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Online Communications Informed Consent
For Online Communications with: Dr. Anne Weaver
1. Instructions for Using Online Communications
Take steps to keep your online communications to and from me confidential:
a. Do not store messages on your employer-provided computer. Such personal information could be accessible or owned by your employer.
b. Use screen savers or close your messages. Do not leave your messages on the screen for passersby to read. c. Keep your password safe and private. d. Do not allow other individuals or third parties access to the computer(s) upon which you store medical messages or other personal medical information. e. Do not email me at any personal email addresses that I may use. Standard email lacks security and privacy features and may expose medical communications to unintended third parties access.
Use good communications etiquette:
a. Confirm that your name and other personal information in the message is correct
b. Review the message before sending it to make sure that it is clear and that all relevant information is included.
Keep your contact information updated, including changes to your regularly used email address.
For security reasons, I do not use your standard email account, but notifications are sent to your standard email address when a message has been sent and is waiting for you in your secure mailbox.
2. Charges for Using Online Communications
There may be charges for certain online communications. You will be informed in advance when/if these charges apply and you will be responsible for payment of these charges if you accept and use any fee-based service. You may choose to contact your insurance carrier to determine if they cover online communications.
3. Conditions for Using Online Communications
a. You agree that a copy of your online communication may be included in your medical record. This means it will be handled like other items in your record, with appropriate HIPAA protections and permissions.
b. You agree to follow any procedures that will allow me to verify your identity in connection with online communications, and you acknowledge that failure to comply with these procedures may terminate our online communications.
c. You agree that online communication will be used only for limited purposes. It cannot be used for emergencies or time-sensitive matters.
d. You agree to accept variations in response times. I will make every attempt to respond within the time frame I have designated, but there may be times when this is not feasible, possibly because of my schedule or because of technical problems. You may always telephone, send a letter, or make an appointment instead of emailing.
4. Access to Online Communications
a. I alone will decide which medical topics are appropriate for online communications and with whom I communicate online.
b. I may, at any time without prior notification to you, stop providing online communications with you or change the online services I provide.
5. Risks of Using Online Communications
All medical communications carry some level of risk. While the likelihood of risks associated with the use of online communications, particularly in a secure environment, are substantially reduced, they are nonetheless real and very important to understand. It is very important that you consider these risks each time you plan to communicate with me, and communicate in such a fashion as to mitigate the potential for any of these risks. These risks include, but are not limited to:
a. Online communication may travel much farther than you planned. It is easier for online communications to be forwarded, intercepted, or even changed without your knowledge.
b. Online communications is easier to falsify than handwritten or signed hard copies. A dishonest person could attempt to impersonate you to try to get your medical records.
c. It is harder to get rid of online communications. Backup copies may exist on a computer or in cyberspace, even after both of us have deleted our copies.
d. Employers and online services have a right to inspect and keep online communications transmitted through their systems. Some employers may also use video-cams and keystroke monitoring to monitor email use.
d. Online communications are admissible as evidence in court.
e. Online communications may disrupt or damage your computer if a computer virus is attached.
6. Patient Acknowledgement and Agreement
I acknowledge that I have read and fully understand this consent form. I understand the risks associated with online communications between my physician and me. I consent to abide by the conditions and follow the instructions outlined herein, as well as future conditions or instructions that may be promulgated. I understand that withdrawal of this Informed Consent must be done by written online communication or in writing to Amherst Family Practice.
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