Acknowledgement of Receipt of Privacy Practices & Electronic Communication Waiver  

Robin Bone MD & Associates LLC d.b.a Signature Health By Robin Bone, MD, Ms.Medicine and its affiliates, are required by law to maintain the privacy of our patients' protected health information (PHI) and to provide patients with notice of our legal duties and privacy practices with respect to PHI. We are required to abide by the terms of this Notice for as long as it remains in effect. We reserve the right to change the terms of this notice as necessary and to make a new notice of privacy practices effective for all PHI maintained by the Practice. We are required to notify you in the event of a breach of your unsecured PHI. We are also required to inform you that there may be a provision of state law that relates to the privacy of your health information that may be more stringent than a standard or requirement under the Federal Health Insurance Portability and Accountability Act (“HIPAA”). A copy of any revised Notice of Privacy Practices or information pertaining to a specific State law may be obtained by mailing a request to the Privacy Officer at the Practice address.  

Text Messaging & Mobile Information Privacy
 
We respect your privacy. No mobile information will be shared with third parties or affiliates for marketing or promotional purposes.  

Information sharing with subcontractors in support services (such as customer service, secure messaging platforms, electronic health record vendors, and telecommunications providers) is permitted as necessary to provide services on our behalf.  

Text Messaging Opt-In Data Protection
 
All text messaging originator opt-in data and consent information will not be shared with any third parties, excluding aggregators and providers of the Text Message services.  

Text messaging originator opt-in data and consent will not be shared with any third parties, excluding aggregators and providers of the Text Message services.  

We do not sell or rent personal information, including mobile numbers or messaging consent, to third parties.  

I understand that by choosing to provide a wireless telephone number or email address I consent to receive calls, text, messages, or emails- including but not limited to communications regarding appointment reminders, billing, payment, and information related to my Protected Health Information (PHI) unless I notify the Practice in writing. Such calls, text messages, or email may be delivered via artificial or pre-recorded messages, automatic telephone dialing devices, or any other forms of electronic communication from the Provider, its affiliates, contractors, or agents (including collection agencies). I understand that by signing below I acknowledge and expressly waive the Practice or Provider’s obligation to guarantee confidentiality with response to any of these correspondences and grant permission for the Practice, Provider, or affiliate to respond in kind via your chosen platform.