Looking for some advice!
We carry out a lot of blood tests that are not currently built into a health check structure. Patients have got into a habit of ringing and booking "just need my bloods checking" without an initial doctor's appointment or request. This has become worse through Covid.
I think this is an opportune time to improve our service delivery.
We have discussed this again in-house and want to ensure that this practice is discontinued. Clinically I am concerned that patients are being falsely reassured by "normal" results and want to ensure we are providing a more robust and comprehensive health screening service. I know we will get some push back from patients who dont want to spend the time (or money) to get a more comprehensive health check done.
What are others doing?
Any advice and tips?
How often? What should be tested? Follow up and reviews?
Gavin
We have the same issue Gavin. It’s a historical thing and this practice was very convenient for us. Our initial thought was get the bloods done and then review pt. something will happen and like all good plan, will go down the long finger.
The big issue we have is hard to give appointments when we have none to give for review and for blood test. I know it’s an excuse but, what can I say.
Would love to change this behaviour but don’t know if I have the energy to do so, now.
I need a holiday
K
Kandan
On 23 May 2021, at 14:29, Gavin Maguire gavin.maguire@centrichealth.ie wrote:
Looking for some advice!
We carry out a lot of blood tests that are not currently built into a health check structure. Patients have got into a habit of ringing and booking "just need my bloods checking" without an initial doctor's appointment or request. This has become worse through Covid.
I think this is an opportune time to improve our service delivery.
We have discussed this again in-house and want to ensure that this practice is discontinued. Clinically I am concerned that patients are being falsely reassured by "normal" results and want to ensure we are providing a more robust and comprehensive health screening service. I know we will get some push back from patients who dont want to spend the time (or money) to get a more comprehensive health check done.
What are others doing?
Any advice and tips?
How often? What should be tested? Follow up and reviews?
Gavin
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Hi Gavin,
We say ‘yes sure’ but we do it like this- we email a letter which invites them to a nurse appt, then a gap (in case of running behind) and then a dr appt. Nurse does bloods, height, weight, BP, pulse and u/a.
Dr does general exam including PR /DRE where appropriate. The letter says that if there is a specific symptom they’ll need a half hour appt .
Can share the template if anyone wants to have a look.
K
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From: Gavin Maguire gavin.maguire@centrichealth.ie
Sent: Sunday, May 23, 2021 2:28:35 PM
To: gpdiscussion@centricgpforum.com gpdiscussion@centricgpforum.com
Cc: MAC mac@centrichealth.ie
Subject: Centric GP Forum Health Screening
Looking for some advice!
We carry out a lot of blood tests that are not currently built into a health check structure. Patients have got into a habit of ringing and booking "just need my bloods checking" without an initial doctor's appointment or request. This has become worse through Covid.
I think this is an opportune time to improve our service delivery.
We have discussed this again in-house and want to ensure that this practice is discontinued. Clinically I am concerned that patients are being falsely reassured by "normal" results and want to ensure we are providing a more robust and comprehensive health screening service. I know we will get some push back from patients who dont want to spend the time (or money) to get a more comprehensive health check done.
What are others doing?
Any advice and tips?
How often? What should be tested? Follow up and reviews?
Gavin
This e-mail and any attachments including voice attachments may contain confidential, personal, sensitive, proprietary or legally privileged information. Anyone who is not the intended recipient should not use or open the document. Any information or voice recording used within this document or e-mail should not be forwarded to any other legal person or organisation or posted on any social media platform as to do so would be in breach of privacy and data protection legislation. If you have erroneously received this email or document, please delete immediately and notify the sender. If you have received this e-mail or documentation where there is a precise reason to forward to a third party, all rules regarding privacy and data protection should be followed. You will be liable for a third party breach.The recipients acknowledge that Centric Health or associated companies are unable to exercise control to ensure or guarantee the integrity of/over the contents of the information contained in e-mail transmission and further acknowledge that any views expressed in this message are those of the individual sender and no binding nature of the message shall be implied or assumed unless the sender does so expressly with due authority of Centric Health.
I know this is a simplistic response but we do not allow any patient to
ring up to order blood tests. If someone calls they are told to discuss
their request with the doctor. Our nurse will not take blood or urine
unless she sees a doctor’s approval in the note.
I think it’s a financial Issue. Isn’t it always?
