MARKETING CONSENT FORM

Urgent Care 24/7, and its AffiliatesPatient Consent for Use and Disclosure Of Protected Health Information

I understand that HIPPA stands for Health Insurance Portability and Accountability Act and that law affords me privacy and security protections for my health information. HIPPA guidelines provide that if a patient is made aware of risks of unencrypted emails and text messages, but that same patient provides consent to receive health information through email or text messages the health provider may communicate with the patient and transmit personal medical information through unencrypted email or text messages. I am aware that some of the most popular email service providers such as Gmail, Yahoo, and Hotmail do not utilize encrypted email.
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Email and text messages are a very popular and convenient way to communicate for a lot of people, so in their latest modification to the HIPAA act, the federal government provided guidance. The information is available at the U.S. Department of Health and Human Services website: https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/index.html

When Urgent Care 24/7, and its Affiliates send you an email, or you send us an email, the information that is sent is not encrypted. This means a third party may be able to access the information and read it since it is transmitted over the Internet. In addition, once the email is received by you, someone may be able to access your email account and read it.
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The guidelines state that if a patient has been made aware of the risks of unencrypted communications, and that same patient provides consent to receive health information via email, text message, telephone, or facsimile then a health entity may send that patient personal medical information in such a manner with the implementation of appropriate safeguards to protect patient privacy.
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HAVING REVIEWED THE NOTICE OF PRIVACY PRACTICES, THE INFORMATION CONTAINED IN THE PATIENT HIPPA CONSENT FORM, AND THIS MARKETING CONSENT FORM, I CONSENT TO ALLOW UNENCRYPTED EMAIL, TEXT MESSAGES, FACSIMILES AND VOICEMAILS FROM URGENT CARE 24/7, AND ITS AFFILIATES FOR THE PURPOSE OF MARKETING UNTIL SUCH TIME THAT I ELECT TO OPTION OUT OF SUCH COMMUNICATIONS.