Email Consent Form

Warden Wood Health Centre uses email communication with its patients and clients to improve the convenience and efficiency of your visits and care.

Please read this policy thoroughly prior to signing the consent form.

Risks of Using Email

Warden Wood Health Centre offers patients the opportunity to communicate by email in certain circumstances. Transmitting patient information poses several risks of which the patient should be aware. Patients should not agree to communicate via email without understanding and accepting these risks.

The risks include, but are not limited to, the following:

• The privacy and security of email communication cannot be guaranteed.
• Employers and online services may have a legal right to inspect and keep emails that pass through their system.
•  Email is easier to falsify than handwritten or signed hard copies. In addition, it is impossible to verify the true identity of the sender, or to ensure that only the recipient can read the email once it has been sent.
•  Emails can introduce viruses into a computer system, and potentially damage or disrupt the computer.
•  Email can be forwarded, intercepted, circulated, stored or even changed without the knowledge or permission of the physician or the patient. Email senders can easily misaddress an email, resulting in it being sent to many unintended and unknown recipients.
•  Email is indelible. Even after the sender and recipient have deleted their copies of the email, back-up copies may exist on a computer or in cyberspace.
•  Use of email to discuss sensitive information can increase the risk of such information being disclosed to third parties.
•  Email can be used as evidence in court.
•  Email communication is not an appropriate substitute for clinical examinations. The patient is responsible for following up and scheduling appointments where warranted.
•  If the patient’s email requires or invites a response from Warden Wood Health Centre and the patient has not received a response within a reasonable time period, it is the patient’s responsibility to follow up by phone.
•  Warden Wood Health Centre is not responsible for information loss due to technical failures associated with the patient’s email software or internet service provider.

The Patient

•  Agrees to and will comply with the use of encryption software.
•  Chooses not to use encryption software when communicating with the physician, with the full understanding that this increases the risk of violation of the patient’s privacy.

Conditions of Using Email

Warden Wood Health Centre will use reasonable means to protect the security and confidentiality of email information sent and received. However, because of the risks outlined above, we cannot guarantee the security and confidentiality of email communication. Thus, patients must consent to the use of email for patient information. Consent to the use of email includes agreement with the following conditions:

•  other individuals authorized to access the medical record, such as staff will have access to emails.
•  It is up to the Physicians’ discretion as to whether email is an appropriate vehicle for communication, and Warden Wood Health Centre cannot guarantee an email response.
•  Warden Wood Health Centre will endeavour to read and respond promptly to an email from the patient, we cannot guarantee that any particular email will be read and responded to within any particular period of time. Thus, the patient should not use email for medical emergencies or other time-sensitive matters.

Instructions for Communication by Email

To communicate by email, the patient shall:

•  Limit or avoid using an employer’s or other third party’s computer.
•  Inform Warden Wood Health Centre of any changes in the patient’s email address.
•  Include in the email: the category of the communication in the email’s subject line
•  Review the email to make sure it is clear and that all relevant information is provided before sending
•  Take precautions to preserve the confidentiality of emails, such as using screen savers and safeguarding computer passwords.
•  Withdraw consent only by email or written communication to Warden Wood Health Centre
•  Should the patient require immediate assistance, or if the patient’s condition appears worse please call Warden Wood Health Centre for a consultation or an appointment, or take other measures as appropriate. Do not email.

Patient Acknowledgment and Agreement

“I acknowledge that I have read and fully understand the warden Wood Health Centre Email Communication Policy & Consent Form. I am aware of the conditions of use, risks, limitations, and instructions for use of email communication services as explained by Warden Wood Health Centre. I fully acknowledge that sending information via electronic communication is not secure and I fully accept the risks and responsibility involved with this. I hereby waive any and all claims against physicians and staff at Warden Wood Health Centre in connection with the disclosure of personal information via email.
I consent to the conditions and will follow the instructions outlined, as well as any other conditions that Warden Wood Health Centre may impose on communications with patients using email services.
I acknowledge the permitted purposes of online communications and agree to use email communications only for those purposes. I understand that email communication must not be used for urgent or immediate requests to my physician or their staff.

I acknowledge that either the clinic staff or I may, at any time, withdraw the option of communicating electronically upon providing written or email notice. Any questions I had have been answered.”