Authorization for SMS/Text Communications

Information to Be Used and Disclosed

In connection with the telehealth services (the “Care Services”) I am receiving, Pure Access Care of Florida, P.A., and its affiliates, engaged subcontractors, and service providers (collectively, “Pure Access Care”) may choose to contact me via SMS/text messaging at the mobile telephone number(s) I provide. These communications may include, but are not limited to: appointment reminders, prescription refill reminders, test or lab results notifications, care management communications, billing notices, patient experience surveys, and other health-related or operational communications.

By checking the related box, I may also receive marketing and promotional content via SMS/text, such as offers, coupons, information about Pure Access Care services, and messages from pharmacy, pharmaceutical, or laboratory partners of Pure Access Care.

Purpose

As permitted by applicable law, the purpose of this Authorization is to:

• Allow Pure Access Care to send me SMS/text messages related to my care, treatment, and the operation of the Care Services.
• Allow Pure Access Care to send me optional marketing and promotional messages if I have opted in. I understand that Pure Access Care may receive direct or indirect compensation in relation to these marketing messages.
• Allow Pure Access Care to otherwise use my contact information for SMS/text messaging in accordance with Pure’s Privacy Policy.

Your Rights

I understand and agree that:

• Message and data rates may apply from my mobile carrier.
• Message frequency may vary depending on my use of the Care Services.
• I may revoke this Authorization, or opt out of SMS/text messaging at any time by replying “STOP” to a received message or by sending a request to admin@pureaccesscare.com  . My opt-out request will not affect my ability to receive Care Services, though it may limit how I receive certain reminders or communications.
• I may request help regarding text messages by replying “HELP” to any received message.
• Pure Access Care will not condition treatment, payment, enrollment, or eligibility for benefits on my agreement to receive SMS/text messages, unless services cannot be communicated in any other secure way with patients.

Privacy and Security

Please update us right away if your mobile number changes. It is your responsibility to give us a correct mobile number and to update any changes. If you don’t give us your new mobile number, we are not responsible for any text message sent to the wrong number.

We recommend you use a password to open your mobile device. Text messages may include protected health information (PHI). Since text messaging is unencrypted, there is a risk that this PHI could be intercepted or viewed by third parties, including others who look at your device. When you choose to get text messages from us, you do so at your own risk. The use and disclosure of PHI in text messaging may be governed by other privacy notices, including applicable Pure’s Notice of Privacy Practices.

Expiration

This Authorization will remain in effect until I revoke it.

By checking the related box, I am authorizing the use and disclosure of my information as outlined in the [SMS / TCPA Authorization].