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  • Email Consent
  • RISK OF USING EMAIL
  • Coastal Fertility Medical Center (CFMC) offers patients the opportunity to communicate by e-mail. Transmitting patient information by e-mail, however, has a number of risks that patients should consider before using e-mail. These include, but are not limited to, the following risks:
  • E-mail can be circulated, forwarded, and stored in numerous paper and electronic files.
  • E-mail can be immediately broadcast worldwide and be received by many intended and unintended recipients.
  • E-mail senders can easily misaddress an email.
  • Email is easier to falsify than handwritten or signed documents.
  • Backup copies of e-mail may exist even after the sender or the recipient has deleted his or her copy.
  • Employers and online services have a right to archive and inspect e-mails transmitted through their systems,
  • E-mail can be intercepted, altered, forwarded, or used without authorization or detection.
  • E-mail can be used to introduce viruses into computer systems.
  • E-mail can be used as evidence in court
  • CONDITION FOR THE USE OF E-MAIL
  • CFMC will use reasonable means to protect the security and confidentiality of e-mail information sent and received. However, because of the risks outlined above, CFMC cannot guarantee the security and confidentiality of e-mail communication and will not e liable for improper disclosure of confidential information that is not caused by Provider’s intentional misconduct. Thus, patients must provude written consent, except as authorized or required by law.
  • Consent to the use of e-mail for patient information. Consent to the use of E-mail includes agreement with the following conditions:
  • a. All e-mails to or from the patient concerning diagnosis or treatment will be printed out and made part of the patient’s medical record. Because they are a part of the medical record, other individuals, authorized to access the medical record, such As staff and billing personnel, will have access to those e-mails.
  • b. Your Provider may forward e-mails internally to CFMC staff and agents as necessary for diagnosis, treatment, reimbursement, health care operations, and other handling .Your Provider will not, however forward e-mails to independent third parties without the patient’ s prior written Consent, except as authorized or required by law.
  • c. Although CFMC staff will endeavor to read and respond Promptly to an e-mail from the patient, we cannot guarantee that any particular e-mail will be read and responded to within any particular period of time. Thus the patient shall not use e-mail for medical emergencies or other time-sensitive matters.
  • d. If the patients e0mail requires or invites a response from Provider and the patient has not received a response within a reasonable time period, it is the patient’s responsibility to follow up to determine whether the intended recipient received the e-mail and when the recipient will respond.
  • e. The patient should not use e-mail for communicationregarding sensitive medical information such as information regarding sexually transmitted diseases, AIDS/HIV, mental Health, developmental disability, substance abuse.
  • f. The patient is responsible for informing your provider of any type of information the patient does not want to be sent by e-mail, in addition to those set out in 2(e) above
  • g. The patient is responsible for protecting his/her pass word or other means of access to e-mail. CFMC is not liable for breaches of confidentiality caused by the patient or any third party.
  • h. CFMC Providers shall not engage in e-mail communication that is unlawful, such as unlawful practicing medicine across state lines.
  • i. It is the patient’s responsibility to follow up and/or schedule an appointment if warranted.
  • INSTRUCTIONS
  • To communicate by e-mail, the patient shall:
  • a. Limit or avoid se of his/her employer’s computer.
  • b. Inform CFMC of changes in his/her e-mail address.
  • c. Put the patient’s name in the body if the e-mail.
  • d. Include the category of the communication in the e.mail’s subject line, for routing purposes (e.g., billing question).
  • e. Review the e-mail to make sure it is clear and that all relevant information is provided before sending to your Provider.
  • f. Inform your Provider that the patient received an email from your Provider.
  • g. Take precautions to preserve the confidentiality of e-mails, such as using screen savers and safeguarding his/her computer password.
  • h. Withdraw consent only by e-mail or written communication to your Provider.
  • PATIENT ACKNOWLEDGMENT AND AGREEMENT
  • I acknowledge that I have read and fully understand this consent form. I understand the risks associated with the communication of e-mail between CFMC staff and me, and consent to the conditions outlined herein, as well as any other instructions that Provider may impose to communicate with patients by e-mail. Any questions I may have had were answered.

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