Consent to Treat
Primary Care Treatment and Services:
I understand that I am consenting for Home Physicians Group to treat and provide primary care services to me. This may include ancillary services provided by the HPG Ecosystem: Podiatry, Psychiatry, Pulmonary, Wound Care, Pharmacy, Case Management, Remote Monitoring, etc. Any visit is voluntary and none of my rights to confidentiality or privacy are waived by my consent. I understand that refusal to consent to a Home Physicians Group visit will have no effect on the level or nature of Medicare/Medicaid benefits to which I am entitled.
Release of Healthcare information.
I acknowledge and agree that HPG/PCCFL, Inc., may disclose my PHI and medical record information to the people listed on my Patient registry who may be individuals who are my family members, legal representatives, guardians, healthcare surrogates, caregivers, and/or have power of attorney on my behalf. (Please list all applicable names on Patient Registration
Practice Policies:
By signing this form, you consent to our use and disclosure of protected information about you for treatment, payment, and/ or health care operations as described in this form. You have the right to revoke this consent in writing, except where we have already made a disclosure in reliance prior to your consent.
Notice of Privacy Practices:
We are required by law to protect and maintain the privacy of your health information, to provide this Notice about our legal duties and privacy practices and to abide by the terms of this Notice.
Consent for Use of AI Scribing Tools
I acknowledge and consent to the use of Al-powered scribing tools to assist in the documentation, transcription, and summarization of conversations, meetings, or other communications. I understand that these tools use artificial intelligence to process and generate text and that their accuracy may vary.
By providing this consent, I agree that:
1. Al-generated transcripts or notes may be reviewed for accuracy and completeness.
2. The use of AI scribing tools does not replace professional judgment or human oversight.
3. I retain the right to request modifications, corrections, or deletion of any Al-generated content as appropriate.
4. The confidentiality and security of the information processed by the AI tools will be maintained in accordance with applicable privacy policies and regulations.
I understand that I can revoke this consent at any time by providing written notice.