Tony Peacock
Terenure Medical
On Sun 23 May 2021 at 15:27, Kandan nasilemak1978@gmail.com wrote:
We have the same issue Gavin. It’s a historical thing and this practice
was very convenient for us. Our initial thought was get the bloods done and
then review pt. something will happen and like all good plan, will go down
the long finger.
The big issue we have is hard to give appointments when we have none to
give for review and for blood test. I know it’s an excuse but, what can I
say.
Would love to change this behaviour but don’t know if I have the energy to
do so, now.
I need a holiday
K
Kandan
On 23 May 2021, at 14:29, Gavin Maguire gavin.maguire@centrichealth.ie
wrote:
Looking for some advice!
We carry out a lot of blood tests that are not currently built into a
health check structure. Patients have got into a habit of ringing and
booking "just need my bloods checking" without an initial doctor's
appointment or request. This has become worse through Covid.
I think this is an opportune time to improve our service delivery.
We have discussed this again in-house and want to ensure that this
practice is discontinued. Clinically I am concerned that patients are being
falsely reassured by "normal" results and want to ensure we are providing a
more robust and comprehensive health screening service. I know we will get
some push back from patients who dont want to spend the time (or money) to
get a more comprehensive health check done.
What are others doing?
Any advice and tips?
How often? What should be tested? Follow up and reviews?
Gavin
Gpdiscussion mailing list -- gpdiscussion@centricgpforum.com
To unsubscribe send an email to gpdiscussion-leave@centricgpforum.com
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To unsubscribe send an email to gpdiscussion-leave@centricgpforum.com
Post on Keith please as sounds like a good idea
Gavin Maguire
On 23 May 2021, at 15:30, Keith Perdue keith.perdue@centrichealth.ie wrote:
Hi Gavin,
We say ‘yes sure’ but we do it like this- we email a letter which invites them to a nurse appt, then a gap (in case of running behind) and then a dr appt. Nurse does bloods, height, weight, BP, pulse and u/a.
Dr does general exam including PR /DRE where appropriate. The letter says that if there is a specific symptom they’ll need a half hour appt .
Can share the template if anyone wants to have a look.
K
Get Outlook for iOShttps://aka.ms/o0ukef
From: Gavin Maguire gavin.maguire@centrichealth.ie
Sent: Sunday, May 23, 2021 2:28:35 PM
To: gpdiscussion@centricgpforum.com gpdiscussion@centricgpforum.com
Cc: MAC mac@centrichealth.ie
Subject: Centric GP Forum Health Screening
Looking for some advice!
We carry out a lot of blood tests that are not currently built into a health check structure. Patients have got into a habit of ringing and booking "just need my bloods checking" without an initial doctor's appointment or request. This has become worse through Covid.
I think this is an opportune time to improve our service delivery.
We have discussed this again in-house and want to ensure that this practice is discontinued. Clinically I am concerned that patients are being falsely reassured by "normal" results and want to ensure we are providing a more robust and comprehensive health screening service. I know we will get some push back from patients who dont want to spend the time (or money) to get a more comprehensive health check done.
What are others doing?
Any advice and tips?
How often? What should be tested? Follow up and reviews?
Gavin
This e-mail and any attachments including voice attachments may contain confidential, personal, sensitive, proprietary or legally privileged information. Anyone who is not the intended recipient should not use or open the document. Any information or voice recording used within this document or e-mail should not be forwarded to any other legal person or organisation or posted on any social media platform as to do so would be in breach of privacy and data protection legislation. If you have erroneously received this email or document, please delete immediately and notify the sender. If you have received this e-mail or documentation where there is a precise reason to forward to a third party, all rules regarding privacy and data protection should be followed. You will be liable for a third party breach.The recipients acknowledge that Centric Health or associated companies are unable to exercise control to ensure or guarantee the integrity of/over the contents of the information contained in e-mail transmission and further acknowledge that any views expressed in this message are those of the individual sender and no binding nature of the message shall be implied or assumed unless the sender does so expressly with due authority of Centric Health.
