Consent for Patient Reminders and Notifications

Terms and Conditions.

·         You are consenting to receive unencrypted email, text, voice, and pre-recorded messages from your healthcare provider that may contain health related information or healthcare management advice at the telephone number(s) and/or email that you have provided.

·         You understand that such methods of delivery may be unsecure and may be intercepted by unrelated third parties.

·         By accepting these terms, you agree that we may send you automated voice and text messages through your wireless provider to the valid mobile or landline number and email to the email address that you have provided us.

·         You agree to indemnify, defend, and hold your healthcare provider, its technology service vendors, Healow LLC and Broadvoice LLC, our electronic medical record vendor, eClinicalWorks LLC, and its affiliated companies harmless from any third-party claims, liability, damages or costs arising from your request to receive emails, automated voice or text messages or from providing your healthcare provider with a phone number that is not your own.

·         You agree that your healthcare provider and its technology solution vendors will not be liable for failed, delayed, or misdirected delivery of, any information sent to you or from you, including opt-out requests.

·         You must be 18 years or older in order to participate or have the express permission of a parent/guardian (but in any case, you must be at least 13 years old).

·         You understand that you are not required to consent in order to receive medical care and advice from your healthcare provider.

·         This is a standard-rate messaging program where message and data rates may apply. Frequency of messages may vary depending on the number of messages that you are due to be sent by your healthcare provider.

·         You may opt out at any time. Supported carriers include AT&T, Verizon Wireless, T-Mobile®, Metro PCS®, Sprint, Boost, Virgin Mobile, U.S. Cellular®, and others. Additional Carriers may be added at any time. Carriers are not liable for delayed or undelivered messages.

·         If at any time you wish to stop receiving text messages from us, you can text STOP on reply to a text message that you receive from us. Upon texting STOP, your phone number will be unsubscribed from this service, and you will not receive any further health and wellness messaging notifications via text. 

I have read the consent form and the above information, and I accept the conditions.   

Please DO NOT use Patient Portal to communicate with your Practice for urgent or emergency medical issues. If you are experiencing an urgent medical need, please contact us by phone. For emergencies call 911.

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Patient Portal User Agreement and Consent

·         The Patient Portal (defined below) is owned and operated by ENHANCED WELLNESS OF OAK GROVE PLLC to which you are seeking online access (the Practice).

·         The Practice has adopted this user agreement (User Agreement) to make you aware of the terms and conditions of your use of the Patient Portal and any derivative websites of the Patient Portal (collectively, the Patient Portal).

·         In the event that you purport to be the agent of, represent, or otherwise act on behalf of any other person, references to you, your or User shall include such entity or person in addition to such representative, and your acceptance of this Agreement shall constitute acceptance on behalf of such person.

·         The Practice uses reasonable efforts to maintain the Patient Portal, but the Practice is not responsible for any defects or failures associated with the Patient Portal, any part thereof or any damage (such as lost profits or other consequential damages) that may result from any such defects or failures.

·         The Patient Portal may be inaccessible or inoperable for any reason, including, without limitation: (a) equipment malfunctions, (b) periodic maintenance procedures or repairs which the Practice may undertake from time to time or (c) causes beyond the control of the Practice or which are not foreseeable by the Practice.

·         In addition, the Practice makes no guarantees as to the web sites and information located worldwide throughout the Internet that you may access as a result of your use of the Patient Portal, including as to the accuracy, content, or quality of any such sites and information or the privacy practices of any such site.

·         The Practice is not a backup service for storing data you submit to the Patient Portal, and the Practice shall have no liability regarding any loss of such data.

·         You are solely responsible for creating backups of any data you submit using the Patient Portal.

·         The Patient Portal is a secure website that allows you to use a computer to interact with medical information via the internet.

·         The Patient Portal also allows you to communicate with the Practice via secure messaging. Please note that all communication via the Patient Portal will be included in your permanent patient record.

Responsibilities, Risks and Benefits:

·         The Patient Portal is provided as a convenience to you at no cost and is only available in English at this time.

·          We do not sell or give away any private information, including email addresses.

·         We reserve the right to suspend or terminate the Patient Portal access at any time and for any reason.

·         All messages sent to you will be electronically secure. Messages and emails from you to any staff member must be sent through the Patient Portal for security and confidentiality reasons.

·         The Patient Portal messages will be handled by our staff in a manner similar to how phone communication is handled.

·         Although we strive to reply to Patient Portal messages within one business day, we cannot guarantee that we will be able to address your messages in that timeframe.

·         We encourage you to use the Patient Portal at any time but understand that we can only reply to messages during our office hours, excluding holidays recognized by the Practice.

·         If you do not receive a response within two business days, please feel free to call our office.

·         You are responsible for providing us with your correct email address and informing us immediately of any change.

·         You are also responsible for the protection of your login information and password. Please understand that all electronic communications carry some degree of risk, even in a secure environment.

·         Even with all due precautions, online communications may be intercepted, forwarded or changed without a patient or the healthcare providers knowledge.

·         By using or accessing the Patient Portal, you expressly accept these risks. Note that it is easier for a patient’s identity to be stolen or for someone to try to impersonate a patient via online communication.

·         Online communications are admissible as evidence in court just as medical records are in the event the physician- patient privilege is waived or if a court orders disclosure.

·         Online communications may disrupt or damage a computer if a computer virus is transmitted via an attached file, hyperlink or other method. You assume liability for such disruptions or damages caused by such transmissions.

           Responses to online communications are limited by the information provided and your question may necessitate a follow-up phone call or a request to meet with you in person to gain further information.

·         Electronic communications will be viewed by not only the physician, but the staff members assigned to handle such communications and any other provider covering for the patient’s physician if the patient’s physician is unavailable to respond.

·         Applicable law may allow a health care professional to determine that a minor patient is mature to keep a portion of the minors medical information confidential. If the minor patient is determined to be mature by his or her physician, all Patient Portal communication will be with the minor directly and a new consent form with the minor’s email address will be required.

