Third Party Collection. I acknowledge that South Texas Cardiovascular Consultants may utilize the services of a third party business associate or affiliated entity as an extended business office (“EBO Servicer”) for medical account billing and servicing.
Third Party Collection. We collect personal information from vendor partners that provide goods and services to the University the information includes: (Program Administrators, Please Check All That Apply) The Program Information will be used in the following manor: (Program Administrator, Please Check All That Apply) I hereby consent to the Program and its third party service providers to collect information from me and my child in connection with my child’s participation in the Program.
Third Party Collection. I acknowledge that Women’s Specialists of Clear Lake, PLLC may utilize the services of a third party business associate or affiliated entity as an extended business office (“EBO Servicer”) for medical account billing and servicing.
Third Party Collection. I acknowledge that Cardiology Clinic of San Antonio may utilize the services of a third party business associate or affiliated entity as an extended business office (“EBO Servicer”) for medical account billing and servicing.
Third Party Collection. I acknowledge that iMED HEALTHCARE ASSOCIATES may utilize the services of a third party business associate or affiliated entity as an extended business office (“EBO Servicer”) for medical account billing and servicing.
Third Party Collection. I acknowledge and understand that if I fail to pay the charges incurred by me for the medical care and treatment provided by Washington Regional, Washington Regional will undertake collection activities in accordance with the terms of the Washington Regional Financial Assistance and Collection Policy, a copy of which can be obtained at xxx.xxxxxxxxx.xxx/xxxx/xxxxxxxxx-xxxxxxxxxx, which activities may include the assignment of my past-due account to a third- party collection agency and the initiation of Extraordinary Collection Activities as defined in the Financial Assistance and Collection Policy. I further acknowledge and agree that in the event Washington Regional or a third-party collection agency to whom Washington Regional assigns my outstanding account(s) initiates collection efforts to recover any amounts owed by me, then, in addition to the outstanding amount owed and incurred by me for medical care and treatment, I will pay, to the extent permitted by law, any and all costs incurred by Washington Regional or its assignee in pursuing collection, including court costs, pre-judgment and post-judgment interest, and reasonable attorney’s fees. I acknowledge, consent and agree that the federal or state courts situated in Washington County, Arkansas shall serve as the proper venue for any legal proceeding filed to collect any amounts owed by me for medical care and treatment rendered by Washington Regional.
Third Party Collection. I acknowledge that NW FL Heart Institute may utilize the services of a third party business associate or affiliated entity as an extended business office (“EBO Servicer”) for medical account billing and servicing.
Third Party Collection. I acknowledge that F.I.N.E. may utilize the services of a third party business associate or affiliated entity as an extended business office (“EBO Servicer”) for medical account billing and servicing.
Third Party Collection. I acknowledge that SUNCOAST OB/GYN ALL WOMEN’S may utilize the services of a third party business associate or affiliated entity as an extended business office (“EBO Servicer”) for medical account billing and servicing.
Third Party Collection. We collect personal information from vendor partners that provide goods and services to the University the information includes: (Program Administrators, Please Check All That Apply) Identification Information, such as name, preferred name and xxxxxxx, date of birth, Social Security Number, photo, etc. Contact Information, such as email address, address, phone number, parent/guardian contact information, etc. Academic Records, such as education history, transcripts, test scores, recommendations, etc. Medical Information, such as allergies, medications, medical history, medical contacts, etc. Financial Information, such as payment method and payment details. Program Deliverables, such as portfolio of work, performance statistics and assessments, etc. User Content in Learning Management Systems and Videoconferencing Tools, such as recordings of voice, image, and surroundings, chat messages, discussion posts, uploaded files, speech to text transcripts, conversations with classmates and instructors, assignment submissions, survey and quiz responses, etc. System Logging Information, such as browser, operating system, and device type, IP and MAC address, date and time of login, length of session, time of transactions and submissions, etc. The Program Information will be used in the following manor: (Program Administrator, Please Check All That Apply) Program Enrollment and Management: support processes associated with selecting and attending programs, managing enrollment, issuing certificates, etc. Teaching and Learning Process: facilitate effective and engaging learning experiences by providing useful information to instructors and participants. Life on Campus: provide services, such as emergency alerts, housing, transportation, recreation sports, libraries, etc. Communications: provide program participants with information on relevant services, events, etc.
