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Member is not required to authorize the use of email and text messages and a decision to not authorize electronic communication will <br /> not affect Member's health care in any way. <br /> Frontier and its Primary Care Providers have taken considerable effort to protect the personal health information of our members and <br /> recommend that all members provide Frontier and its Primary Care Providers with this authorization so that Frontier and its Primary <br /> Care Providers can more efficiently communicate with members. <br /> For privacy of member health information, Frontier and its Primary Care Providers recommend that members provide Frontier and its <br /> Primary Care Providers with a personal email address and phone number instead of an email address or phone number affiliated with <br /> your employer. <br /> By completing this fonn,Member authorizes Frontier to send email or text messages which may include unencrypted protected health <br /> information. In the event Frontier or its Primary Care Providers need to contact Member via email or text message and are unable to <br /> send a detailed message,Frontier and its Primary Care Providers may contact Member and request that Member contacts Frontier and <br /> its Primary Care Providers,or Frontier and its Primary Care Providers may notify you through other means. <br /> Preferred Phone Number: <br /> Preferred Email Address: <br /> Frontier and its Primary Care Providers may send a detailed message at the preferred phone number above. _Yes _No <br /> Frontier and its Primary Care Providers may send a detailed message to the preferred email address above._Yes_No <br /> Item H. Information on Member Access to Frontier <br /> This is an informational document between Frontier Direct, LLC with its primary office located at 119 W Van Buren, Suite 10, <br /> Harlingen, TX 78550 (hereinafter called "Frontier"), Primary Care Provider in his/her capacity as an agent of Frontier, and you, <br /> (hereinafter called"Member"). <br /> Background <br /> The Primary Care Provider, who specializes in family medicine, delivers care on behalf of Frontier, at the address set forth <br /> above.In exchange for certain fees paid by Member's employer,Frontier,through its Primary Care Provider,agrees to provide Member <br /> with the Services described in this Document on the terns and conditions set forth in this document. <br /> Definitions <br /> 1.Member.A Member is defined as those persons for whom the Primary Care Provider shall provide Services as enrolled through <br /> Member's employer. <br /> 2. Services. As used in this Document, the tern Services, shall mean a package of services, both medical and non-medical, and <br /> certain amenities(collectively"Services"),which are offered by Frontier, and set forth in Item III. <br /> 3. Term; Termination. Frontier will begin providing the Services on the date determined by Member's employer. In the event <br /> Member's employer no longer contracts with Frontier to provide the Services,Member's employer will notify Member of this change. <br /> Questions should be directed to Member's Human Resources Department. <br /> 4.Non-Participation in Insurance.Neither Frontier,nor the Primary Care Providers,participate in any health insurance or HMO <br /> plans or panels and the Primary Care Providers do not participate in Medicare. As part of Frontier's agreement with Member's <br /> employer,neither of the above make any representations whatsoever that any fees paid under this Document are covered by Member's <br /> 13 <br />