Acknowledgement
I acknowledge and understand the privacy policy and consent to the collection, use and disclosure of my personal health information within Enhanced Care Clinic, lab and pharmacy and to other healthcare providers, insurers, and where required by law, for the purposes of providing or assisting in the provision of health care services to me.
I acknowledge that I understand the risks and limitations for the use of this email or other electronic communication and it is not encrypted. Despite this, I agree to communicate with Gotodoctor and its physician clinics, and to other healthcare providers, for the purposes of providing or assisting in the provision of health care services to me. I acknowledge that I can withdraw the option of communicating electronically by notifying Gotodoctor.
For Treatment of Patients Residing Outside of Canada or Provinces Not Serviced by Gotodoctor.ca
The patient agrees that the relationship between himself/herself and the doctors and health care providers of Enhanced Care Clinic/Gotodoctor.ca shall be governed by and construed in accordance with the laws and acknowledges that the treatment/service was performed by doctors and health care providers based in one of the “Provinces” (1), and that the Courts of these specific Provinces shall have jurisdiction to entertain any complaint, demand, claim or cause of action, whether based on the alleged breach of contract or alleged negligence arising out of the treatment. The patient hereby agrees that he/she will commence any such legal proceedings only in one of these specific Provinces and hereby submits to the jurisdiction of the Court of one of these specific Provinces.
(1) Alberta/British Columbia/Manitoba/New Brunswick/Nova Scotia/Ontario/Saskatchewan/Quebec
Before your appointment, we would like to inform you about using Virtual Care
Our virtual clinic offers virtual care to make sure that we can continue to care for our patients safely and effectively. This means that we will be using video and audio technologies for some patient visits. A virtual care visit is just like a regular doctor’s appointment; except the physician you will see and speak with is on a monitor or over the telephone.
Some of these technologies are provided by the Province and other certified service providers. A trained healthcare provider will assist you during your virtual care appointment; he/she will make the connection with the physician at another location. Protecting your personal health information is important to us. All existing laws regarding your access to medical information and copies of your medical records apply to this telemedicine consultation. Your telemedicine appointment is private and confidential, and it is only seen and heard by the health care provider involved. For more information about our privacy policy, please visit – https://gotodoctor.ca/our-policies/.
We do our best to make sure that any information you give to us during virtual care visits is private and secure, but no video or audio tools are ever completely secure. There is an increased security risk that your health information may be intercepted or disclosed to third parties when using video or audio communications tools. To help us keep your information safe and secure, you can:
• Understand that this method of communication is not secure in the same way as a private appointment in an exam room.
• Use a private computer/device (i.e., not an employer’s or third party’s computer/device) and a secure internet connection. For example, using a personal computer or tablet is more secure than at a library, and your access to the Internet on your home network will generally be more secure than an open guest Wi-Fi connection.
• You may withdraw consent to the telemedicine appointment at any time without affecting your right to future care or treatment; You should also understand that virtual care is not a substitute for in-person communication or clinical examinations, where appropriate, or for attending the Emergency Department when needed (including for any urgent care that may be required). By providing your information, you agree to let us collect, use, or disclose your personal health information through video or audio communications (while following applicable privacy laws) in order to provide you with care. In particular, the following means of electronic communication may be used: videoconferencing and Telephone Call.
• It is our clinic’s policy that no narcotics or controlled substances will be prescribed during walk-in appointments. The same applies to virtual care appointments.
• Please note that NOT ALL conditions can be looked at through telemedicine. In some cases your doctor may ask you to visit a hospital or other health care facility if necessary, for a physical examination. You also understand that you have the option to seek care at other clinics.
Risks of using electronic communication (Appendix)
The Physician will use reasonable means to protect the security and confidentiality of information sent and received using the Services (“Services” is defined in the attached Consent to use electronic communications). However, because of the risks outlined below, the Physician cannot guarantee the security and confidentiality of electronic communications:
• Use of electronic communications to discuss sensitive information can increase the risk of such information being disclosed to third parties.
• Despite reasonable efforts to protect the privacy and security of electronic communication, it is not possible to completely secure the information.
• Employers and online services may have a legal right to inspect and keep electronic communications that pass through their system.
• Electronic communications can introduce malware into a computer system, and potentially damage or disrupt the computer, networks, and security settings.
• Electronic communications can be forwarded, intercepted, circulated, stored, or even changed without the knowledge or permission of the Physician or the patient.
• Even after the sender and recipient have deleted copies of electronic communications, back-up copies may exist on a computer system.
• Electronic communications maybe disclosed in accordance with a duty to report or a court order.
• Videoconferencing using services such as Skype or FaceTime may be more open to interception than other forms of videoconferencing.
If the email or text is used as an e-communication tool, the following are additional risks:
• Email, text messages, and instant messages can more easily be misdirected, resulting in increased risk of being received by unintended and unknown recipients.
• Email, text messages, and instant messages can be easier to falsify than handwritten or signed hard copies. It is not feasible to verify the true identity of the sender, or to ensure that only the recipient can read the message once it has been sent.
Conditions of using the Services
• While the Physician will attempt to review and respond in a timely fashion to your electronic communication, the Physician cannot guarantee that all electronic communications will be reviewed and responded to within any specific period of time. The Services will not be used for medical emergencies or other time-sensitive matters.
• If your electronic communication requires or invites a response from the Physician and you have not received a response within a reasonable time period, it is your responsibility to follow up to determine whether the intended recipient received the electronic communication and when the recipient will respond.
• Electronic communication is not an appropriate substitute for in-person or over-the-telephone communication or clinical examinations, where appropriate, or for attending the Emergency Department when needed. You are responsible for following up on the Physician’s electronic communication and for scheduling appointments where warranted.
• Electronic communications concerning diagnosis or treatment may be printed or transcribed in full and made part of your medical record. Other individuals authorized to access the medical record, such as staff and billing personnel, may have access to those communications.
• The Physician may forward electronic communications to staff and those involved in the delivery and administration of your care. The Physician might use one or more of the Services to communicate with those involved in your care. The Physician will not forward electronic communications to third parties, including family members, without your prior written consent, except as authorized or required by law.
• The Physician is not responsible for information loss due to technical failures associated with your software or internet service provider. Instructions for communication using the Services
Instructions for communication using the Services
To communicate using the Services, you must:
• Reasonably limit or avoid using an employer’s or other third party’s computer.
• Inform the Physician of any changes in the patient’s email address, mobile phone number, or other account information necessary to communicate via the Services.
If the Services include email, instant messaging and/or text messaging, the following applies:
• Include in the message’s subject line an appropriate description of the nature of the communication (e.g. “prescription renewal”), and your full name in the body of the message.
• Review all electronic communications to ensure they are clear and that all relevant information is provided before sending to the physician.
• Ensure the Physician is aware when you receive an electronic communication from the Physician, such as by a reply message or allowing “read receipts” to be sent.
• Take precautions to preserve the confidentiality of electronic communications, such as using screen savers and safeguarding computer passwords.
• Withdraw consent only by email or written communication to the Physician.
• If you require immediate assistance, or if your condition appears serious or rapidly worsens, you should not rely on the Services. Rather, you should call the Physician’s office or take other measures as appropriate, such as going to the nearest Emergency Department or urgent care clinic.
• Other conditions of use in addition to those set out above
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 I will receive occasional updates and notices from Enhanced Care Clinic/Gotodoctor.ca and can unsubscribe at any time.
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.
