The Heart Institute Invites you to its 2023 Patient and Family Reunion.
Enjoy games, light bites and refreshments while you reunite with your doctors, nurses and caregivers at Nicklaus Children's.
Nicklaus Children's Hospital
Advanced Pediatric Care Pavilion
3100 SW 62 Ave
Miami, FL 33155
Please park in the blue garage.
Monday, February 20 (Presidents' Day)
11 AM to 2 PM
Ver en Español
Please fill in RSVP and media consent below:
Consent for Photography, Video/Television, Audio/Sound Recordings and Interviews*:
I hereby give my consent and authorization to Nicklaus Children’s Health System, Nicklaus Children’s Hospital, and Nicklaus Children’s Hospital Foundation, including its physicians, authorized technicians, employees, and authorized agents (collectively “NCHS”) to photograph, film, create digital images, video, interview, create sound recordings, or otherwise create media content (“Content”) of me/my child related to the event identified above or treatment of my/my child’s medical condition(s), including any operative or special procedures performed, for the purposes indicated in this consent.
I understand that such media content may include my/my child’s face, image, likeness, voice, name, age, any and all information regarding my/my child’s medical condition(s), treatment, status, prognosis, and other protected health information as defined by the Health Insurance Portability and Accountability Act (HIPAA) as amended, and other federal or state privacy laws. I hereby consent to and specifically authorize NCHS to disclose and use such Content as indicated:
The Content may be used by NCHS for purposes of medical education, study and training, including possible publication in scientific or professional journals, articles, or other publications. Disclosures may be made to physicians, residents, fellows, medical students, affiliated academic and educational institutions, local and national medical, scientific, and educational entities and groups, and any source for medical education purposes.
Marketing or Media Purposes*:
The Content may be used by NCHS for internal and external marketing, public relations, communications, and promotional purposes. Disclosures may be made to national and local reporters, television programs, news agencies, radio stations, internet, and social marketing or media sites.
Hold Harmless Agreement*:
I understand the Content and any and all reproductions of the Content
obtained or created by NCHS remains the property of that NCHS entity. Any Content
created by external media remains the property of that external media, unless otherwise
agreed. All Content disclosed in reliance on this consent may be re-disclosed to
other parties and may no longer be protected by state or federal privacy
I hereby agree to hold NCHS free and harmless from any and
all liability arising out of the use and/or release of Content.
I may refuse to sign this consent, and that my refusal to sign will not affect in any
way my or my child’s ability to obtain treatment at NCHS or any
of its sites. I understand that NCHS is not requiring me to sign this
consent as a condition to getting treatment, making payments on any bills, or gaining
enrollment or eligibility in any health insurance plan, unless the Federal Privacy Regulations
allow it. I realize that I/my child will not be compensated in
any way by NCHS for providing, participating in, or consenting to use of
I understand that I may revoke this authorization at any time, provided
I do so in writing and send such writing to NCHS, attention: Marketing Department. I understand
that any Content disclosed between the effective date of this consent and the date
of my revocation may still be used by NCHS. This consent shall remain in full force and
effect as of the effective date below, unless and until a written revocation is received by NCHS.