Consent for Use & Disclosure of Health Information
Purpose of Consent: By registering for HealthwoRx™ Online, you will consent to our use and disclosure of your protected health information to carry out treatment, payment activities and healthcare operations including the use of such information in e-mail communications.
Notice of Privacy Practices: You have the right to read our Notice of Privacy Practices and our E-MAIL POLICY before you decide whether to electtronically sign this Consent. Our notice provides a description of our treatment, payment activities and healthcare operations, of the uses and disclosures we may make of your protected health information, and of other important matters about your protected health information. Our E-MAIL POLICY describes how we communicate via email including the use of your protected health information in such communications. We encourage you to read them carefully and completely before signing this Consent. You may read these policies posted in our waiting room, online, or request a copy of these policies at our front desk.
Notice of E-MAIL POLICY: By establishing an account at HealthwoRx™ Online, you consent to our receipt and transmission of e-mail messages with you, including messages that may contain your protected health information.
We reserve the right to change our privacy practices as described in our Notice of Privacy Practices and/or our e-mail policies as described in our E-MAIL POLICY. If we change our practices, we will issue a revised Notice of Privacy Practices or a revised E-MAIL POLICY which will contain the changes, as applicable. Those changes may apply to any of your protected health information that we maintain.
You may obtain a copy of our Notice of Privacy Practices, including any revisions of our Notice and/or a copy of our E-MAIL POLICY, at any time by contacting us on our contact page or calling 954.967.6550.
Right to Revoke: You will have the right to revoke this Consent at any time by giving us written notice of your revocation submitted to the Contact person listed above. Please understand that revocation of this Consent will not affect any action we took in reliance on this Consent before we received your revocation, and that we may decline to treat you or to continue treating you if you revoke this Consent.
Electronic Signature: By registering online, you agree that you have read and had full opportunity to read the Notice of Privacy Practices and E-MAIL POLICY posted on this website and you may request a copy of this form. You understand that, by establishing an account at HealthwoRx™ Online, you are giving consent to HealthwoRx™ to use and disclosure your protected health information and to carry out treatment, payment activities and healthcare operations and to communicate with you via e-mail.