Nomad Health Direct Primary Care · Miami Beach, Florida
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E-Signature & Electronic Records Consent

Effective July 23, 2026 · Last updated July 23, 2026

Provider: Nora Bassam Khoury, MD, PLLC, a Florida professional limited liability company doing business as Nomad Health ("Nomad Health," "we," "us")
Version: 1.0
Contact: info@mynomadhealth.com · 400 Arthur Godfrey Rd #200-01, Miami Beach, FL 33140. Please contact us by email or mail; a direct phone line will be added.

This consent is referenced by, and incorporated into, the Terms of Use. Acceptance is captured when you join the interest list (where you agree to our Privacy Policy) and, once the Practice is live, before you draw your first signature on any portal form and before a provider signs a clinical note.

1. What You Are Consenting To

Nomad Health uses electronic records and electronic signatures for practice documents, including: intake and history forms, consents and authorizations (consent to treat, telehealth consent, HIPAA Notice acknowledgment, release-of-information authorizations), the financial policy/Good Faith Estimate acknowledgment, school/sports physical intake, membership documents, invoices and receipts, and this consent itself.

By accepting this consent, you agree that:

  1. We may provide these documents, disclosures, and notices to you electronically — through the patient portal, by display on our websites, or by email to your on-file address — instead of on paper; and
  2. You may sign documents electronically, and your electronic signature will have the same legal force and effect as a handwritten ink signature.

This consent is given under the federal Electronic Signatures in Global and National Commerce Act (ESIGN, 15 U.S.C. § 7001 et seq.) and the Florida Uniform Electronic Transaction Act (Chapter 668, Part I, Florida Statutes).

2. How Our Electronic Signatures Work (Drawn Signatures)

Our portal captures a hand-drawn signature: you draw your signature on a signature pad on your screen using a mouse, trackpad, finger, or stylus, then confirm it. There are no typed-name signatures on our forms.

When you sign a form this way:

  • Your drawn signature is captured as an image;
  • It is embedded into a PDF of the completed form, together with your printed name, the form's name and version, and the date and time of submission;
  • The signed PDF is filed into your medical chart as part of your record;
  • A form cannot be submitted without both a drawn signature and a printed name, and required fields must be completed first.

Your drawn electronic signature is intended to be legally binding — it is your signature, exactly as if you had signed a paper form in ink. Do not sign unless you have read the document and agree to it. The same mechanism is used by our providers: clinical notes are signed and co-signed electronically within the EHR, with the provider's own drawn signature stored in the record.

Under Florida's UETA (§ 668.50, Fla. Stat.) and ESIGN, a record or signature may not be denied legal effect or enforceability solely because it is in electronic form.

3. Your Right to Paper

  • Paper copies: you may request a paper copy of any document you signed or received electronically, at any time, by contacting us at info@mynomadhealth.com. Electronic copies you access through the patient portal are provided at no charge; for paper copies we may charge a reasonable, cost-based fee at the rates permitted by Florida law. You can also download your submitted forms from the portal.
  • Paper alternative: you may choose to complete and sign practice forms on paper instead of electronically. Ask our staff; using paper forms will not affect your care, though it may take longer to process.

4. Withdrawing This Consent

You may withdraw your consent to electronic records and signatures at any time, at no cost, by written notice to info@mynomadhealth.com or 400 Arthur Godfrey Rd #200-01, Miami Beach, FL 33140, or by telling our staff and confirming in writing. Withdrawal:

  • Takes effect within a reasonable time after we receive it, for documents going forward;
  • Does not affect the validity or enforceability of anything you signed electronically before the withdrawal;
  • Means we will provide subsequent documents and collect subsequent signatures on paper, which may slow some processes (for example, form turnaround before visits);
  • Does not affect your right to receive care.

Note that certain portal functions (electronic form submission) inherently require electronic records; withdrawing consent means using paper equivalents for those items.

5. Updating Your Contact Information

Keep your email address and phone number current so electronic documents and notices reach you. Update them through the portal intake form or by contacting the office. We are not responsible for documents you do not receive because your on-file email is out of date, provided we sent them to the address on file.

6. Hardware and Software Requirements

To receive and sign electronic records through the Services you need:

  • A device (computer, tablet, or smartphone) with a current, supported web browser (a recent version of Chrome, Safari, Edge, or Firefox) with JavaScript enabled;
  • A pointing or touch input (mouse, trackpad, touchscreen, or stylus) capable of drawing a signature;
  • An internet connection and a valid email address;
  • The ability to view PDF files (built into modern browsers), and — if you want to keep your own copies — the ability to download and store PDFs or print them.

There is no application to install; the portal runs in your browser. If our hardware/software requirements change in a way that creates a material risk you will not be able to access or retain electronic records, we will notify you and you may withdraw consent without penalty (and, per ESIGN, without fees for the withdrawal itself).

7. Retention; Your Copies

Signed electronic documents are retained in your medical record per our records-retention obligations under Florida law and are available to you under the Notice of Privacy Practices (access rights) and through the portal. We encourage you to download or print copies of documents at the time you sign them.

8. Consent

By checking the acceptance box (or signing below with a drawn signature), you confirm that:

  1. You have read and agree to this E-Signature & Electronic Records Consent;
  2. You can access, read, and retain electronic documents as described in Section 6 (viewing this consent electronically demonstrates that access);
  3. You consent to receiving records and disclosures electronically and to signing with a drawn electronic signature, and you intend your drawn electronic signature to be legally binding;
  4. You understand you may request paper copies and may withdraw this consent as described above.

Patient (or parent/guardian) printed name: ______________________________

Signature (drawn): ______________________________

Date: ____________

(For a minor patient: the parent or legal guardian signs on the minor's behalf; the school/sports physical intake form may be signed by the student only if 18 or older.)