Online Communications Informed Consent


For Online Communications with: Miguel Flores and Associates, P.A.


1. Instructions for Using Online Communications
You agree to take steps to keep your online communications to and from me confidential, including:

Use good communications etiquette:

Update your contact information on the network as soon as it changes including and changes to your regularly used email address. I do not use your standard email account for security reasons, but notifications are sent to your standard email address when a message has been sent to you and is waiting for you in your secure mailbox.

2. Charges for Using Online Communications
My office may charge for certain online communications. You will be informed in advance when/if these charges apply and you will be responsible for payment of these charges if you accept and use any fee-based service. You may choose to contact your insurance carrier to determine if they cover online communications.

3. Conditions of Using Online Communications
The following agreements and procedures relate online communications:

4. Access to Online Communications
The following pertains to access to and use of online communications:

5. Risks of Using Online Communications
All medical communications carry some level of risk. While the likelihood of risks associated with the use of online communications, particularly in a secure environment, are substantially reduced, they are nonetheless real and very important to understand. It is very important that you consider these risks each time you plan to communicate with me, and communicate in such a fashion as to mitigate the potential for any of these risks. These risks include, but are not limited to:

6. Patient Acknowledgement and Agreement
I acknowledge that I have read and fully understand this consent form. I understand the risks associated with the communication of online communications between my physician and me, and consent to the conditions outlined herein. In addition, I agree to the instructions outlined herein, as well as any other instructions that my physician may impose to communicate with patients via online communications. I have had a chance to ask any questions that I had and to receive answers. I have been proactive about asking questions related to this consent agreement. My questions have been answered and I understand and concur with the information provided in the answers.

 

 

 

 

After reading if you have any questions please contact Georgia Witt at 936-760-2300 or 936-441-2300 for your answers.  After any questions are answered please copy the remainder of this page and paste into an email to us.  You will be asked to sign your email when you next come into the clinic.

 

 

I acknowledge that I have read and fully understand Online Communications Informed Consent form. I understand the risks associated with the communication of online communications between my physician and me, and consent to the conditions outlined herein. In addition, I agree to the instructions outlined herein, as well as any other instructions that my physician may impose to communicate with patients via online communications. I have had a chance to ask any questions that I had and to receive answers. I have been proactive about asking questions related to this consent agreement. My questions have been answered and I understand and concur with the information provided in the answers.

 

 

 

 

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