Formulario de ayuda para la facturación del paciente

Disclaimer: "I Acknowledge that I have requested Baylor Scott & White Health to transmit certain personal financial information to me via email. I understand that, although Baylor has taken appropriate precautions to protect against unauthorized access to electronically-transmitted information, it is possible that email transmission may be intercepted or accessed by individuals other than the intended recipient. Nevertheless, I authorize Baylor Scott & White Health to transfer the requested information to me via email with the understanding that Baylor is not responsible for, and cannot guarantee, the privacy of the transmitted information following delivery to me. Furthermore, I represent that I am the patient or the patient's authorized representative, for whom such information has been requested."