COMMUNICATION POLICY

North Star Guidance Center recognizes the increased venues of communication. In an effort to maintain ethical boundaries and respect client confidentiality, North Star Guidance Center contacts cannot be accepted by employees on their personal social network accounts such as Facebook, MySpace and Twitter. We at  North Star Guidance also realize that email has become a convenient and practical form of communication.  Please be informed that if you choose to email the employees at North Star, we are unable to guarantee the confidentiality of the contents of any given email.  If you decide against emailing, you are welcome to call or talk to your clinician at your next scheduled appointment.  By submitting an email, you acknowledge that you have read and fully understand this consent form below. 

IN A MEDICAL EMERGENCY, DO NOT USE E-MAIL. CALL 911.

1. RISK OF USING E-MAIL

North Star Guidance Center, Inc. offers patients the opportunity to communicate by e-mail. Transmitting patient information by e-mail, however, has a number of risks that patients should consider before using e-mail. These include, but are not limited to, the following risks:

·          E-mail can be circulated, forwarded, and stored in numerous paper and electronic files.

·          E-mail can be immediately broadcast worldwide and be received by many intended and unintended recipients.

·          E-mail senders can easily misaddress an e-mail

·          E-mail is easier to falsify than handwritten or signed documents.

·          Backup copies of e-mail may exist even after the sender or the recipient has deleted his or her copy.

·          Employers and on-line services have a right to archive and inspect e-mails transmitted through their systems.

·          E-mail can be intercepted, altered, forwarded, or used without authorization or detection.

·          E-mail can be used to introduce viruses into computer systems.

·          E-mail can be used as evidence in court.

2. CONDITIONS FOR THE USE OF E-MAIL

North Star Guidance Center, Inc. will use reasonable means to protect the security and confidentiality of e-mail information to be sent and received. However, because of the risks outlined above, we 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 North Star Guidance Center’s intentional misconduct. Thus, you must consent to the use of e-mail for patient information. Consent to the use of e-mail includes agreement with the following conditions:

·         North Star Guidance Center may forward e-mails internally to our staff and agent necessary for scheduling. North Star Guidance 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.

·         Although North Star Guidance Center will endeavor to read and respond promptly to an e-mail from a patient, we 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.

·         If the patient’s e-mail requires or invites a response from North Star Guidance 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 will respond.

·         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.

·         The patient is responsible for informing North Star Guidance Center of any types of information the patient does not want to be sent by e-mail, in addition to sensitive material previously described.

·         The patient is responsible for protecting his/her password or other means of access to e-mail. North Star Guidance Center is not liable for breaches of confidentiality caused by the patient or any third party.

·         North Star Guidance Center shall not engage in e-mail communication that is unlawful, such as unlawfully practicing medicine across state lines.

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

·         The patient must be 18 years or older or an emancipated or self-sufficient minor before North Star Guidance Center can send an e-mail about the patient.

 3. INSTRUCTIONS

To communicate by e-mail, the patient shall:

·        Inform North Star Guidance Center of changes in his / her e-mail.

·          Put the patient’s name in the body of the e-mail.

·          Include the category of the communication in the e-mail’s subject line, for routing purposes.

·          Review the e-mail to make sure it is clear and that all relevant information is provided before sending to North Star Guidance Center include a phone number at which the patient can be reached.

·          Take precautions to preserve the confidentiality of your e-mail.

·          Withdraw consent to use e-mail only by written communication to North Star Guidance Center.

4. ALTERNATE FORMS OF COMMUNICATION

I understand that I may also communicate with the Provider via telephone or during a scheduled appointment and that the e-mail is not a substitute for the care that may be provided during an office visit.  Appointments should be made to discuss any new issues as well as any sensitive medical information. 

5. TYPES OF E-MAIL TRANSMISSIONS THAT PATIENT AGREES TO SEND AND/OR RECEIVE

The types of information that can be communicated via e-mail with the Provider include prescription refills, patient referrals and appointment scheduling requests, billing and insurance questions and patient education.  If you are not sure if the issue you wish to discuss should be included in an e-mail, you should call the Provider’s office to schedule an appointment.

6. SECURITY MEASURES USED BY THE PROVIDER

As stated above, communicating via e-mail does come with privacy risk as stated above.  While the Provider cannot guarantee total confidentiality, the Provider has and will use reasonable safeguards to protect your health care information as required by law.  The security measures taken by the Provider include password protected screen savers, policies and procedures, and staff training requirements.

7. TERMINATION OF THE E-MAIL RELATIONSHIP

The Provider shall have the right to immediately terminate the e-mail relationship with you if he/she determines, in his/her sole discretion, that you have violated the terms and conditions set forth above or otherwise breached this agreement, or have engaged in conduct which the Provider determines, in his/her sole discretion, to be unacceptable.  The e-mail relationship between the Provider and the patient will terminate in the event the Provider, in his/her sole discretion, no longer wishes to utilize the e-mail to communicate with all of his/her patients. 

8. PATIENT ACKNOWLEDGEMENT AND AGREEMENT

By submitting an email, I acknowledge that I have read and fully understand this consent form. I understand the risks associated with the communication of e-mail between North Star Guidance Center and me, and consent to the conditions herein. In addition, I agree to the instructions outlined herein, as well as any other instructions that North Star Guidance Center may impose to communicate with patients by e-mail.

North Star Guidance Center, Inc.

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