Email Confidentiality Policy

Email Confidentiality Policy

Dr. Milan Patel offers patients the option to communicate by e-mail. This form provides information about the risks of e-mail, guidelines for e-mail communication and how we will use e-mail communication. It also will be used to document your consent for us to communicate with you by e-mail.

RISKS

Communication by e-mail has several risks which include, but are not limited to, the following:

E-mail can be circulated, forwarded and stored in paper and electronic files.
Backup copies of e-mail may exist even after the sender or the recipient has deleted his/her copy.
E-mail can be received by unintended recipients.
E-mail can be intercepted, altered, forwarded or used without authorization or detection.
E-mail senders can easily type in the wrong e-mail address.
E-mail can be used to introduce viruses into computer systems.

HOW WE WILL USE E-MAIL

1) We will limit e-mail correspondence to patients in treatment with us who are adults 18 years or older, or the legal representatives of established patients.

2) We will use e-mail to communicate with you only about non-sensitive and non-urgent issues such as:

Questions about prescription refills,
Routine follow-up questions,
Appointment scheduling, and/or
Billing questions

3) All e-mails to or from you will be made a part of your medical record. You will have the same right of access to such e-mails as you do to the remainder of your medical file.

4) Your e-mail messages may be forwarded to another office staff member as necessary for appropriate handling.

5) We will not disclose your e-mails to others unless allowed by state or federal law.

IN A MEDICAL EMERGENCY, DO NOT USE E-MAIL. CALL 911.

Also, do not use e-mail for urgent problems. If you have an urgent problem, call our office (917) 830-7505 or go to an urgent care facility.

CONSENT

I may want to communicate with Dr. Patel and the office staff by e-mail. I understand the risks of communicating by e-mail, in particular the privacy risks explained in this form. I understand of Dr. Milan Patel cannot guarantee the security and confidentiality of e-mail communication. Dr. Milan Patel will not be responsible for messages that are not received or delivered due to technical failure, or for disclosure of confidential information unless caused by intentional misconduct.

I understand that I may also communicate with Dr. Patel by telephone or during a scheduled appointment, and that e-mail is not a substitute for care that may be provided during an office visit. Appointments should be made to discuss any new issues or any sensitive medical information.

I understand that either I or Dr. Patel may stop using e-mail as a means of communication upon my written request. I understand that I may revoke this consent at any time by so Dr. Patel in writing. My revocation of consent will not affect my ability to obtain future health care nor will it cause the loss of any benefits to which I am otherwise entitled.

I have read and understand this form. I have had the opportunity to ask questions and my questions have been answered to my satisfaction. I understand and agree with the information contained in this form and give my consent for e-mail communications to and from Dr. Milan Patel.

I am:*

a patient of Dr. Milan Patelthe legal representative of a patient

Patient Name*

First NameLast Name

Name of Patient Representative (skip if not applicable)

First NameLast Name

Date of Birth*

Date

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Today's Date*

Date

Signature*