·         Applicable law may also permit confidential communication with a minor patient in regard to treatment and reporting of sexually transmitted diseases to the minor and communications with pregnant minors in regard to questions about the health of her fetus.

·         In these situations, all Patient Portal communications will be directly with the minor and a new consent form with the minor’s email address will be required.

·         The Practice will keep a copy of all medically important online communications in your medical record secure pursuant to applicable federal and state laws and regulations.

·         Print or store in a secure place (on a computer or storage device owned and controlled by you) a copy of all online communications that are important to you.

·         The Practice will not forward online communications with you to third parties except as authorized or required by law.

·         Please note that online communications should never be used for emergency communications or urgent requests.

·         These should occur via telephone or using existing emergency communications tools as noted above.

·         Following up is solely your responsibility. You are responsible for scheduling any necessary appointments and for determining if an online communication did not receive a response.

·         You are responsible for taking steps to protect yourself from unauthorized use of online communications, such as keeping your password confidential.

·         The Practice is not responsible for breaches of confidentiality caused by you or an independent third-party.

Guidelines for Safe Online Communications

·         Take steps to keep your online communications to and from the Practice confidential, including:

·         Do not store messages on your employer-provided devices (e.g. computer, cell phone, tablet, etc.); otherwise, personal information could be accessible or owned by your employer.

·         Use a screen saver or close your messages instead of leaving your messages on the screen for passersby to read and keep your password safe and private.

·         Do not allow other individuals or third parties access to the devices(s) upon which you store medical communications.

·         Keep your login and password information secure and confidential.

·         Do not use email for medical communications.

·         Standard email lacks the necessary security and privacy features and may expose medical communications to employers or other unintended third parties.

Access to Online Communications

·         The following pertains to access to and use of online communications:

·         Online communications do not decrease or diminish any of the other ways in which you can communicate with your provider.

·         It is an additional option and not a replacement.

·         The Practice may stop providing online communications with you or change the services provided online at any time without prior notification to you.

 I acknowledge that I have read and fully understand the Patient Portal User Agreement and Consent.

I have read and understand the responsibilities and benefits of the Patient Portal and understand the risks associated with online communications between me and my physician’s office.

I consent to the conditions outlined and I agree to keep my password confidential and notify the office if my email address changes at any time.

I have had a chance to ask any questions that I had and to receive answers.

I have been proactive about asking questions related to this Agreement.

All of my questions have been answered, and I understand and concur with the information. I am over the age of 18 and have sole responsibility of my medical care.

 I have read the consent form and the above information, and I accept the conditions.

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STATEMENT OF PATIENT FINANCIAL RESPONSIBILITY

It is the intention of ENHANCED WELLNESS OF OAK GROVE PLLC to provide you with a clear understanding of our financial agreements and billing procedures in the hopes to prevent any misunderstanding. If you have any questions regarding these agreements, please notify the front office coordinator. Please take the time to read, initial, and sign the patient financial responsibility form. If you have medical insurance, it is your responsibility to fill out the insurance details on the patient form. Please provide your insurance card(s) to the front office coordinator to bill your insurance carrier completely and accurately. If benefits cannot be determined at the time of service, or when there is any doubt, payment in full is expected. Please be advised that a medical insurance card does not inform our office of active coverage. Your insurance policy is a contract between you and your insurance company. We are not a party to that contract and therefore do not know the details or specific benefits allowed by your insurer. As a service to you and upon your request we can bill your insurance company. I understand it is my responsibility to verify my insurance coverage prior to my appointment including but not limited to obtaining a PCP referral or prior authorization (PA). If a referral is required, we need to have your referral reference number in hand prior to your appointment date. We cannot attain referrals on the appointment date. You are responsible for payment of any unmet deductible, co-payment, and co-insurance as determined by your contract with your insurance carrier. We expect these payments when services are rendered. Many insurance companies have additional stipulations that may affect your coverage. You are responsible for any amounts not covered by your insurer. If your insurance carrier denies or does not pay in full any part of your claim, you will be responsible for your balance in full. (If ABN/Financial Consent is signed - insurance contractual adjustments do not apply.) There are normal and expected times that we will need to bill your insurance company. However, if there becomes a time when the costs of completing your billing are over and above the usual and customary time spent to process and follow-up on a claim, we will contact you. If at this time payment has not been received by your insurance carrier payment will be expected in full by you and you may pursue collecting personally. If payment is received from your insurance carrier you will be reimbursed. Once payment is received on your behalf from your insurance carrier any balances due for unmet deductible, co- payments, and co-insurance that have not already been collected will be billed to you. After thirty (30) days of the first bill, a per month finance charge will begin to apply on your account per outstanding claim. Any bill over sixty (60) days past due will be subject to collection procedures. If you fail to make payment arrangements or set up a payment plan, your account will be turned over to a professional collection agency. Upon receipt of payment from your insurance provider, you may end up with a credit balance. Any overpayment will remain on your account as a credit to be used towards future services or material purchases. If you would like to be issued a refund, please let us know and we will issue a check within thirty (30) days of your verbal or written request. There will be a $30.00 service charge for any returned check. After receiving a returned check, we will no longer accept a check on your account. Payments will have to be made using cash or credit card. 

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ASSIGNMENT OF BENEFITS

I have read the above policy regarding my financial responsibility to ENHANCED WELLNESS OF OAK GROVE, PLLC for services performed to myself or the above-named patient. I authorize my insurer to pay any benefits directly to ENHANCED WELLNESS OF OAK GROVE, PLLC. I agree to pay the full and entire amount of all bills incurred by the above-named patient, as well as any amount due after my insurance carrier has made a payment.

