Messages and Mail Sample Clauses

Messages and Mail. Please advise friends and family of your cottage’s name, location number and telephone number. GreyBeard Realty is not staffed to deliver messages.

Messages and Mail. I understand you may communicate with me through US Mail, electronic mail, telephone or voice mail messages, to remind me about my appointments, treatment follow-up or to tell me about new services that are available. I understand that I must tell you if I do not want you to communicate with me like this. Sharing PHI with family and friends: I understand you will share my PHI with the family members, friends, or other individuals who are present with me unless I tell you otherwise. Wireless Calls and Texting: I agree and have initialed below for Pulmonary Practice Associates to use an automated telephone dialing system, and texting, to contact the cellular telephone number(s) that I provided for appointment, treatment, and payment purposes. Initial here: Signatures BY SIGNING BELOW, I AM AGREEING TO THE PERMISSIONS, AGREEMENTS, AND AUTHORIZATIONS DESCRIBED IN THIS AGREEMENT. I HAVE READ THIS AGREEMENT AND HAVE BEEN ABLE TO ASK QUESTIONS. I UNDERSTAN THIS AGREEMENT IS VALID FOR ONE YEAR FROM THE DATE I SIGN IT. Printed Name of Patient or Legal Representative: Date: Date of Birth: Patient or Legal Representative Signature: Date: Relationship of Person signing if not Patient: Date: Please review the highly confidential information as defined by your state: Florida: Mental health, HIV/AIDS, genetic testing, venereal disease, and tuberculosis information Intake Form (Page 1) Directions: All sections must be completed. Write “N/A” if not applicable PATIENT INFORMATION Name DOB FAMILY HISTORY Unobtainable/Unknown (Adopted) No Significant History Early Deaths (Use the following “M” = Mother, “F” = Father, “S” = Sister(s), “B” = Brother(s): Who in your family has had… Allergies Heart Disease Alpha 1 Antitrypsin Deficiency High Blood Pressure Arthritis Pulmonary Embolism Arthritis type Renal (Kidney) Disease Asbestosis Sarcoidosis Asthma Sleep Disorder Cancer Stroke Syndrome Cancer type Thyroid Disorders COPD Tuberculosis Deep Venous Thrombosis SURGICAL HISTORY Please check any surgeries you have had and provide details (check all that apply): General Surgery Date & Details Date & Details Amputation (s) Tonsillectomy Aneurysm Uvuloplasty Sinus Wrist Thyroid Other Cardiovascular Surgery AAA Heart Valve Replacement CABG Angioplasty Carotid Endarterectomy Pacemaker Stent Total # Performed Lung Surgery Bronchoscopy Lobectomy Lung Biopsy Lung Surgery Thoracentesis Pneumonectomy Excision of Lesion of Mediastinum Excision Lesion of Chest Wall Wedge Resection of Lung Intake...