Agreement for Personal Information Collection

This agreement (the “Agreement”) sets out the terms and conditions under which Miami Surgical Center (“MSC”) will collect, use and disclose your personal information. By providing your personal information to MSC, you agree to be bound by the terms of this Agreement.

1. Collection of Personal Information
MSC may collect personal information from you when you complete and submit forms, questionnaires or surveys, or when you provide information through phone calls, emails or other forms of communication. The types of personal information that MSC may collect include, but are not limited to, your name, address, date of birth, contact details, health information and insurance information.

2. Use of Personal Information
MSC may use your personal information for the following purposes:
– To provide medical services to you
– To communicate with you regarding your medical care
– To bill for services provided
– To comply with legal and regulatory requirements
– To conduct quality assurance activities
– To conduct research and analysis to improve our services

3. Disclosure of Personal Information
MSC may disclose your personal information to the following parties:
– Healthcare providers involved in your medical care
– Insurance companies for billing purposes
– Regulators and authorities as required by law
– Third-party service providers engaged by MSC to perform services on our behalf

4. Security of Personal Information
MSC takes reasonable measures to protect your personal information against unauthorized access, use, disclosure, and destruction. MSC maintains physical, electronic and procedural safeguards to protect your personal information.

5. Access to Personal Information
You may request access to your personal information held by MSC at any time by contacting us. We will respond to your request within a reasonable time and provide you with the requested information.

6. Changes to this Agreement
MSC reserves the right to change this Agreement at any time without notice. Any changes to this Agreement will be effective immediately upon posting on the MSC website.

7. Data Rates May Apply
By providing your personal information to MSC, you acknowledge that standard data rates may apply when submitting personal information through phone calls or text messages.

By providing your personal information to MSC, you acknowledge that you have read and understood this Agreement, and consent to the collection, use and disclosure of your personal information as set out in this Agreement.

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