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POLICIES / PROCEDURES / CONSENTS

  ACKNOWLEDGMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES

I hereby acknowledge that I have the right to read a copy of Enhanced Wellness of Oak Grove's (the "Practice") Notice of Privacy Practices (the "Notice"). I can view it in the clinic by request. I understand that I may address any questions or concerns I may have about the Notice. 

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PRESCRIPTION REFILL POLICY

I understand that prescription refills and follow up care are my responsibility, and that I should call ENHANCED WELLNESS OF OAK GROVE, PLLC at least 1 week before I need a prescription refill. Refills are provided only at provider’s discretion and can take up to 3 business days to review/approve. We DO NOT do same day prescription refills. 

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NO SHOW / LATE / MISSED APPOINTMENTS POLICY

We understand that circumstances may arise that do not allow you to keep your appointment or that you may forget once in a while. Please remember to be courteous to us and the other patients by calling at least 24 hours prior to your appointment time to cancel if you cannot make it. This will allow us to serve our patients better. Patients arriving more than 15 minutes late for their appointments will be counted as a NO SHOW, and they will need to reschedule their appointments. We enforce a 3-strike policy for missed/late/no show appointments. After your 3rd strike, we will no longer be able to serve you as your health care provider. Missed appointments cost us all time, effort, and money. If you have any questions, please ask any of the staff or your provider. 

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GENERAL CONSENT FOR CARE AND TREATMENT

This consent provides us with your permission to perform reasonable and necessary medical examinations, testing and treatment. By signing below, you are indicating that (1) you intend that this consent is continuing in nature even after a specific diagnosis has been made and treatment recommended; and (2) you consent to treatment at this office or any other satellite office under common ownership. You have the right to discuss the treatment plan with your physician about the purpose, potential risks and benefits of any test ordered for you. I understand I will be responsible for the cost of any treatment, procedures, or diagnostics testing (IE-lab work) if it is denied or not paid by my insurance. I understand I have the right to verify any cost before the testing is done as we cannot revoke any charges once services/treatment is completed. If you have any concerns regarding any test or treatment recommend by your health care provider, we encourage you to ask questions. I voluntarily request any health care providers, or the designees as deemed necessary, to perform reasonable and necessary medical examination, testing and treatment for the condition which has brought me to seek care at this practice.

Please DO NOT use Patient Portal to communicate with your Practice for urgent or emergency medical issues. If you are experiencing an urgent medical need, please contact us by phone (601) 264-7286.**** For emergencies call 911. **** I am over the age of 18 and have sole responsibility of my medical care.

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PATIENT PORTAL CONSENT (via Healow app)

ENHANCED WELLNESS OF OAK GROVE offers secure viewing and communication as a service to patients who wish to view parts of their records and communicate with our staff. Secure messaging can be a valuable communications tool, but has certain risks. In order to manage these risks we need to impose some conditions of participation. This form is intended to show that you have been informed of these risks and the conditions of participation, and that you accept the risks and agree to the conditions of participation.

HOW THE SECURE PATIENT PORTAL WORKS

A secure web portal is a type of webpage that uses encryption to keep unauthorized persons from reading communications, information, or attachments. Secure messages and information can only be read by someone who knows the right password or pass-phrase to log in to the portal site. Because the connection channel between your computer and the website uses secure sockets layer technology you can read or view information on your computer, but it is still encrypted in transmission between the website and your computer.

PROTECTING YOUR PRIVATE HEALTH INFORMATION AND RISKS

This method of communication and viewing prevents unauthorized parties from being able to access or read messages while they are in transmission. However, keeping messages secure depends on two additional factors: 1) the secure message must reach the correct email address, and 2) only the correct individual (or someone authorized by that individual) must be able to have access to the message. Only you can make sure these two factors are present. It is imperative that our practice has your correct e-mail address and that you inform us of any changes to your e-mail address. You are responsible for protecting yourself from unauthorized individuals learning your password. If you think someone has learned your password, you should promptly go to the website and change it. Online communications should never be used for emergency communications or urgent requests.

PATIENT ACKNOWLEDGEMENT AND AGREEMENT

I acknowledge that I have read and fully understand this consent form and the Policies and Procedures regarding the Patient Portal. I understand the risks associated with online communications between my providers office and me, and consent to the conditions outlined herein. In addition, I agree to follow the instructions set forth herein, as well as any other instructions that my providers office may impose to communicate with patients via online communications. I understand and agree with the information that I have been provided and am aware I may refuse to disclose my email address.

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CONSENT TO OBTAIN EXTERNAL PRESCRIPTION HISTORY

I authorize ENHANCED WELLNESS OF OAK GROVE PLLC and it's providers to view my external prescription history via eClinicalWorks EHR system. I understand that this includes but is not limited to prescription history from other unaffiliated medical providers, insurance companies, and/or pharmacy benefit managers may be viewable by provider and staff at ENHANCED WELLNESS OF OAK GROVE PLLC. This also may include prescriptions dating back several years. MY SIGNATURE CERTIFIES THAT I HAVE READ AND UNDERSTOOD THE CONSENT TO OBTAIN EXTERNAL PRESCRIPTION HISTORY.

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eSIGNATURE ACCEPTED

By accepting this consent, I am signing this document electronically. I agree that my electronic signature is the legal equivalent of my manual/handwritten signature on this document. By selecting I agree/accept using any device, means, or action, I consent to the legally binding terms and conditions of this document. I further agree that my signature on this document is as valid as if I signed the document in writing. I am also confirming that I am authorized to enter into this Agreement. If I am signing this document on behalf of a minor, I represent and warrant that I am the minor's parent or legal guardian. I may decline to electronically sign this document and withdraw my consent to sign this document electronically by contacting the signature requestor directly, which may delay transactions. I may contact the signature requester separately to request to sign this document on paper or to receive a paper copy of the signed document.

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PHI DISCLOSURE FOR TPO

I authorize Enhanced Wellness of Oak Grove to release my PHI (Protected Healthcare Information) to a third party for routine treatment, payment, file claims, or health care operations (TPO).

