Patient Disclaimer and Authorisation Sample Contracts
PATIENT DISCLAIMER AND AUTHORISATIONPatient Disclaimer and Authorisation • June 8th, 2017
Tricefy™ is a communication service licensed to QUFW. This Disclaimer and Authorisation Agreement sets forth the terms and conditions under which you, the undersigned patient authorise your provider to transmit your ultrasound examination through Trice Imaging, Inc. to a mobile phone number of your choice. This Agreement will become effective on the date of your signature and will terminate after all images throughout your current pregnancy are sent to you. After you complete and sign this Agreement, a mobile telephone you designate will be entered into our ultrasound system and re-verified with you.