CONSENT TO USE ELECTRONIC COMMUNICATIONS
Doxy.me and Email communications
Acqua Medical is excited to offer telemedicine visits via secure two-way video conferencing. Our patients would be able to use their webcam-enabled computers (Firefox or Chrome browsers), iPad/iPhone (iphone app), or Android smartphones (Chrome web browser) to have a video conference with our doctors. We will be sending files through this application as well as through our email address:
acquamedical.online@gmail.com.
Pathways
We are also excited to be providing upcoming communication via Pathways. Pathways is an online resource that allows referring physicians and their office staff (“Physicians”) to quickly access current and accurate referral information, including wait times and areas of expertise , for specialists/consultants and specialty clinics and their staff (“Specialists”). It helps our clinic to send and track referrals, helps Specialist to track referrals and allows Specialist and referring Physicians to communicate with each other, notify patients of upcoming appointments and appointment changes, and send reminders to patients. Your Physician and the Specialist have offered to use Pathways to communicate referral information between themselves and their offices using electronic communication.
PATIENT ACKNOWLEDGMENT AND AGREEMENT :
I acknowledge that I have read and fully understand the risks, limitations, conditions of use, and instructions for use of the selected electronic communication services more fully described in the Appendix to this consent form.
I understand and accept the risks outlined in the Appendix to this consent form, associated with the use of the Services in communications with the Physician and the Physician’s staff.
I consent to the conditions and will follow the instructions outlined in the Appendix, as well as any other conditions that the Physician may impose on communications with patients using the Services.
I acknowledge and understand that despite recommendations that encryption software be used as a security mechanism for electronic communications, it is possible that communications with the Physician or the Physician’s staff using the Services may not be encrypted. Despite this, I agree to communicate with the Physician or the Physician’s staff using these Services with a full understanding of the risk.
I acknowledge that either I or the Physician may, at any time, withdraw the option of communicating electronically through the Services upon providing written notice. Any questions I had have been answered.
By signing below, I am consenting to allow my Physician (and Specialists in case of Pathways) to communicate electronically with me (and between themselves about me) as set out in above.