TPO Disclosures for Treatment

Disclose PHI to help improve patient treatment, which involves any activities related to providing health care services to patients. Treatment disclosures include:

1.       Sharing PHI with other departments or an external provider (ex. Pharmacy, Lab Company)

2.       Ordering tests (ex. Labs)

3.       Communicating with other staff members as needed

TPO Disclosures for Payment

 Additionally, you may disclose PHI to provide or obtain reimbursement for healthcare services. Payment disclosures include: 

1.       Billing       

2.       Managing claims       

3.       Determining eligibility for coverage               

4.       Conducting collection or utilization review activities

Sharing PHI to insurance for HEDIS/Quality Care/Biometrics measures

 The consent will remain fully effective until it is revoked in writing. You have the right at any time to discontinue services.

I certify that I have read and fully understand the above statements and consent fully and voluntarily to its contents.

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SMS Campaign Information and Disclaimers:

CAMPAIGN DESCRIPTION/CALL TO ACTION:

This SMS Messaging with existing patients is regarding appointments, scheduling, billing support, insurance verification, refill requests, and patient inquiries. We emphasize two-way conversational communication between staff and patients, ensuring that responses are tailored to specific inquiries. We do not send promotional content, marketing, or automated recurring messages. Messages will be dispatched by the Office Staff and overseen by the Office Manager. The contents of the patients or customers messages will pertain to direct healthcare communication for medical clinic patients.

Consent Mechanism:

Users can opt-in to receive messages by completing a consent form available on our website. The SMS opt-in compliance consent form is located at https://www.enhancedwellnessog.com/sms. Consent will be indicated by the submission of the consent form. To opt-in, users must provide their name, email, and phone number, and check the SMS Consent box. By submitting the form or initiating a SMS message, users are consenting to receive patient customer service messages from us. Upon registration, patients receive an email that includes our SMS text line phone number, an Opt-In and Out message. Disclaimer states that they have examined and accepted our full terms and privacy policy at https://www.enhancedwellnessog.com/sms-privacy-policy-and-terms-of-service.

Customer consents are stored in Electronic Medical Records software.

Users wishing to opt-out of receiving messages can do so by replying with "STOP."

Upon opting out, users will receive a message stating, "You have successfully unsubscribed from [ENHANCED WELLNESS OF OAK GROVE PLLC] texts. You will no longer receive messages from this number."

For support related to our services, please contact Enhanced Wellness of Oak Grove PLLC at 601-264-7286.

Website: https://www.enhancedwellnessog.com

Direct path to SMS Consent Form: https://www.enhancedwellnessog.com/sms

Direct path to Privacy Policy and Terms: https://www.enhancedwellnessog.com/sms-privacy-policy-and-terms-of-service.

 DISCLAIMERS:

·        I have thoroughly examined and accepted the SMS Privacy Policy and Terms of Service of ENHANCED WELLNESS OF OAK GROVE PLLC.

·        By submitting my information via the checkbox confirmed SMS Consent Form or by initiating a text message to our office, I hereby acknowledge/provide my explicit Opt-In consent to be contacted through SMS.

·        These healthcare communications are direct interactions with staff and are regarding appointments, scheduling, billing support, insurance verification, refill requests, and general inquiries.

·        By providing this consent, the patient confirms and guarantees they are an authorized user of the mobile phone number provided.

·        Message and data rates may apply, and message frequency may vary.

·        The process is straightforward: a patient initiates contact by sending an SMS, and a staff member responds directly to address any inquiries.

·        This service is intended solely for one-on-one communication and does not include any marketing or promotional content.

·        For support related to our services, please contact Enhanced Wellness of Oak Grove PLLC at 601-264-7286.

·        To unsubscribe and cease receiving messages from us, please reply with STOP.

WELCOME/OPT-IN MESSAGE:

By enrolling in the text messaging service provided by Enhanced Wellness of Oak Grove PLLC, you consent to receive communications regarding patient-related matters, including appointment reminders, scheduling, billing support, insurance verification, referrals, lab results, refill requests, and general inquiries about our services. The frequency of messages may vary. Standard message and data rates may apply. You have the option to opt out of these messages at any time. For assistance, inquiries, or concerns, please contact Enhanced Wellness of Oak Grove PLLC at 601-264-7286. To unsubscribe and cease receiving messages, please reply with STOP.

HELP

Assistance is available at any time; simply text HELP, and we will provide you with instructions on how to unsubscribe. For support related to our services, please contact Enhanced Wellness of Oak Grove PLLC at 601-264-7286.

 OPT-OUT:

To discontinue receiving messages from Enhanced Wellness of Oak Grove PLLC 601-264-7286, please respond with STOP. Following this action, you will cease to receive communications from us. Upon opting out, users will receive a confirmation message indicating, "You have successfully unsubscribed from ENHANCED WELLNESS OF OAK GROVE PLLC texts. Future messages from this number will not be sent." 

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NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

 This Notice of Privacy Practices (this “Notice”) tells you about the ways we may use and disclose your medical information. This Notice applies to ENHANCED WELLNESS OF OAK GROVE, PLLC including its professionals, employees and contractors (the “Practice”).

 I.                   OUR OBLIGATIONS.

 We are required by law to:

 ·                    Make sure that the medical information we have about you is kept private, to the extent required by state and federal law;

·                    Give you this Notice explaining our legal duties and privacy practices with respect to medical information about you;

·                    Inform you that the Practice may create and/or receive medical information about you and such medical information may be subject to further disclosure to authorizedparties;

·                    Accommodate your request (unless required by law to make a disclosure) that we not disclose to a health plan your medical information related solely to services provided by the Practice, if you have paid for services out of pocket in full.

·                    Notify you of any breach of your unsecured protected health information; and

·                    Abide by the terms of this Notice.