This e-mail and any attachments including voice attachments may contain confidential, personal, sensitive, proprietary or legally privileged information. Anyone who is not the intended recipient should not use or open the document. Any information or voice recording used within this document or e-mail should not be forwarded to any other legal person or organisation or posted on any social media platform as to do so would be in breach of privacy and data protection legislation. If you have erroneously received this email or document, please delete immediately and notify the sender. If you have received this e-mail or documentation where there is a precise reason to forward to a third party, all rules regarding privacy and data protection should be followed. You will be liable for a third party breach.The recipients acknowledge that Centric Health or associated companies are unable to exercise control to ensure or guarantee the integrity of/over the contents of the information contained in e-mail transmission and further acknowledge that any views expressed in this message are those of the individual sender and no binding nature of the message shall be implied or assumed unless the sender does so expressly with due authority of Centric Health. _______________________________________________
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We have a rule for a few years that we don’t do bloods unless ordered by a doctor first. So if someone rings looking for 'routine bloods' they see a doctor first and then the nurse for bloods. Its safer and more useful for the patient.
Exceptions might be annual TFTs/ methotrexate monitoring/ calcium pre prolia injections and a few others.
if bloods ordered by a consultant we do them but send results to consultant for follow up (and direct patient accordingly).
We do have a 'full medical' offering too.
Jean
Get Outlook for iOShttps://aka.ms/o0ukef
From: Gavin Maguire gavin.maguire@centrichealth.ie
Sent: Sunday, May 23, 2021 2:28:35 PM
To: gpdiscussion@centricgpforum.com gpdiscussion@centricgpforum.com
Cc: MAC mac@centrichealth.ie
Subject: Health Screening
Looking for some advice!
We carry out a lot of blood tests that are not currently built into a health check structure. Patients have got into a habit of ringing and booking "just need my bloods checking" without an initial doctor's appointment or request. This has become worse through Covid.
I think this is an opportune time to improve our service delivery.
We have discussed this again in-house and want to ensure that this practice is discontinued. Clinically I am concerned that patients are being falsely reassured by "normal" results and want to ensure we are providing a more robust and comprehensive health screening service. I know we will get some push back from patients who dont want to spend the time (or money) to get a more comprehensive health check done.
What are others doing?
Any advice and tips?
How often? What should be tested? Follow up and reviews?
Gavin
Do you have a “format” for medical Jean - paper or pc
Gavin Maguire
On 23 May 2021, at 18:25, Jean Gallagher jgallagher@ranelaghmedical.ie wrote:
We have a rule for a few years that we don’t do bloods unless ordered by a doctor first. So if someone rings looking for 'routine bloods' they see a doctor first and then the nurse for bloods. Its safer and more useful for the patient.
Exceptions might be annual TFTs/ methotrexate monitoring/ calcium pre prolia injections and a few others.
if bloods ordered by a consultant we do them but send results to consultant for follow up (and direct patient accordingly).
We do have a 'full medical' offering too.
Jean
Get Outlook for iOShttps://aka.ms/o0ukef
From: Gavin Maguire gavin.maguire@centrichealth.ie
Sent: Sunday, May 23, 2021 2:28:35 PM
To: gpdiscussion@centricgpforum.com gpdiscussion@centricgpforum.com
Cc: MAC mac@centrichealth.ie
Subject: Health Screening
Looking for some advice!
We carry out a lot of blood tests that are not currently built into a health check structure. Patients have got into a habit of ringing and booking "just need my bloods checking" without an initial doctor's appointment or request. This has become worse through Covid.
I think this is an opportune time to improve our service delivery.
We have discussed this again in-house and want to ensure that this practice is discontinued. Clinically I am concerned that patients are being falsely reassured by "normal" results and want to ensure we are providing a more robust and comprehensive health screening service. I know we will get some push back from patients who dont want to spend the time (or money) to get a more comprehensive health check done.
What are others doing?
Any advice and tips?
How often? What should be tested? Follow up and reviews?
Gavin
I do same as Jean
Get Outlook for Androidhttps://aka.ms/AAb9ysg
From: Gavin Maguire gavin.maguire@centrichealth.ie
Sent: Sunday, May 23, 2021 7:01:17 PM
To: Jean Gallagher jgallagher@ranelaghmedical.ie
Cc: gpdiscussion@centricgpforum.com gpdiscussion@centricgpforum.com; MAC mac@centrichealth.ie
Subject: Centric GP Forum Re: Health Screening
Do you have a “format” for medical Jean - paper or pc
Gavin Maguire
On 23 May 2021, at 18:25, Jean Gallagher jgallagher@ranelaghmedical.ie wrote:
We have a rule for a few years that we don’t do bloods unless ordered by a doctor first. So if someone rings looking for 'routine bloods' they see a doctor first and then the nurse for bloods. Its safer and more useful for the patient.
