Informed Consent for Electronic Communications

By agreeing to receive electronic communications from the affiliated professional medical corporation that delivers clinical services and its management services organization (collectively, the “Practice”) and licensed healthcare providers (“Providers”), I agree to the following terms:

1. Appointment Reminders, Reschedules and Cancellations

I understand that the Practice can reach me any time to remind me of my appointments or let me know in case of any change about my appointments. I also understand that the Practice may use a third-party automated system to notify me about information regarding my care, including but not limited to: appointment reminders, confirmations, and cancellations.

2. Communications with Providers

I understand I may use the secure messaging platform in the Practice’s EHR to communicate with my Provider. If my Provider has enabled additional communications methods like SMS / text, I can only use these methods if I accept the terms below.

If I engage in text communications with my Provider, I understand that I am using that at my own risk. I understand that SMS communications are not secure and may be intercepted by third parties. I understand that my health information sent via text is at risk of unauthorized disclosure, that my Provider may not use a HIPAA-compliant texting platform, and standard message and data rates may apply to these communications. By consenting to SMS communications, I accept these risks and release Provider from liability for unauthorized access, disclosure, or technical failures related to SMS communications. I understand I can opt out at any time by texting STOP or notifying the Provider directly.

3. General Electronic Communication Risks

I understand that transmitting information by e-mail and/or text has a number of risks that should be considered.

Electronic communication risks include, but are not limited to the following:

• Electronic communications can be circulated, forwarded, and stored in numerous paper and electronic files.
• Electronic communications can be immediately broadcast worldwide and be received by both intended and unintended recipients.
• Electronic communications senders can misaddress the communication.
• Backup copies of electronic communications may exist even after the sender or the recipient has deleted his or her copy.
• Employers and on-line services have a right to archive and inspect e-mails/texts transmitted through their systems.
• Electronic communications can be intercepted, altered, forwarded, or used without authorization or detection.
• Electronic communications can be used to introduce viruses into technology systems.

I understand that because medical information is sensitive, e-mail and texts should not be used for communications concerning diagnosis.

I understand that it is the responsibility of the patient to protect my passwords or other means of access to electronic communications to protect confidentiality.

The Practice and Providers are not liable for breaches of confidentiality caused by the patient.

4. Contact Information Change

I accept that I am responsible for notifying the Practice when my contact information has changed.

5. Notification Preferences

I understand that the Practice’s EHR sends e-mail and push notifications to keep me up to date on messages received from my Provider, upcoming appointments, goals, and other healthcare communications for my review.

I understand that I can configure the e-mail and push notifications that I would like to receive across the web and mobile apps, from within my account. I understand, however, that certain account communication (including appointment reminders) is set by my Provider, and likely cannot be disabled for my account.