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Patient Portal - Informed Consent
        
 

Purpose of this Form:CAC offers secure, HIPAA compliant viewing of parts of your medical record and communication from our staff as a service to our patients. Secure messaging can be a valuable communications tool, but it is not free of risks. In order to minimize risks, we must implement guidelines for participation. This form obtains your consent and implies that you have been informed appropriately of the risks and you agree to participate. The service is optional. Please know, upon discretion of the physician, your care may be transitioned to a mid-level provider. We cannot provide assistance through email interaction. The only HIPAA compliant communication is via phone or patient portal.

How Patient Portal Works: The secure web portal is like a web page which utilizes encryption to keep unauthorized people from accessing the communication between patients and staff. Secure messages can only be read by a person who has their log in credentials with password for the portal site.

How to participate in Patient Portal: It is an efficient way for communication. Once this form is filled & signed, the system will generate a username & password with instructions to guide you step by step to register initially. You will then be able to look in your message box and see all messages and parts of your chart. You can review your information which is encrypted in transmission between the website and your computer. You can review specific information or access the patient portal through our office website www.aliarthritis.com

Protecting your private health information and risks: The encryption helps prevent unauthorized access to information in the transmission process. When you receive a secure message from the portal you need to keep unauthorized persons from knowing your log in information. If you think your password is compromised please change it immediately. If you are unable to do so please call the office and we can de-activate your account. Please make sure to provide current email address. We strive to protect your information and ask you to actively participate following these guidelines.

Conditions of participating in the patient portal: Access to secure web portal is optional but highly recommended. We reserve the right to suspend or terminate it at any time and for any reason. If we do suspend/ terminate, you will receive a notification. You agree to release the practice, its providers and all staff of any liability for any network infractions beyond our control.