Consent Form: Release of Health Information (email)

IMPORTANT: PLEASE READ

Purpose: Patient Consent: To allow the practice to send an email containing your personal and sensitive health information

The practice is committed to patient privacy and ensuring all health information is safe and secure. The use of unencrypted and unsecured email can create risks to the privacy and security of personal and sensitive health information.

Although the practice prefers to use paper-based communication or secure messaging, it understands that this is not always possible. To cater for this, the practice allows a limited number of emails to be sent to patients.

Note: Not everything can be sent via email and this is at the GP's discretion. Please discuss it with your doctor.

Before the practice can release information, it is important you understand the risks.

The risks of using unsecured or unencrypted email include:
• emails can easily be sent to the wrong recipient
• email is often accessed on portable devices, such as smart phones, tablets and laptops, which are easily lost or stolen
• emails can be forwarded or changed without the knowledge or consent of the original sender
• email is vulnerable to interception.

To reduce these risks, the practice has implemented the following eight (8) requirements:
(1) Every request must be approved by a GP. Only fill this form out if you have had a consultation with a GP. This is because our admin staff do not have access to these requests and our doctors will only be looking for their own requests.
(2) This form will need to be filled out every-time a new request is made even if you have previously fill out this form.
(3) This form is used to capture email consent and to ensure that we are sending the information to the correct email address. Please double check your email before submitting.
(4) The practice will try to action your request within 3-4 business days. If you have discussed a shorter time-frame with your GP then it may be sent earlier. Please note that sometimes a form may not submit correctly. If you are unsure, please email us at nurse@mortlakemedical.com.au
(5) You will receive an email with a password protected Dropbox link. You do not need to sign up to Dropbox to retrieve your files. Your password will be your date of birth in the format (DDMMYYYY). i.e. if your birthday is the 1st February 1990 then your password is "01021990".
(6) The Dropbox link will expire after 7 days. This is to protect your privacy. Please download your documents within that time-frame. If your link expires then a new request (i.e. another consultation) with a GP will need to be made. Some doctors are booked out days/weeks in advance so please download your documents. The administration staff do not have access to retrieve your old document.
(7) If you have any concerns using this consent form, email or Dropbox then the process will default to a paper copy for collection with our reception. It is important that you fully understand the risks of using email, Dropbox and similar technologies.
(8) Your Name and Date of Birth must match our records.

Acknowledgement

I have read and understood the above risks and practice procedures. The practice is not responsible for your data if the email address you entered is incorrect or if the email is intercepted/forwarded.