Digital Communication Disclosure

AS A PATIENT OF COMPREHENSIVE ORTHOPAEDICS AND MUSCULOSKELETAL CARE, LLC; I AUTHORIZE PRACTICE GROUP TO SEND AND RECEIVE TEXT MESSAGES AND EMAILS TO AND FROM BOTH PATIENT AND PRACTICE GROUP’S BUSINESS ASSOCIATES REGARDING PATIENT’S MEDICAL TREATMENT AND RELATED ACCOUNTING, FINANCE AND DEBT AND UNPAID BILL COLLECTION ISSUES 

Your health care is important to us. In order to provide you with the best possible care, we occasionally send convenient text messages to our Patients about their health care and the products and services we offer. Occasionally these messages contain “protected health information” or “PHI”. PHI includes all information of any kind you provide to the Practice Group to assist the Practice Group in the billing and payments processes and with debt collections. This Notice will tell you about the ways in which we may use and disclose protected health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of such information.

You are currently set to receive text messages for appointment reminders, bill payment, digital statements and information about your health care treatment, but you will not receive text messages about promotions or other services we offer unless you provide consent.

As a patient of Comprehensive Orthopaedics & Musculoskeletal Care, LLC, please state your preference to have my physician, and other staff at the Practice Group communicate with me by email, SMS text messaging, telephone communication regarding various aspects of my medical care, which may include, but shall not be limited to, test results, prescriptions, appointments, accounting and billing and debt collection which might include disclosure of my financial information.

I understand that my cellular service provider may charge me a fee for transmitting and delivering text messages. To opt out of receiving text messages and email messages from the Practice Group, I understand that I am required to send an email to Info@COMCLLC.COM requesting that the Practice Group stop sending me text messages and email messages. I understand that if either my cellular number or email address changes that I will notify the Practice Group of such changes.

Patient Understanding The Risks of Sending E-Mails and Text Messages

I understand that email and standard SMS text messaging are not confidential methods of communication and may be insecure. I understand these risks as explained to me and I still prefer to receive communication via text or email, notwithstanding the risks.

Patient Releasing Practice Group From Liability For Damages Suffered By Patient In The Event Any Patient E-Mails or Text Messages Are Lost, Stolen or the Subject of a Data Breach or Cyber Attack

 I understand that emails and text messages sent by the Practice Group to me and also messages sent by me to the Practice Group may be communications that are insecure and that these messages might be intercepted and read or disseminated by a third party. Notwithstanding the Practice Group’s obligations under HIPAA, I agree that the Practice Group is not liable for any damages that I might suffer or incur in any manner with regard to any emails or text messages sent to me by the Practice Group or for any emails or text messages sent by me to the Practice Group that might be intercepted, read or disseminated by a third party. I further agree that the Practice Group is not liable for any damages I might incur in the event my email account or cellular phone are the subject of a cyber-attack or data breach or if I share any text messages or email messages with a third party that I receive from the Practice Group.

Practice Group To Send Patient Information To Third Party Business Associates That May Contain PHI

Business Associates. I consent for the Practice Group to disclose my PHI to its vendors and contractors (“business associates”) that perform functions on the Practice Group’s behalf or provide the Practice Group with services, if the information is necessary for such functions or services. For example, the Practice Group may use other companies to perform billing and accounting services on its behalf or it may use a debt collection agency or law firm who might contact Patient regarding an unpaid medical bill. The Practice Group’s business associates are obligated, under contract with the Practice Group, to protect the privacy of Patient information and are not permitted to use or disclose any information other than as specified in the Practice Group’s contract or as otherwise permitted by federal, state or local law.

Patient Releasing Practice Group of Liability For Any Damages Suffered By Patient As a Result of the Actions of The Practice Group’s Business Associates

I AGREE THAT NOTWITHSTANDING THE PRACTICE GROUP’S OBLIGATIONS UNDER HIPAA THAT IN NO EVENT SHALL THE PRACTICE GROUP OR ITS AFFILIATES BE LIABLE FOR ANY DAMAGES THAT I MIGHT SUFFER (WHETHER CONSEQUENTIAL, DIRECT, INCIDENTAL, EXEMPLARY, INDIRECT, PUNITIVE, SPECIAL OR OTHERWISE) ARISING IN CONNECTION WITH THE ACTIONS OF THE PRACTICE GROUP’S BUSINESS ASSOCIATES, REGARDLESS OF WHETHER SUCH DAMAGES ARE BASED ON CONTRACT, STRICT LIABILITY, TORT OR OTHER THEORIES OF LIABILITY, AND ALSO REGARDLESS OF WHETHER I WAS GIVEN ACTUAL OR CONSTRUCTIVE NOTICE THAT SUCH DAMAGES WERE POSSIBLE.

As a Comprehensive Orthopaedics & Musculoskeletal Care, LLC Patient, I am: (i) acknowledging that I Understand The Risks of Sending and Receiving E-Mails and SMS Text Messages; (ii) Releasing Practice Group From Liability For Damages Suffered By Patient In The Event Any Patient E-Mails or Text Messages Are Lost, Stolen or the Subject of a Data Breach or Cyber Attack; (iii) Giving Consent for Practice Group To Send Patient Information To Third Party Business Associates That May Contain PHI; and (iv) Releasing Practice Group From Liability For Any Damages Suffered By Patient As a Result of the Actions of The Practice Group’s Business Associates.