II.                HOW WE MAY AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.

 The following categories describe the different reasons that we typically use and disclose your medical information. These categories are intended to be generic descriptions only, and not a list of every instance in which we may use or disclose your medical information. Please understand that for these categories, the law generally does not require us to get your consent in order for us to release your medical information.

A.                For Treatment. We may use medical information about you to provide you with medical treatment and services, and we may disclose medical information about you to doctors, nurses, technicians, medical students, or hospital personnel who are providing medical care to you. For example, physicians and nursing staff will have access to your medical record to provide treatment to you.

B.                 For Payment. We may use and disclose medical information about you so that we may bill and collect from you, an insurance company, or a third party for the services we provide. This may also include the disclosure of medical information to obtain prior authorization for treatment and procedures from your insurance plan. For example, we may send a claim for payment to your insurance company, and that claim may have a code on it that describes the services that have been rendered to you. The Practice is required to restrict disclosure of your medical information to a health plan or third-party payor if the disclosure is for payment or health care operations and pertains to a health care item or service that you paid for in full out-of-pocket.

C.                For Health Care Operations. We may use and disclose medical information about you for our health care operations. Theses uses/disclosures are necessary to operate our practice appropriately and make sure all of our patients receive quality care. For example, we may need to use or disclose your medical information in order to conduct certain cost- management practices, or to provide information to our insurance carriers.

D.                Business Associates. There are some services the Practice provides through business associates. The Practice may also use the services of business associates to perform certain functions on behalf of the Practice, for example, billing services. When these services are provided by our business associates, the business associate may need access to your medical information in order to perform these services. To protect your medical information, the Practice enters into an agreement with the business associate which requires the business associate to appropriately safeguard your information.

E.                 Quality Assurance. We may need to use or disclose your medical information for our internal processes to determine that we are providing appropriate care to our patients.

F.                 Utilization Review. We may need to use or disclose your medical information to perform a review of the services we provide to ensure that the proper level of services is received by our patients, depending on their condition and diagnosis.

G.                Peer Review. We may need to use or disclose medical information about you in order for use to review the credentials and actions of our health care personnel to ensure they meet our qualifications and standards.

H.                Treatment Alternatives. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that we believe may be of interest to you.

I.                   Health Related Benefits and Services. We may use and disclose medical information about to tell you about health-related benefits or services that we believe may be of interest to you.

J.                  Individuals Involved in Your Care or Payment for Your Care. We may release medical information about you to a friend or family member who is involved in your medical care, as well as to someone who helps pay for your care, but we will do so only as allowed by state or federal law, or in accordance with your prior authorization.

K.                As Required By Law. We will disclose medical information about you when required to do so by federal, state, or local law.

L.                 To Avert a Serious Threat to Health or Safety. We may use or disclose medical information when necessary to prevent or decrease a serious and imminent threat to your health or safety or the health and safety to the public or another person. Such disclosure would only be to someone able to help prevent the threat, or to appropriate law enforcement officials.

M.               Organ and Tissue Donation. If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank as necessary to facilitate organ or tissue donation and transplantation.

N.                Research. We may use or disclose your medical information to an Institutional Review Board or other authorized research body if your consent has been obtained as required by law, or if the information we provide them is “de-identified”.

O.                Military and Veterans. If you are or were a member of the armed forces, we may release medical information about you as required by the appropriate militaryauthorities.

P.                 Workers’ Compensation. We may release medical information about you for your employer’s workers’ compensation or similar program. These programs provide benefits for work-related injuries. For example, if you have injuries that resulted from your employment, workers’ compensation insurance or a state workers’ compensation program may be responsible for payment for your care, in which case we might be required to provide information to the insurer or program.

Q.                Public Health Risks. We may disclose medical information about you to public health authorities for public health activities. As a general rule, we are required by law to disclose certain types of information to public health authorities, such as the Texas Department of State Health.

R.                Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include audits, civil, administrative, or criminal investigations and proceedings, inspections, licensure and disciplinary actions, and other activities necessary for the government to monitor the health care system, certain governmental benefit programs, certain entities’ compliance with government regulations related to health information and civil rights laws.

S.                  As Required by Law. If you are involved in a lawsuit or a legal dispute, we may disclose medical information about you in response to a court of administrative order, subpoena, discovery request, or other lawful process. In addition to lawsuits, there may be other legal proceedings for which we may be required or authorized to use or disclose your medical information, such as investigations of health care providers, competency hearings on individuals, or claims over the payment of fees for medical services.

T.                 Law Enforcement. We may disclose your medical information if we are asked to do so by law enforcement officials, or if we are required by law to do so.

U.                Coroners, Medical Examiners and Funeral Home Directors. We may disclose your medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about our patients to funeral home directors as necessary to carry out their duties.

V.                National Security and Intelligence Activities. We may disclose medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

W.              Inmates. If you are an inmate of a correctional institution or under custody of a law enforcement official, we may disclose medical information about you to the correctional institution or the law enforcement official. This would be necessary for the institution to provide you with health care, to protect your health and safety and the health and safety of others, or for the safety and security of the correctional institution or law enforcement official.

III.             OTHER USES OF MEDICAL INFORMATION.

 There are times we may need or want to use or disclose your medical information other than for the reasons listed above, but to do so will need your prior permission. Disclosures which require your authorization include: (i) release of psychotherapy notes, (ii) uses and disclosures of protected health information for marketing purposes, (iii) sale of protected health information, and (iv) other uses and disclosures not outlined in this Notice. If you provide us permission to use or disclose medical information about you for such other purposes, you may revoke that permission in writing at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

 IV.             YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.

 Federal and state laws provide you with certain rights regarding the medical information we have about you. The following are a summary of those rights.

 A.                Right to Inspect and Copy. Under most circumstances, you have the right to inspect and/or copy your medical information that we have in our possession, which generally includes your medical and billing records. To inspect or copy your medical information, you must submit your request in writing to the Practice’s Privacy Officer at the address listed in Section VI below.