Exceptions might be annual TFTs/ methotrexate monitoring/ calcium pre prolia injections and a few others.
if bloods ordered by a consultant we do them but send results to consultant for follow up (and direct patient accordingly).
We do have a 'full medical' offering too.
Jean
Get Outlook for iOShttps://aka.ms/o0ukef
From: Gavin Maguire gavin.maguire@centrichealth.ie
Sent: Sunday, May 23, 2021 2:28:35 PM
To: gpdiscussion@centricgpforum.com gpdiscussion@centricgpforum.com
Cc: MAC mac@centrichealth.ie
Subject: Health Screening
Looking for some advice!
We carry out a lot of blood tests that are not currently built into a health check structure. Patients have got into a habit of ringing and booking "just need my bloods checking" without an initial doctor's appointment or request. This has become worse through Covid.
I think this is an opportune time to improve our service delivery.
We have discussed this again in-house and want to ensure that this practice is discontinued. Clinically I am concerned that patients are being falsely reassured by "normal" results and want to ensure we are providing a more robust and comprehensive health screening service. I know we will get some push back from patients who dont want to spend the time (or money) to get a more comprehensive health check done.
What are others doing?
Any advice and tips?
How often? What should be tested? Follow up and reviews?
Gavin
This e-mail and any attachments including voice attachments may contain confidential, personal, sensitive, proprietary or legally privileged information. Anyone who is not the intended recipient should not use or open the document. Any information or voice recording used within this document or e-mail should not be forwarded to any other legal person or organisation or posted on any social media platform as to do so would be in breach of privacy and data protection legislation. If you have erroneously received this email or document, please delete immediately and notify the sender. If you have received this e-mail or documentation where there is a precise reason to forward to a third party, all rules regarding privacy and data protection should be followed. You will be liable for a third party breach.The recipients acknowledge that Centric Health or associated companies are unable to exercise control to ensure or guarantee the integrity of/over the contents of the information contained in e-mail transmission and further acknowledge that any views expressed in this message are those of the individual sender and no binding nature of the message shall be implied or assumed unless the sender does so expressly with due authority of Centric Health.
Here it is…………..
[cid:image001.png@01D750B7.1D7875F0]
From: Gavin Maguire gavin.maguire@centrichealth.ie
Sent: Sunday 23 May 2021 16:26
To: Centric GP Forum gpdiscussion@centricgpforum.com
Cc: MAC mac@centrichealth.ie
Subject: Centric GP Forum Re: Health Screening
Post on Keith please as sounds like a good idea
Gavin Maguire
On 23 May 2021, at 15:30, Keith Perdue <keith.perdue@centrichealth.iemailto:keith.perdue@centrichealth.ie> wrote:
Hi Gavin,
We say ‘yes sure’ but we do it like this- we email a letter which invites them to a nurse appt, then a gap (in case of running behind) and then a dr appt. Nurse does bloods, height, weight, BP, pulse and u/a.
Dr does general exam including PR /DRE where appropriate. The letter says that if there is a specific symptom they’ll need a half hour appt .
Can share the template if anyone wants to have a look.
K
Get Outlook for iOShttps://aka.ms/o0ukef
From: Gavin Maguire <gavin.maguire@centrichealth.iemailto:gavin.maguire@centrichealth.ie>
Sent: Sunday, May 23, 2021 2:28:35 PM
To: gpdiscussion@centricgpforum.commailto:gpdiscussion@centricgpforum.com <gpdiscussion@centricgpforum.commailto:gpdiscussion@centricgpforum.com>
Cc: MAC <mac@centrichealth.iemailto:mac@centrichealth.ie>
Subject: Centric GP Forum Health Screening
Looking for some advice!
We carry out a lot of blood tests that are not currently built into a health check structure. Patients have got into a habit of ringing and booking "just need my bloods checking" without an initial doctor's appointment or request. This has become worse through Covid.
I think this is an opportune time to improve our service delivery.
We have discussed this again in-house and want to ensure that this practice is discontinued. Clinically I am concerned that patients are being falsely reassured by "normal" results and want to ensure we are providing a more robust and comprehensive health screening service. I know we will get some push back from patients who dont want to spend the time (or money) to get a more comprehensive health check done.
