Patient Consent to Electronic Communication

RISKS OF USING ELECTRONIC MESSAGES

Semmes Murphey Clinic, A Professional Corporation (referred to as “Semmes Murphey” in this consent) offers patients the opportunity to communicate with Semmes Murphey through electronic messages over the Internet, the World Wide Web, and other electronic networks. Examples of electronic messages might include, among others, messages or other information sent through approved email accounts or webpages. Transmitting patient information by email or other electronic messages, however, has a number of risks that you, as a patient, should consider before deciding to use electronic messages to facilitate your treatment by Semmes Murphey. These risks include, among others, the following:

  • Messages can be circulated, forwarded, and stored in numerous paper and electronic files.
  • Messages can be immediately broadcast worldwide and may be received by many intended and unintended recipients.
  • Message senders can easily misaddress messages.
  • Electronic messages are easier to falsify than handwritten or signed documents.
  • Backup copies of messages may exist even after the sender or the recipient has deleted his or her copy.
  • Employers and online service providers often have a right to archive and inspect messages transmitted through their systems.
  • Messages are insecure and can be intercepted, altered, forwarded, or used without authorization or detection.
  • Messages can be used to introduce viruses into computer systems.
  • Messages can be used as evidence in court. 

CONDITIONS FOR THE USE OF ELECTRONIC MESSAGES

Semmes Murphey will use reasonable means to protect the security and confidentiality of electronic messages sent and received. However, because of the risks outlined above and others, Semmes Murphey cannot guarantee the security and confidentiality of electronic messages and will not communicate with patients electronically unless they agree to not hold Semmes Murphey liable for any injuries, losses, or damages arising from or in connection with electronic messages. Thus, patients should be aware of these risks and must sign a consent to the use of electronic messages involving their information before Semmes Murphey can engage in these messages with patients. Consent to the use of electronic messages includes your agreement with the following conditions:

  • All electronic messages to or from you concerning diagnosis or treatment will be printed out or stored electronically by Semmes Murphey and made part of the your medical record. Because the messages are a part of the medical record, other individuals authorized to access the medical record, such as staff and billing personnel, will have access to those messages.
  • Semmes Murphey practitioners may forward messages internally to other Semmes Murphey practitioners, Semmes Murphey staff, and agents as necessary for diagnosis, treatment, payment, health care operations, and other purposes central to Semmes Murphey’s relationship with you. Semmes Murphey will not, however, forward messages to independent third-parties without your prior written authorization, except as permitted or required by law.
  • Although Semmes Murphey will endeavor to read and respond promptly to a message from you, Semmes Murphey cannot guarantee that any particular message will be read and responded to within any particular period of time. Thus, you cannot use email or other electronic messages for medical emergencies or other time-sensitive matters.
  • If your message requires or invites a response from Semmes Murphey and you have not received a response within a reasonable time period, it is your responsibility to follow up to determine whether the intended recipient received the message and when the recipient will respond.
  • You should not use electronic messages for communications regarding sensitive medical information, such as information regarding sexually transmitted diseases, AIDS/HIV, mental health, developmental disability, or substance abuse.
  • You are responsible for informing Semmes Murphey of any types of information you do not want to be sent by electronic message (in addition to those set out in 2(e) above).
  • You are responsible for protecting your password or other means of access to electronic messages. Semmes Murphey is not liable for breaches of confidentiality caused by you or any third-party.
  • Semmes Murphey practitioners will not knowingly engage in electronic messages that are unlawful, such as any that would result in unlawful practice of medicine across state lines.
  • It is your responsibility to follow up and/or schedule an appointment if warranted.

INSTRUCTIONS

To communicate by electronic messages, you shall:

  • Limit or avoid use of your employer’s computer.
  • Inform Semmes Murphey of changes in your email address or similar electronic account information.
  • Put your name in the body of the message.
  • For routing purposes, include the category of the communication in the message’s subject line, (e.g., billing question).
  • Review the message to make sure it is clear and that all relevant information is provided before sending it to Semmes Murphey.
  • Each time you receive a message from Semmes Murphey, reply to that message to let them know you received it.
  • Take precautions to preserve the confidentiality of messages, such as using screen savers and passwords, and safeguarding your passwords.
  • Withdraw your consent reflected in this document only by electronic message or written communication.

PATIENT ACKNOWLEDGMENT AND AGREEMENT

I wish to use electronic messages to facilitate my receipt of health care from Semmes Murphey Clinic, A Professional Corporation (referred to as “Semmes Murphey” in this consent). I acknowledge that I have read and fully understand this consent form. I understand the risks associated with the electronic messages between Semmes Murphey and me; agree to hold Semmes Murphey harmless for any injuries, losses, or damages arising from or connection with electronic messages; and consent to the conditions outlined in this consent form. In addition, I agree to the instructions outlined above, and will abide by any other instructions that Semmes Murphey provides to me regarding electronic messages. I have asked any questions that I have, and any such questions have been fully answered.

Accept  Decline