The Practice will coordinate a mutually agreeable time for you to inspect or obtain a copy of your medical information within thirty (30) days of your request. To the extent that the Practice maintains a portion of your record in an electronic format, the Practice will provide a paper copy of that portion of your record or will provide you with an electronic copy of that portion of your record if you prefer. If you request a copy of your information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request. The fee we charge will be the amount allowed by State law.

In certain very limited circumstances allowed by law, we may deny your request to review or copy your medical information. We will give you any such denial in writing. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by the Practice will review your request and the denial. The person conducting the review will not be the person who denied your request. We will abide by the outcome of the review.

B.                 Right to Request an Amendment. If you feel the medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by the Practice. To request an amendment, your request must be in writing and submitted to the Privacy Officer at the address listed in Section VI below. In your request, you must provide a reason as to why you want this amendment. If we accept your request, we will notify you of that in writing.

The Practice is not required to amend your information at your request. The Practice may deny your request for an amendment if it is not in writing or does not include a reason to support your request. In addition, we may deny your request if you ask us to amend information that (i) was not created by us, (ii) is not part of the information kept by the Practice, (iii) is not part of the information which you would be permitted to inspect or copy, (iv) is accurate and complete, or

(v) is not part of the Designated Record Set. If we deny your request, we will notify you of that denial in writing.

C.                Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures” of your medical information. This is a list of the disclosures we have made for up to six years prior to the date of your request of your medical information, but does not include disclosures for Treatment, Payment, or Health Care Operations (as described in Sections II A, B, and C of this Notice, unless the practice maintains an electronic health record, discussed below), or disclosures made pursuant to your specific authorization (as described in Section III of this Notice), or certain other disclosures. To request this accounting, you must submit your request in writing to the Practice’s Privacy Officer at the address set forth in Section VI below.

Your request must state a time period the accounting should cover which may not be longer than six years. The first request for an accounting within a twelve-month period will be free. However, the Practice may charge a reasonable fee for each additional accounting provided at your request during the same twelve-month period. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs areincurred.

 To the extent the Practice maintains and electronic health record, the Practice will account for disclosures made of the electronic information even if made for treatment, payment, or health care operations. If you request an electronic accounting, the accounting by law is only required to cover the three years prior to the date of your request for an accounting. Depending upon how long the Practice has had an electronic health record in place, the Practice may not be able to provide an electronic accounting for the years prior to the full implementation of its electronic health record.

 D.                Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you in various situations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.

 We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment. In addition, there are certain situations where we won’t be able to agree to your request, such as when we are required by law to use or disclose your medical information. To request restrictions, you must make your request in writing to the Practice’s Privacy Officer at the address listed in Section VI below. In your request, you must specifically tell us what information you want to limit, whether you want us to limit our use, disclose, or both, and to whom you want the limits to apply.

 E.                 Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we contact you at home, not at work, or, conversely, only at work and not at home. To request such confidential communications, you must make your request in writing to the Practice’s Privacy Officer at the address listed in Section VI below.

 We will not ask the reason for your request, and we will use our best efforts to accommodate all reasonable requests, but there are some requests with which we will not be able to comply. Your request must specify how and where you wish to be contacted.

 F.                 Notification of a Breach. You have a right to be notified if your medical information is used or disclosed in a manner that is not permitted by federal law (HIPAA). In the event of a breach, the Practice actively takes steps to rectify the disclosure.

G.                Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. To obtain a copy of this Notice, you must make your request in writing to the Practice’s Privacy Officer at the address set forth in Section VI below.

V.                CHANGES TO THIS NOTICE.

 We reserve the right to change this Notice at any time, along with our privacy policies and practices. We reserved the right to make the revised or changed Notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice, along with an announcement that changes have been made, as applicable, in our office. When changes have been made to the Notice, you may obtain a revised copy by sending a letter to the Practice’s Privacy Officer at the address listed in Section VI below or by asking the office receptionist for a current copy of the Notice.

VI.             COMPLAINTS.

If you believe that your privacy rights as described in this notice have been violated, you may file a complaint with the Practice at the following address or phone number:

  Enhanced Wellness of Oak Grove Attn: Privacy Officer

56 98 Place Blvd

Hattiesburg, MS 39402

Telephone: (601) 264-7286

 MANAGERS: Leigh Michaels Laurie Ryba Cori Marzoni

To file a complaint, you may either call or send a written letter. The Practice will not retaliate against any individual who files a complaint. In addition, if you have any questions about this Notice, please contact the Practice’s Privacy Officer at the address or phone number listed above.

 You may also file a written or electronic complaint with the Secretary of the Department of Health and Human Services (HHS). Please note, your complaint must name the person or business that is the subject of your complaint, describe the acts or omissions you believe violate your rights, and file the complaint within 180 days of becoming aware of the act/omission.

How to request or access your medical records

• Obtain your records directly from our Patient Portal. Please contact our office to request access.
• Submit a written request to our office for your medical records.
• You are welcome to reach out to our office, and we will provide you with a blank copy of the request form for medical records or
• You may download the AUTHORIZATION TO RELEASE MEDICAL INFORMATION form from our website at https://www.enhancedwellnessog.com
• We can send your records to you by mail or fax.
• Additionally, your records can be collected in person once they are ready.
• Typically, it takes 7-10 days for medical records requests to be processed, but it may take up to 30 days for the request to be fulfilled.         

SMS Privacy Policy and Terms of Service

Last Updated - January 31, 2025

BY SENDING A MESSAGE TO OUR SMS TEXT LINE AT 601-450-0953, YOU (THE PATIENT) ARE CONFIRMING THAT YOU HAVE READ AND ACCEPTED THE PRIVACY POLICY, TERMS AND CONDITIONS, AND THE SMS POLICY.

