Halo Medical Weight Loss and Anti-Aging provides patients the opportunity to communicate with their physicians, health care providers, and administrative staff by email. Transmitting confidential health information by email, however, has a number of risks, both general and specific, that should be considered before using email.
1. Risks:
a. General email risks are the following: email can be immediately broadcast worldwide and be received by many intended and unintended recipients; recipients can forward email messages to other recipients without the original sender(s) permission or knowledge; users can easily misaddress an email; email is easier to falsify than handwritten or signed documents; backup copies of email may exist even after the sender or the recipient has deleted his/her copy.
b. Specific email risks are the following: email containing information pertaining to diagnosis and/or treatment must be included in the protected personal health information; all individuals who have access to the protected personal health information will have access to the email messages; patients who send or receive email from their place of employment risk having their employer read their email.
2. It is the policy of The Halo Medical Weight Loss and Anti-Aging that all email messages sent or received which concern the diagnosis or treatment of a patient will be a part of that patient’s protected personal health information and will treat such email messages or internet communications with the same degree of confidentiality as afforded other portions of the protected personal health information. The Halo Medical Weight Loss and Anti-Aging will use reasonable means to protect the security and confidentiality of email or internet communication. Because of the risks outlined above, we cannot, however, guarantee the security and confidentiality of email or internet communication.
3. Patients must consent to the use of email for confidential medical information after having been informed of the above risks. Consent to the use of email includes agreement with the following conditions:
a.All emails to or from patients concerning diagnosis and/or treatment will be made a part of the protected personal health information. As a part of the protected personal health information, other individuals, such as The Halo Medical Weight Loss and Anti-Aging physicians, nurses, other health care practitioners, insurance coordinators and upon written authorization other health care providers and insurers will have access to email messages contained in protected personal health information.
b.Halo Medical Weight Loss and Anti-Aging may forward email messages within the practice as necessary for diagnosis and treatment. Halo Medical Weight Loss and Anti-Aging will not, however, forward the email outside the practice without the consent of the patient as required by law.
c. Halo Medical Weight Loss and Anti-Aging will endeavor to read email promptly but can provide no assurance that the recipient of a particular email will read the email message promptly. Therefore, email must not be used in a medical emergency.
d. It is the responsibility of the sender to determine whether the intended recipient received the email and when the recipient will respond.
e. Because some medical information is so sensitive that unauthorized discloser can be very damaging, email should not be used for communications concerning diagnosis or treatment of AIDS/HIV infection; other sexually transmissible or communicable diseases, such as syphilis, gonorrhea, herpes, and the like; Behavioral health, Mental health or developmental disability; or alcohol and drug abuse.
f. Halo Medical Weight Loss and Anti-Aging cannot guarantee that electronic communications will be private. However, we will take reasonable steps to protect the confidentiality of the email or internet communication but Halo Medical Weight Loss and Anti-Aging is not liable for improper disclosure of confidential information not caused by its employee’s gross negligence or wanton misconduct.
g. If consent is given for the use of email, it is the responsibility of the patient’s to inform Halo Medical Weight Loss and Anti-Aging of any types of information you do not want to be sent by email.
h. It is the responsibility of the patient to protect their password or other means of access to email sent or received from The Halo Medical Weight Loss and Anti-Aging to protect confidentiality. The Halo Medical Weight Loss and Anti-Aging is not liable for breaches of confidentiality caused by the patient.
Any further use of email initiated by the patient that discusses diagnosis or treatment constitutes informed consent to the foregoing.
I understand that my consent to the use of email may be withdrawn at any time by email or written communication to Halo Medical Weight Loss and Anti-Aging.
In addition to email, Halo Medical Weight Loss and Anti-Aging offers online tools and resources, some of which provides the patient an opportunity to record data. The patient hereby acknowledges that while SSL security and other efforts are made to protect the data, information that is in the cloud is always at risk for breach.
I have read this form carefully and understand the risks and responsibilities associated with the use of email. I agree to assume all risks associated with the use of email and online tools.