communications or whether you choose to opt-out of receiving certain electronic communications. It provides information about the risks and guidelines of the use of electronic communications.
We provide 2 categories of electronic communications, Business Transactional Electronic Messages and Marketing or Commercial Electronic Messages.
We send Business Transactional Electronic Messages to better assist in our service to our patients. Business Transactional Electronic Messages facilitate, complete, or confirm a previously agreed upon medical transaction. These messages include specific appointment reminders, payment reminders and follow-up care requests. They may be automatically sent via email, SMS/text message, or phone call to the email and/or phone number that we have on file for you. For convenience, our office may use pre-recorded, artificial voice messages and/or automatic dialing technology to send these messages. If you would like to limit the amount or type of Business Transactional Electronic Messages you may receive, please speak to one of our staff members, who will by happy to assist you.
Periodically we may use Marketing or Commercial Electronic Messages. There are electronic messages that do not directly involve an existing medical transaction, including general reminders to schedule new appointments, advertisements of new services or other offers, or messages providing health tips. Our office may automatically send these messages via email, SMS/text message, fax message and/or phone call to the email address and/or phone number we have on file for you. For purposes of convenience, we may use prerecorded voice messages, artificial voice messages and/or automatic dialing technology to send these messages. Please indicate below whether you consent to receive or opt out of these messages. Please note that your decision regarding these type messages will not affect the service provided to you by our office in any way.
Fort Worth Dermatology Associates uses electronic communications methods to communicate with patients regarding their healthcare. Some of the methods that we use are unencrypted and unsecured in nature, such as regular email service and/or text/SMS messaging. We use these methods of electronic communication only to communicate with patients about non-sensitive and non-urgent issues. All electronic communications to or from you may be made a part of your medical record to which you have access. We will not disclose electronic communications to or from you or your identifiable information to third parties without your consent, except as authorized by law. We are not liable for breaches of confidentiality caused by you or any third party. If you have a medical emergency CALL 911. Do not use electronic means other than direct phone calls to communicate urgent medical problems or to discuss complex or sensitive information; please call our staff directly. Although we try to respond to email messages daily, we cannot guarantee that any email will be read and responded to within any particular period of time. It is your responsibility to follow up with our staff if you do not receive a timely response.
You should be aware that the use of unsecured and unencrypted electronic communications has a number of risks that you should consider. These risks include, with limitation the risk fo the electronic communications being circulated, forwarded or broadcasted to unintended recipients, the risk of misaddressing an electronic communication to an unintended recipient, the risk backup copies of emails and text/SMS messages existing even after deletion, the risk of such electronic communications being intercepted, altered, forwarded or used with authorization or detection and the risk of a third party breaching the confidentiality of such electronic communications; Please note that although we will us reasonable means to attempt to maintain the security and confidentiality of the electronic communications, we cannot make any guarantees, and therefore disclaim any liability in connection with these risks, which you hereby acknowledge and accept.
By signing below, I acknowledge that I have read, understand, and accept the terms of this Consent Form.
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