OPT IN Disclaimers:

SMS Privacy Policy and Terms of Service

 I have reviewed and accept Enhanced Wellness of Oak Grove PLLC's PRIVACY POLICY and TERMS AND CONDITIONS POLICY. By initiating a text message to us, you are consenting (opting-in) to receive communication text message responses from Enhanced Wellness of Oak Grove PLLC. Contact us at 601-264-7286 or 601-450-0953 for questions or concerns. Our Privacy Policy and Terms of Services is on our website https://www.enhancedwellnessog.com/sms-privacy-policy-and-terms-of-service. Msg and data rates may apply. Msg frequency varies. 

For HELP call our office at 601-264-7286 or 601-450-0953. Reply STOP" to unsubscribe from messages at any time.

10DLC Privacy Policy

At [ENHANCED WELLNESS OF OAK GROVE PLLC] ("we," "our," "us"), we prioritize client confidentiality and privacy. This Privacy Policy explains how we collect, use, disclose, and protect your information concerning SMS (Short Message Service) messaging through 10DLC to enable effective communication between our staff and clients.

1. Information We Collect
2. When you opt-in to receive SMS messages from us, we may collect the following types of information:
3. Personal Information: Phone number, Name, Email address (if provided)
4. Healthcare Related Information
5. Relevant details necessary for effective communication regarding your healthcare
6. Message Data
7. The content of SMS messages sent and received, Delivery status of SMS messages, Interaction data related to SMS messages 
8. How We Use Your Information
   We use the collected information strictly for case management and communication purposes, specifically for:
9. Communication
10. Providing healthcare updates and essential information via SMS
11. Responding to client inquiries and delivering necessary support
12. Service Improvement:
13. Understanding and analyzing the use of our SMS services
14. Improving communication methods to better serve clients
15. Legal Compliance:
16. Complying with applicable laws and regulations
17. Responding to lawful requests and legal processes 
18. Sharing Your Information
    We will not share, sell, or disclose your information to third parties except in the two cases noted below.
19.  Service Providers:
20. We may share your information with trusted third-party service providers that assist us in operating our SMS services. These parties are required to maintain the confidentiality and security of your information.
21. Legal Requirements:
22. We may disclose your information if required by law or in response to a legal request, such as a subpoena, court order, or government demand.
23. Security of Your Information
    We take reasonable measures to protect your information from unauthorized access, disclosure, alteration, or destruction. However, no method of transmission over the Internet or electronic storage is 100% secure, and we cannot guarantee absolute security.
24. Your Rights and Choices
    You have the right to:
25. Opt-Out: You can opt out of receiving SMS messages from us by replying "STOP" to any message or contacting us.
26. Access and Correction: You can request access to or correction of your personal information by contacting us.
27. Changes to This Policy
    We may update this Privacy Policy from time to time. Any changes will be effective when we post the revised policy on our website, or provided via email. We encourage you to review this Privacy Policy periodically.
28. Contact Us
    If you have any questions or concerns about this Privacy Policy or our privacy practices, please contact us at:
29. [Enhanced Wellness O, 56 98 Place Blvd, Hattiesburg, MS 39402]
30.  [Ph: 601-264-7286 or 601-450-0953]
    

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Privacy Policy

No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. All the above categories exclude text messaging originator opt-in data and consent; this information will not be shared with any third parties.

• Use of Information
  Your information is used to provide medical services, process payments, communicate with you, and improve our services. We may use 10DLC compliant messaging services for secure text-based communication. 
• Data Security
  We implement various security measures to ensure the protection of your personal information against unauthorized access, alteration, disclosure, or destruction.
•  Consent for 10DLC Messaging
  By providing your mobile phone number, you consent to receive text messages from us for appointment reminders, treatment follow-up, and other healthcare-related communications. Standard message and data rates may apply.
•  Message Content and Frequency:
  Our text messages are intended to provide valuable information related to our services or products. We commit to sending messages at a reasonable frequency and ensuring the content is relevant and appropriate.
•  Opt-Out Policy
  You have the right to opt-out of 10DLC messaging services at any time. To opt-out, you can reply with a specific keyword like 'STOP' or contact our office directly.
•  Prohibited Content
  We strictly adhere to regulations prohibiting certain types of content. This includes, but is not limited to, content related to SHAFT (Sex, Hate, Alcohol, Firearms, Tobacco), as well as any fraudulent, malicious, abusive, or illegal content.

 Data Protection and Privacy:
We prioritize the security and confidentiality of your personal information. Our systems and processes are designed to protect your data and comply with relevant data protection laws.
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Terms and Conditions for Enhanced Wellness of Oak Grove PLLC:

• Introduction
  Welcome to Enhanced Wellness of Oak Grove PLLC. These Terms and Conditions govern your use of our services and website. By accessing our services, you agree to these Terms and Conditions in full.
• Medical Services
  We provide medical services as outlined on our website. These services are offered by qualified healthcare professionals and are subject to change.
• Privacy and Confidentiality
  We are committed to protecting your privacy. All personal and medical information is handled in compliance with HIPAA (Health Insurance Portability and Accountability Act) and other relevant privacy laws.
• User Responsibilities
  Users of our services are responsible for providing accurate and complete health information and for following the treatment plans prescribed by our healthcare providers.
• Communication
  We may use 10DLC compliant messaging services for communication purposes. This ensures the authenticity and security of our text-based communications with patients.
• Limitations of Liability
  Our medical practice is not liable for any indirect, special, or consequential loss or damage arising under these terms and conditions or in connection with our website, whether arising in tort, contract, or otherwise.
• Intellectual Property
  The content on our website is owned by Enhanced Wellness of Oak Grove PLLC or its licensors and is protected by copyright and intellectual property laws.
• Amendments
  We may update these terms and conditions from time to time. The latest version will always be available on our website.
• Governing Law
  These terms and conditions are governed by the laws of Mississippi, USA.
• Contact Information
  If you have any queries about these Terms and Conditions, please contact us at:
       ​Address: 56 98 Place Blvd * Hattiesburg, MS 39402  Phone: 601-264-7286 or 601-450-0953    

 "Once a referral has been received by your doctor, you may receive up to 1 message per week. To “Unsubscribe”, send “STOP”. Standard message and data rates may apply. Text messages may come from either (601) 264-7286 and/or (601) 450-0953." 
_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

SMS Terms and Conditions

Enhanced Wellness of Oak Grove PLLC (the “Company”) offers a text messaging program (“Text Message Program”) to communicate with patients on topics relevant to their relationship with the Company. For example, you may receive updates related to your visits, Healow account, one-time passcode, billing notifications, prescription reminders and care management. All communication will be in accordance with the Health Insurance Portability and Accountability Act (“HIPAA”).

