Consent for Email Communication
I acknowledge and agree that:
- E-mail, is not a secure or confidential form of communication. As the message leaves Riverside South Medical Centre, it is sent across the internet, where it could be intercepted and read. For this reason Riverside South Medical Centre cannot guarantee the security of messages that are sent to and by me.
- Specific issues that will not be discussed via-e-mail, include: Information regarding sexually transmitted diseases, AIDS/HIV, mental health, development disability or substance abuse. In addition, the patient is responsible for informing the care provider of any type of information the patient does not want to be sent by e-mail.
- E-mail will not be used to communicate emergency or urgent health matters, as I understand that: E-mail, messages can be delayed for both technical reasons and issues relating to the availability of the health practitioner and my condition or the emergency situation cannot be adequately assessed via e-mail.
- Clinical decisions about treatment or care may be made on the basis of health information conveyed in e-mail.
-Either party may stop communication via e-mail at any time if the conditions in this agreement are not adhered to. Notice must be given in writing to the patient or health care provider as applicable, if this form of communication is to stop.
Acknowledgement of terms - By answering "I agree" you are acknowledging that you have read the above statement and are consenting to email communication from Riverside South Medical Centre
Date of Birth (for verification purposes only)
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