NOTICE OF PRIVACY POLICIES
Acknowledgment of Receipt You have been presented with a copy of North County Lifeline, Inc.’s (Lifeline) NOTICE OF PRIVACY POLICIES, detailing how your protected healthy information (PHI) may be used and disclosed as permitted under Federal and State Law. We encourage you to review it carefully. Our NOTICE OF PRIVACY POLICIES is subject to change. If we change our Notice, you may obtain a copy of the revised Notice by visiting our website at http://www.nclifeline.org or on request from our staff.
SMS Communication Policy
SMS Consent. Clients may opt in to receive SMS text messages from Lifeline Community Services (North County Lifeline, Inc.) by providing their mobile phone number and indicating consent during the service intake process or through written consent forms. By opting in, clients agree to receive text messages related to the services they receive from Lifeline.
Types of Messages
SMS messages may include:
Message and Data Rates. Message and data rates may apply depending on the client’s mobile carrier.
Opt-Out. Clients may opt out of receiving SMS messages at any time by replying STOP to any message.
Help. Clients may reply HELP for assistance or contact Lifeline Community Services directly.
Privacy. Privacy. Mobile opt-in data and consent information will not be shared, sold, or disclosed to third parties or affiliates for marketing or promotional purposes.
Information may only be shared with service providers that support Lifeline Community Services' messaging services, such as messaging platforms or telecommunications providers, solely for the purpose of delivering SMS communications.
For more information please review our Privacy Policy.
Lifeline’s Technology Informed Consent
It is Lifeline’s policy to utilize technology to better serve our clients. New Health Insurance Portability and Accountability (HIPAA) laws require that Lifeline inform clients of what technology is used. Lifeline uses email, cell phones, computers, laptops, faxes, and on occasion thumb drives. Text messaging service is for conversational person-to-person communication for client communication. We may send you an initial message providing details about the service. After that, the number of text messages you receive will vary depending on how you use our services and whether you take steps to generate more texts from us. It is important to be aware that computers, e-mail and cell phone communication can be relatively easily accessed by unauthorized individuals, and hence can compromise the privacy and confidentiality of such communication. Lifeline has taken numerous precautions to preserve and protect clients’ personal information. Lifeline has its own server with virus protections and firewalls, uses password protections, provides routine security checks, backs up all information and has established policies and procedures to make sure all information is safe and secure. Lifeline staff have been trained and educated about HIPAA rules and regulations and are aware of Lifeline’s established policies and procedures regarding Protected Health Information.
Signing this consent means you have been informed and consent to Lifeline’s use of e-mail, cell phones, computers, including laptops, faxes and, on occasion, thumb drives to better serve you.
If you would like to be contacted via email, please provide us with your current email address:
E-mail address:
May Lifeline leave you voice messages and/or texts on your cell phone? Yes___ No___
By consenting and submitting this form, you expressly consent to receive recurring SMS text messages from Lifeline Community Services regarding appointment reminders and notifications. Message frequency may vary. Message and data rates may apply. Reply STOP to unsubscribe or HELP for help. View our Privacy Policy https://lifelinecs.org/policies-procedures.
My cell phone number is______________
I acknowledge receipt of the Notice of Privacy Policies from North County Lifeline, Inc. and consent to the use of electronic technology.
Signature of Client________________________ Date____________
Printed name of Client_____________________
Signature of Parent/Guardian______________ Date____________
Internal Use Only:
To be completed only if no signature is obtained. If it is not possible to obtain the individual’s acknowledgment, describe the good faith efforts made to obtain the individual’s acknowledgement, and the reasons why the acknowledgement was not obtained.
Reasons why the acknowledgement was not obtained:
____Parent/Guardian and/or Client refused to sign
____ Other/Comments:
Presented on date and time: _____________________________
Staff name and title:_____________________________________
Acknowledgment of Receipt You have been presented with a copy of North County Lifeline, Inc.’s (Lifeline) NOTICE OF PRIVACY POLICIES, detailing how your protected healthy information (PHI) may be used and disclosed as permitted under Federal and State Law. We encourage you to review it carefully. Our NOTICE OF PRIVACY POLICIES is subject to change. If we change our Notice, you may obtain a copy of the revised Notice by visiting our website at http://www.nclifeline.org or on request from our staff.
SMS Communication Policy
SMS Consent. Clients may opt in to receive SMS text messages from Lifeline Community Services (North County Lifeline, Inc.) by providing their mobile phone number and indicating consent during the service intake process or through written consent forms. By opting in, clients agree to receive text messages related to the services they receive from Lifeline.
Types of Messages
SMS messages may include:
- Appointment reminders
- Service updates
- Program notifications
- Direct communication between Lifeline staff and clients regarding services
Message and Data Rates. Message and data rates may apply depending on the client’s mobile carrier.
Opt-Out. Clients may opt out of receiving SMS messages at any time by replying STOP to any message.
Help. Clients may reply HELP for assistance or contact Lifeline Community Services directly.
Privacy. Privacy. Mobile opt-in data and consent information will not be shared, sold, or disclosed to third parties or affiliates for marketing or promotional purposes.
Information may only be shared with service providers that support Lifeline Community Services' messaging services, such as messaging platforms or telecommunications providers, solely for the purpose of delivering SMS communications.
For more information please review our Privacy Policy.
Lifeline’s Technology Informed Consent
It is Lifeline’s policy to utilize technology to better serve our clients. New Health Insurance Portability and Accountability (HIPAA) laws require that Lifeline inform clients of what technology is used. Lifeline uses email, cell phones, computers, laptops, faxes, and on occasion thumb drives. Text messaging service is for conversational person-to-person communication for client communication. We may send you an initial message providing details about the service. After that, the number of text messages you receive will vary depending on how you use our services and whether you take steps to generate more texts from us. It is important to be aware that computers, e-mail and cell phone communication can be relatively easily accessed by unauthorized individuals, and hence can compromise the privacy and confidentiality of such communication. Lifeline has taken numerous precautions to preserve and protect clients’ personal information. Lifeline has its own server with virus protections and firewalls, uses password protections, provides routine security checks, backs up all information and has established policies and procedures to make sure all information is safe and secure. Lifeline staff have been trained and educated about HIPAA rules and regulations and are aware of Lifeline’s established policies and procedures regarding Protected Health Information.
Signing this consent means you have been informed and consent to Lifeline’s use of e-mail, cell phones, computers, including laptops, faxes and, on occasion, thumb drives to better serve you.
If you would like to be contacted via email, please provide us with your current email address:
E-mail address:
May Lifeline leave you voice messages and/or texts on your cell phone? Yes___ No___
By consenting and submitting this form, you expressly consent to receive recurring SMS text messages from Lifeline Community Services regarding appointment reminders and notifications. Message frequency may vary. Message and data rates may apply. Reply STOP to unsubscribe or HELP for help. View our Privacy Policy https://lifelinecs.org/policies-procedures.
My cell phone number is______________
I acknowledge receipt of the Notice of Privacy Policies from North County Lifeline, Inc. and consent to the use of electronic technology.
Signature of Client________________________ Date____________
Printed name of Client_____________________
Signature of Parent/Guardian______________ Date____________
Internal Use Only:
To be completed only if no signature is obtained. If it is not possible to obtain the individual’s acknowledgment, describe the good faith efforts made to obtain the individual’s acknowledgement, and the reasons why the acknowledgement was not obtained.
Reasons why the acknowledgement was not obtained:
____Parent/Guardian and/or Client refused to sign
____ Other/Comments:
Presented on date and time: _____________________________
Staff name and title:_____________________________________