Bohn & Joseph Eye Center

Risk of Using E-Mail:

Bohn & Joseph Eye Center offers patients the opportunity to communicate by e-mail. However, transmitting patient information by e-mail has a number of risks that patients should consider: These include, but are not limited to, the following risks:

1. E-mail can be circulated, forwarded, and stored in numerous paper and electronic files.
2. E-mail can be immediately broadcast worldwide & be received by many intended & unintended recipients.
3. E-mail senders can easily misaddress an e-mail.
4. E-mail is easier to falsify than handwritten or signed documents.
5. Backup copies of e-mail may exist even after senders or recipients have deleted their copy.
6. Employers and on-line services have a right to archive and inspect e-mails transmitted through their systems.
7. E-mail can be intercepted, altered, forwarded, or used without authorization or detection.
8. E-mail can be used to introduce viruses into computer systems.
9. E-mail can be used as evidence in court.

Conditions for the Use of E-mail:

Bohn & Joseph Eye Center will use reasonable means to protect the security and confidentiality of e-mail information sent and received. However, because of the risks outlined above, Bohn & Joseph Eye Center cannot guarantee the security and confidentiality of e-mail communication, and will not be liable for improper disclosure of confidential information that is not caused by Bohn & Joseph Eye Center�s intentional misconduct. Thus, patients must consent to the use of e-mail for patient information. Consent to the use of e-mail includes agreement with the following conditions:

1. All e-mails to or from the patient concerning diagnosis or treatment will be printed out and made part of the patient�s medical record. Because they are part of the medical record, other individuals authorized to access the medical record, such as staff and billing personnel, will have access to those e-mails.

2. Bohn & Joseph Eye Center may forward e-mails internally to Practice�s staff and agents as necessary for diagnosis, treatment, reimbursement, and other handling. Bohn & Joseph Eye Center will not, however, forward e-mails to independent third parties without the patient�s prior written consent, except as authorized or required by law.

3. Although Bohn & Joseph Eye Center will endeavor to read and respond promptly to an e-mail from the patient, Bohn & Joseph Eye Center cannot guarantee that any particular e-mail will be read and responded to within any particular period of time. Thus, the patient shall not use e-mail for medical emergencies or other time-sensitive matters.

4. If the patient�s e-mail requires or invites a response from Bohn & Joseph Eye Center, and the patient has not received a response within a reasonable time period, it is the patient�s responsibility to follow up to determine whether the intended recipient received the e-mail and when the recipient will respond.

5. The patient should not use e-mail for communication regarding sensitive medical information such as information regarding sexually transmitted diseases, AIDS/HIV, mental health, developmental disability, or substance abuse.

6. The patient is responsible for informing Bohn & Joseph Eye Center of any types of information the patient does not want to be sent by e-mail, in addition to those set out in #5 of this section.

7. The patient is responsible for protecting his/her password or other means of access to e-mail. Bohn & Joseph Eye Center is not liable for breaches of confidentiality caused by the patient or any third party.

8. Bohn & Joseph Eye Center shall not engage in e-mail communication that is unlawful, such as unlawfully practicing medicine across state lines.

9. It is the patient�s responsibility to follow up and/or schedule an appointment if warranted.

Instructions: To communicate by e-mail, the patient shall:

1. Limit or avoid use of his/her employer�s computer as stipulated by employer�s office policy.

2. Inform Bohn & Joseph Eye Center of changes in his/her e-mail address.

3. Put the patient�s name in the body of the e-mail.

4. Include the category of the communication in the e-mail�s subject line, for routing purposes (e.g., billing question).

5. Review the e-mail to make sure it is clear and that all relevant information is provided before sending to Bohn & Joseph Eye Center.

6. Take precautions to preserve the confidentiality of e-mails, such as using screen savers and safeguarding his/her computer password.

7. Withdraw consent only by e-mail or written communication to Bohn & Joseph Eye Center.

Patient Acknowledgment and Agreement:

I acknowledge that I have read and fully understand this consent form. I understand the risks associated with the communication of e-mail between Bohn & Joseph Eye Center 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 Bohn & Joseph Eye Center may impose to communicate with patients by e-mail. Any questions I may have had were answered.