What are others doing?
Any advice and tips?
How often? What should be tested? Follow up and reviews?
Gavin
This e-mail and any attachments including voice attachments may contain confidential, personal, sensitive, proprietary or legally privileged information. Anyone who is not the intended recipient should not use or open the document. Any information or voice recording used within this document or e-mail should not be forwarded to any other legal person or organisation or posted on any social media platform as to do so would be in breach of privacy and data protection legislation. If you have erroneously received this email or document, please delete immediately and notify the sender. If you have received this e-mail or documentation where there is a precise reason to forward to a third party, all rules regarding privacy and data protection should be followed. You will be liable for a third party breach.The recipients acknowledge that Centric Health or associated companies are unable to exercise control to ensure or guarantee the integrity of/over the contents of the information contained in e-mail transmission and further acknowledge that any views expressed in this message are those of the individual sender and no binding nature of the message shall be implied or assumed unless the sender does so expressly with due authority of Centric Health.
This e-mail and any attachments including voice attachments may contain confidential, personal, sensitive, proprietary or legally privileged information. Anyone who is not the intended recipient should not use or open the document. Any information or voice recording used within this document or e-mail should not be forwarded to any other legal person or organisation or posted on any social media platform as to do so would be in breach of privacy and data protection legislation. If you have erroneously received this email or document, please delete immediately and notify the sender. If you have received this e-mail or documentation where there is a precise reason to forward to a third party, all rules regarding privacy and data protection should be followed. You will be liable for a third party breach.The recipients acknowledge that Centric Health or associated companies are unable to exercise control to ensure or guarantee the integrity of/over the contents of the information contained in e-mail transmission and further acknowledge that any views expressed in this message are those of the individual sender and no binding nature of the message shall be implied or assumed unless the sender does so expressly with due authority of Centric Health. _______________________________________________
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This e-mail and any attachments including voice attachments may contain confidential, personal, sensitive, proprietary or legally privileged information. Anyone who is not the intended recipient should not use or open the document. Any information or voice recording used within this document or e-mail should not be forwarded to any other legal person or organisation or posted on any social media platform as to do so would be in breach of privacy and data protection legislation. If you have erroneously received this email or document, please delete immediately and notify the sender. If you have received this e-mail or documentation where there is a precise reason to forward to a third party, all rules regarding privacy and data protection should be followed. You will be liable for a third party breach.The recipients acknowledge that Centric Health or associated companies are unable to exercise control to ensure or guarantee the integrity of/over the contents of the information contained in e-mail transmission and further acknowledge that any views expressed in this message are those of the individual sender and no binding nature of the message shall be implied or assumed unless the sender does so expressly with due authority of Centric Health.
Thanks Keith
From: Keith Perdue keith.perdue@centrichealth.ie
Sent: 24 May 2021 16:09
To: Centric GP Forum gpdiscussion@centricgpforum.com
Subject: Centric GP Forum Re: Health Screening
Here it is…………..
[cid:image001.png@01D750B7.1D7875F0]
From: Gavin Maguire gavin.maguire@centrichealth.ie
Sent: Sunday 23 May 2021 16:26
To: Centric GP Forum gpdiscussion@centricgpforum.com
Cc: MAC mac@centrichealth.ie
Subject: Centric GP Forum Re: Health Screening
Post on Keith please as sounds like a good idea
Gavin Maguire
On 23 May 2021, at 15:30, Keith Perdue <keith.perdue@centrichealth.iemailto:keith.perdue@centrichealth.ie> wrote:
Hi Gavin,
We say ‘yes sure’ but we do it like this- we email a letter which invites them to a nurse appt, then a gap (in case of running behind) and then a dr appt. Nurse does bloods, height, weight, BP, pulse and u/a.
Dr does general exam including PR /DRE where appropriate. The letter says that if there is a specific symptom they’ll need a half hour appt .
Can share the template if anyone wants to have a look.
K
Get Outlook for iOShttps://aka.ms/o0ukef
From: Gavin Maguire <gavin.maguire@centrichealth.iemailto:gavin.maguire@centrichealth.ie>
Sent: Sunday, May 23, 2021 2:28:35 PM
To: gpdiscussion@centricgpforum.commailto:gpdiscussion@centricgpforum.com <gpdiscussion@centricgpforum.commailto:gpdiscussion@centricgpforum.com>
Cc: MAC <mac@centrichealth.iemailto:mac@centrichealth.ie>
Subject: Centric GP Forum Health Screening
Looking for some advice!
