Laserfiche WebLink
Appendix 2: Member Agreement <br /> Item L• Communications and ePHI Waiver <br /> Communications.By registration authorization at time of enrollment,Member authorizes Frontier,and its Primary Care Providers <br /> to communicate with Member by email regarding Member's"Protected Health Information"(PHI)(as that term is defined in the Health <br /> Insurance Portability and Accountability Act(HIPAA)of 1996 and its implementing regulations). <br /> Member acknowledges that: (a) E-mail is not necessarily a secure medium for sending or receiving PHI and, there is always a <br /> possibility that a third party may gain access; (b) While Primary Care Provider will make all reasonable efforts to keep e-mail <br /> communications confidential and secure, neither Frontier, nor the Primary Care Provider can assure or guarantee the absolute <br /> confidentiality of email communications; (c) In the discretion of the Primary Care Provider, e-mail communications may be made a <br /> part of Member's permanent medical record; and, (d) Member understands and agrees that email is not an appropriate means of <br /> communication regarding emergency or other time-sensitive issues or for inquiries regarding sensitive information. In the event of an <br /> emergency, or a situation in which the member could reasonably expect to develop into an emergency,Member shall call 911 <br /> or the nearest Emergency room, and follow the directions of emergency personnel. <br /> Member acknowledges that communications with the Primary Care Provider using email,facsimile,video chat,instant messaging, <br /> and cell phone are not guaranteed to be secure or confidential methods of communications. As such, Member expressly waives the <br /> Primary Care Provider's obligation to guarantee confidentiality with respect to correspondence using such means of communication. <br /> Member acknowledges that all such communications may become a part of Member's medical records.Member acknowledges that all <br /> communication between Member and Primary Care Provider is intended for medical purposes, and Frontier will not tolerate or <br /> encourage crude,obscene,explicit,or harassing language. Such communication is grounds for immediate membership termination and <br /> may be subject to legal action. <br /> If Member does not receive a response to an e-mail message within one day, Member agrees to use another means of <br /> communication to contact the Primary Care Provider.Neither Frontier,nor the Primary Care Provider will be liable to Member for any <br /> loss,cost,injury, or expense caused by, or resulting from,a delay in responding to Member as a result of technical failures,including, <br /> but not limited to, (a) technical failures attributable to any internet service provider, (b) power outages, failure of any electronic <br /> messaging software, or failure to properly address e-mail messages, (c) failure of the Practice's computers or computer network, or <br /> faulty telephone or cable data transmission, (d) any interception of email communications by a third party; or(e)Member's failure to <br /> comply with the guidelines regarding use of e-mail communications set forth in this paragraph. <br /> Member understands that Frontier and the Primary Care Provider are not responsible for any PHI that may be accessed through <br /> unsecure electronic communications.Further,Member understands that neither Frontier nor the Primary Care Provider are responsible <br /> for any direct or indirect costs Member may incur related to the use of electronic communications. Finally, Member understands and <br /> agrees to contact emergency services in the event of an emergency,or a situation that could reasonably develop into an emergency. <br /> Member Name: <br /> Signature: <br /> By providing Frontier and its Primary Care Providers with authorization to email and text, Member allows Frontier and its Primary <br /> Care Providers to exchange information with Member more efficiently. At the same time, Frontier, and its Primary Care Providers <br /> recognize that email and text messaging are not a completely secure means of communication. <br /> 12 <br />