Acknowledgement and Consent
I understand Columbia River Health (CRH) will use and disclose health information about me.
I understand my health information may include information both created and received by the practice, may be in the form of written or electronic records or spoken words and may include information about my health history, health status, symptoms, examinations test results, diagnoses, treatments, procedures, prescriptions, and similar types of health-related information.
I understand and agree this practice may use and disclose my health information in order to:
- Make decisions about and plan for my care and treatment;
- Refer to consult with, coordinate among, and manage along with other health care providers for my care and treatment.
- Determine my eligibility for health plan or insurance coverage, and submit bills, claims and other related information to insurance companies or others who may be responsible to pay for some or all of my health care,
- Perform various office, administrative and business functions that support my physician's efforts to provide me with, arrange and be reimbursed for quality, cost-effective health care.
Notice of Privacy Practices
I also understand I have the right to receive and review a written description of how this practice will handle health information about me. This written description is known as a Notice of Privacy Practice and describes the uses and disclosures of health information made and the information practices followed by the employees, staff and other office personnel of this practice and my right regarding my health information.
I understand the Notice of Privacy Practices may be revised from time to time and I am entitled to receive a copy of the Notice of Privacy Practices.
I also understand a copy or summary of the most current version of CRH's Notice of Privacy Practices in effect will be posted in waiting/reception area.
I understand I have the right to ask some or all of my health information not be used or disclosed in the manner described in the Notice of Practices and I understand that this practice is not required by law to agree to such requests.
Text Messaging
CRH may use text messaging to send appointment reminders, billing notices, care coordination messages, and other important care-related updates. Participation is voluntary and is not required to receive care. Message frequency may vary. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. Messages may be sent by SMS and/or RCS, which are not fully secure and may not be HIPAA-compliant.
Columbia River Health limits text messages to non-sensitive notifications. Detailed Protected Health Information, or PHI, will be sent through a separate secure messaging channel.
We collect mobile phone numbers only to send patient-related text messages. Your number will not be sold or shared with third parties or affiliates for marketing or promotional purposes, and will not be used for unrelated marketing without your express written consent.