CONSENT TO RECEIVE HEALTH INFORMATION VIA EMAIL
VERY IMPORTANT: PLEASE READ CAREFULLY
I hereby request that Hudson Regional Hospital send the results of my COVID test to me TO THE EMAIL ADDRESS STATED ABOVE. I understand that while the hospital takes certain precautions regarding the security of my health information, because it is sent by email, there are inherent risks, and the information MAY NOT BE SECURE from unauthorized disclosure. Even though the hospital has warned me that emails to me may not be secure, I hereby consent to receive such communications by email despite those risks.
I understand that I have the choice to receive communications by more secure means, such as by mail or by telephone. I further understand that can change my mind at any time if I decide NOT to use my email to receive my health information.
BY SIGNING BELOW, I AGREE TO HOLD HUDSON REGIONAL HOSPITAL HARMLESS FOR UNAUTHORIZED USE, DISCLOSURE, OR ACCESS OF MY HEALTH INFORMATION SENT TO THE EMAIL ADDRESS ABOVE.