By texting START to 601-264-7286 or 601-450-0953, you agree to participate in the Company Text Message Program, and acknowledge that you understand the risks associated with sending and receiving protected health information via SMS/MMS text messages.

Your consent to receive SMS text messages from the Company is not a condition of any treatment provided by the Company, and you can opt out of receiving text messages from the Company at any time by texting STOP to 601-264-7286 or 601-450-0953. The Company’s use of your personal information for the Company’s Text Message Program is subject to these Terms and Conditions.

Your wireless carrier's message and data rates may apply to SMS correspondence. The Company does not charge for any text message content that is sent to you; however, downloadable content may incur additional charges from your wireless carrier. You are solely responsible for any fees, including web access and/or data or text message charges that may be billed by your wireless carrier based on your individual plan. Please contact your wireless carrier for information about your messaging plan. Your carrier may impose message or charge limitations on your account that are outside of our control. All charges are billed by and payable to your wireless carrier.

You represent that you are the owner, or authorized user of the wireless device you use to receive text messages. You further represent that you are authorized to approve the applicable charges related to the receipt of text messages from the Company. Message frequency may vary.

The Company will not be liable for any delays or failures in your receipt of any SMS messages, as delivery is subject to effective transmission from your network operator and processing by your mobile device. Additionally, Company is not responsible for any direct or indirect damages arising from the use of SMS messages. SMS message services are provided on an as is, as available basis.

Data obtained from you in connection with the Company’s Text Message Program may include your mobile phone number, your carrier's name, and the date, time, and content of your messages and other information that you may provide. Your wireless carrier and other service providers may also collect data from your SMS usage, and their practices are governed by their own policies. When you provide us with information in connection with the Text Message Program, you agree to provide accurate, complete, and true information.

Participating Carriers

Please be aware that compatibility with carriers is subject to change and may vary over time. While we strive to keep our list of participating carriers updated, The Company does not guarantee that the Text Message Program will be compatible with all mobile devices or mobile carriers. The Company is not liable for any delays, failures, or other damage resulting from carrier services or incompatibility.

Carriers are not liable for delayed or undelivered messages. Message and data rates may apply for any messages sent to you from the Company and to the Company from you. Message frequency may vary.

Join Text Alerts, Questions, Cancel Alerts

Text START to 601-264-7286 or 601-450-0953 to join Company's Text Message Program. When you opt-in to the service, we will send you a message to confirm your signup. If you have any questions, call us at 601-264-7286 or 601-450-0953.

You can also text the word HELP to 601-264-7286 or 601-450-0953 to get additional information about the service. After you send the message "HELP" to us, we will respond with instructions on how to use the Text Message Program as well as how to unsubscribe.

 You can cancel this service at any time. To opt-out, text STOP to 601-264-7286 or 601-450-0953. Message and data rates may apply. After you send the message "STOP" to us, we will send you a reply message to confirm that you have unsubscribed. After this, you will no longer receive text messages from us.

You may re-enroll in the Program and receive text messages from us at any time by texting START to 601-264-7286 or 601-450-0953.

You represent that you are the subscriber for or authorized user of the mobile telephone number that you provided to Company and that you are authorized to approve any related charges for messaging and data applied by your wireless carrier.

Resolving Disputes

In the event that there is a dispute between you and Company relating to Company text messaging communications or arising out of any matter, such dispute will be resolved in the jurisdiction and applicable laws of Mississippi State, Lamar County.

Limitation of Liability and Disclaimer

THE COMPANY HEREBY DISCLAIMS ALL LIABILITY FOR ANY DAMAGES, WHETHER DIRECT, INDIRECT, INCIDENTAL, CONSEQUENTIAL, OR OTHERWISE, ARISING FROM OR IN CONNECTION WITH THE USE OF THE TEXT MESSAGE PROGRAM. THIS INCLUDES, BUT IS NOT LIMITED TO, DAMAGES RESULTING FROM THE DELAY, FAILURE, INTERRUPTION, OR CORRUPTION OF ANY DATA OR OTHER INFORMATION TRANSMITTED IN CONNECTION WITH THE USE OF THE SERVICE. FURTHERMORE, COMPANY PROVIDES THE TEXT MESSAGE PROGRAM ON AN "AS IS" AND "AS AVAILABLE" BASIS WITHOUT ANY WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, OR NON-INFRINGEMENT. THE COMPANY EXPRESSLY DISCLAIMS ANY REPRESENTATION OR WARRANTY THAT THE TEXT MESSAGE PROGRAM WILL BE ERROR-FREE, SECURE, UNINTERRUPTED, OR TIMELY. THE USE OF THE TEXT MESSAGE PROGRAM IS AT YOUR OWN DISCRETION AND RISK AND YOU WILL BE SOLELY RESPONSIBLE FOR ANY DAMAGE TO YOUR DEVICE OR LOSS OF DATA THAT RESULTS FROM THE RECEIPT OR USE OF SUCH SERVICE.

Contact Information

If you have any questions or concerns about these Terms and Conditions you may contact Enhanced Wellness of Oak Grove PLLC’s Compliance Officer at (601) 264-7286 or 601-450-0953 or via mail Attn: Compliance Officer * 56 98 Place Blvd * Hattiesburg, MS 39402 .