We carry out a lot of blood tests that are not currently built into a health check structure. Patients have got into a habit of ringing and booking "just need my bloods checking" without an initial doctor's appointment or request. This has become worse through Covid.
I think this is an opportune time to improve our service delivery.
We have discussed this again in-house and want to ensure that this practice is discontinued. Clinically I am concerned that patients are being falsely reassured by "normal" results and want to ensure we are providing a more robust and comprehensive health screening service. I know we will get some push back from patients who dont want to spend the time (or money) to get a more comprehensive health check done.
What are others doing?
Any advice and tips?
How often? What should be tested? Follow up and reviews?
Gavin
This e-mail and any attachments including voice attachments may contain confidential, personal, sensitive, proprietary or legally privileged information. Anyone who is not the intended recipient should not use or open the document. Any information or voice recording used within this document or e-mail should not be forwarded to any other legal person or organisation or posted on any social media platform as to do so would be in breach of privacy and data protection legislation. If you have erroneously received this email or document, please delete immediately and notify the sender. If you have received this e-mail or documentation where there is a precise reason to forward to a third party, all rules regarding privacy and data protection should be followed. You will be liable for a third party breach.The recipients acknowledge that Centric Health or associated companies are unable to exercise control to ensure or guarantee the integrity of/over the contents of the information contained in e-mail transmission and further acknowledge that any views expressed in this message are those of the individual sender and no binding nature of the message shall be implied or assumed unless the sender does so expressly with due authority of Centric Health.
This e-mail and any attachments including voice attachments may contain confidential, personal, sensitive, proprietary or legally privileged information. Anyone who is not the intended recipient should not use or open the document. Any information or voice recording used within this document or e-mail should not be forwarded to any other legal person or organisation or posted on any social media platform as to do so would be in breach of privacy and data protection legislation. If you have erroneously received this email or document, please delete immediately and notify the sender. If you have received this e-mail or documentation where there is a precise reason to forward to a third party, all rules regarding privacy and data protection should be followed. You will be liable for a third party breach.The recipients acknowledge that Centric Health or associated companies are unable to exercise control to ensure or guarantee the integrity of/over the contents of the information contained in e-mail transmission and further acknowledge that any views expressed in this message are those of the individual sender and no binding nature of the message shall be implied or assumed unless the sender does so expressly with due authority of Centric Health. _______________________________________________
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This e-mail and any attachments including voice attachments may contain confidential, personal, sensitive, proprietary or legally privileged information. Anyone who is not the intended recipient should not use or open the document. Any information or voice recording used within this document or e-mail should not be forwarded to any other legal person or organisation or posted on any social media platform as to do so would be in breach of privacy and data protection legislation. If you have erroneously received this email or document, please delete immediately and notify the sender. If you have received this e-mail or documentation where there is a precise reason to forward to a third party, all rules regarding privacy and data protection should be followed. You will be liable for a third party breach.The recipients acknowledge that Centric Health or associated companies are unable to exercise control to ensure or guarantee the integrity of/over the contents of the information contained in e-mail transmission and further acknowledge that any views expressed in this message are those of the individual sender and no binding nature of the message shall be implied or assumed unless the sender does so expressly with due authority of Centric Health.
This e-mail and any attachments including voice attachments may contain confidential, personal, sensitive, proprietary or legally privileged information. Anyone who is not the intended recipient should not use or open the document. Any information or voice recording used within this document or e-mail should not be forwarded to any other legal person or organisation or posted on any social media platform as to do so would be in breach of privacy and data protection legislation. If you have erroneously received this email or document, please delete immediately and notify the sender. If you have received this e-mail or documentation where there is a precise reason to forward to a third party, all rules regarding privacy and data protection should be followed. You will be liable for a third party breach.The recipients acknowledge that Centric Health or associated companies are unable to exercise control to ensure or guarantee the integrity of/over the contents of the information contained in e-mail transmission and further acknowledge that any views expressed in this message are those of the individual sender and no binding nature of the message shall be implied or assumed unless the sender does so expressly with due authority of Centric Health.