This document is an informed consent form designed to ensure that you, as a patient, fully understand and consent to the use of AI scribe services during your medical encounter with Riverview Psychiatric Medicine PC d/b/a Clearwave Psychiatry and TMS Medical of the Hudson Valley PC d/b/a Clearwave TMS Medical (collectively, "Clearwave"

Description of AI Scribe Services: AI scribe (e.g. Freed) services uses the microphone on a secure smartphone to transcribes-but not record-patient encounters and then uses machine learning and natural-language processing to summarize the conversation's clinical content and produce a note documenting the visit. The AI scribe services with which Clearwave contracts uses technology that is HIPAA-compliant and maintains robust systems to protect all

Purpose and Benefits of Remote Scribe Services: The purpose of AI scribing is to improve the efficiency of your medical encounter by allowing your healthcare provider to focus on patient care while ensuring accurate documentation of the encounter for quality assurance and billing purposes. AI scribing will allow your provider to be even more engaged during your session without the need to continuously document the encounter. Confidentiality and Privacy: Your privacy and the confidentiality of your medical information are of the utmost importance. AI scribe services with which Clearwave contracts adheres to strict confidentiality guidelines. All information transmitted during the encounter will be encrypted to protect your privacy. In the unlikely event that the AI scribe service suffers a data breach that impacts you, you agree that you will not hold Clearwave or its respective officers, directors, managers, employees, contractors and agents liable for any such breach.

IV.Voluntary Participation: Participation in AI scribe services is entirely voluntary. You have the right to refuse the use of AI scribe services at any time during your medical encounter.

By signing below, you acknowledge that you have read and understood the information provided in this document, and you voluntarily consent to the use of AI scribe services during your medical encounter.