HIPAA E-Mail Consent

Riceland Healthcare will use reasonable means to protect the privacy of the patient’s health information. However, because of the risks, Riceland Healthcare cannot guarantee that e-mail will be confidential. Additionally, Riceland Healthcare will not be liable in the event that you or anyone else inappropriately uses or accesses your e-mail. Riceland Healthcare will not be liable for improper disclosure of your health information that is not caused by Riceland Healthcare intentional misconduct. By signing this form, I acknowledge that I have read and fully understand this consent form. I understand the risks associated with the communications of e-mail between Riceland Healthcare and me, and consent to the conditions outlined herein, as well as any other instructions that Riceland Healthcare may impose to communicate with me by e-mail. Any questions I may have had were answered. I understand that this consent is valid until I revoke the consent, except to the extent that a person who is to make a communication has already acted in reliance upon this authorization.

If you select "No", to decline consent for electronic transmission of patient information, we will not keep your e-mail address on file and we will be unable to send you your results via e-mail.

Do you wish to consent to electronic transmission of patient information?