Mobile Messaging Consent, Authorization & Communications Preferences
RonanRx Inc.
[Month Day, Year]
Maya Alvarez
[DOB]
+1 (512) 555-0184
[State]
[Email]
1. Purpose of this consent
I am choosing to receive health-related communications from RonanRx Inc., its providers, care team, and service providers by mobile messaging: Apple Messages/iMessage, RCS, limited SMS/MMS fallback, and secure links that open the App. This documents my communication preference and, where required, my authorization to disclose my information to me through these channels.
2. This consent is optional
I do not have to agree to mobile messaging to use the App. Without it I can still receive information through the secure App, web portal, email, phone, or mail. My treatment, payment, enrollment, and access to care are not conditioned on signing, except where a service technically requires a mobile number.
3. Information that may be sent
Account and service messages; appointment and care-coordination; health-app messages; medication and treatment information; results and clinical updates; billing, pharmacy, and insurance; secure links; and other information I request. RonanRx may send only a notification or link, or withhold detailed information.
4. Sensitive information that may be limited
Unless I separately authorize it, RonanRx may limit or require in-app viewing for psychotherapy notes; 42 CFR Part 2 substance-use records; HIV/STI/sexual and reproductive health; genetic information; certain mental-health information; minors' services; and safety-sensitive communications.
5. Who may send the information
RonanRx Inc.; affiliated, contracted, or participating providers and professional entities; my care team; workforce members and contractors; and business associates and service providers that operate the App, deliver messages, host data, support, secure, or log communications.
6. Who may receive the information
Me, at the mobile number and device I designate and its messaging account; and intermediaries, carriers, and cloud providers only as needed to deliver, secure, log, or troubleshoot. Not another person, caregiver, employer, or third party unless I separately authorize it or the law permits.
7. Agreement to mobile messaging
By signing, I agree to receive these messages at the number and device I designate. Without signing, RonanRx will not send protected health information by message, except limited non-PHI administrative, security, legally required, or transactional messages. RonanRx may still send secure links or require in-app viewing.
8. Channel security and delivery risks
Mobile messaging has privacy and security risks; encryption varies by system, device, and carrier, and SMS/MMS is not end-to-end encrypted. Messages may be seen if my device or accounts are shared, previews appear, messages sync or back up, my device is lost or compromised, my number is reassigned, or I forward them. After delivery, RonanRx may not control who sees it.
9. My responsibilities
The number is mine or controlled by me; I keep my device, passcode, accounts, and backups secure; I can disable lock-screen previews; I notify RonanRx if my number changes or my device is lost or stolen; I will not use messaging for emergencies; and I will call 911 for urgent or life-threatening symptoms.
10. Message frequency, costs & automated messages
Frequency may vary by my use, care plan, and settings. Message and data rates may apply. I consent to informational healthcare, account, care-coordination, security, and service messages, including automated ones. This does not authorize marketing texts unless I separately opt in.
11. No marketing, sale, or research authorization
This consent is for delivery of information to me. It does not authorize sale of my PHI, marketing, research, publication of identifiable information, or third-party disclosure for their own purposes. RonanRx may use information for treatment, payment, operations, safety, compliance, and similar permitted purposes; separate authorization is sought where required.
12. Revocation and opt-out
I may revoke at any time: change my settings in the App, text STOP where supported, contact support, or send a written request. RonanRx honors revocation as soon as practicable; it does not affect messages already sent. Limited non-PHI messages may continue where permitted.
13. Expiration
Effective until the earliest of: I revoke it; my account closes; RonanRx replaces it and I sign a new version; or three years from signature, unless I renew earlier. A shorter period applies if required by law.
14. Redisclosure warning
Information sent to me may be seen, saved, copied, forwarded, or disclosed by me or anyone with access to my device or account; recipients may not be bound by HIPAA. This consent does not waive rights under HIPAA, state privacy, consumer health data, or breach laws that cannot be waived.
15. State-specific terms
This consent applies nationwide; where a state grants stronger privacy rights, that law controls. Specific provisions apply for California (CMIA), Texas, Minnesota, Washington (My Health My Data), Nevada, and other comprehensive-privacy states.
16. Special safety situations
If receiving messages could put me at risk because another person may access my device or account, I should not choose mobile messaging and may request another method. If I tell RonanRx that messaging could endanger me, it will use reasonable efforts to accommodate an alternative as required by law.
17. Electronic records and signature consent
I agree to receive and sign this consent electronically; my electronic signature has the same effect as a handwritten one. RonanRx may keep records of my signature, timestamp, IP address, device, session, version, number, and audit logs. I can download, print, or request a copy, and may withdraw consent to electronic records prospectively.
18. Required acknowledgments
- I request and authorize RonanRx to send mobile messages to my number and device.
- Some messages may include protected health information.
- Messaging systems, carriers, devices, and backups have different security features and risks.
- People with access to my phone, accounts, lock screen, synced devices, or backups may see my information.
- I can use the secure in-app channel instead.
- Signing is optional and not required to receive care.
- I may revoke at any time and this consent does not waive non-waivable rights.
- I consent to electronic records and electronic signature.