PROTECTED HEALTH INFORMATION (PHI) and NOTICE OF PRIVACY PRACTICES
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PURPOSE: This form is used to obtain your consent to communicate with you by email/text regarding your Protected Health Information.
HOLLYWOOD PERFECT SMILE., (HPS) offers patients the opportunity to communicate by e-mail/text. Transmitting patient information by e-mail/text has a number of risks that patients should consider before granting consent to use e-mail/text for these purposes. HPS will use reasonable means to protect the security and confidentiality of e-mail/text information sent and received. However, HPS cannot guarantee the security and confidentiality of email/text communication and will not be liable for inadvertent disclosure of confidential information.