CONSENT FOR EMAIL COMMUNICATIONS OF PERSONAL HEALTH INFORMATION

Capital Laser and Skin Care LLC. strives to deliver the most advanced and effective aesthetic dermatologic treatments in an environment that focuses on creating an unsurpassed patient experience. To that end, we offer our patients the ability to directly communicate with our office via email. Although convenient, unencrypted email has inherent security risks. Please review this notice carefully.

Security Risk

Most standard email providers such as Gmail, Yahoo, Hotmail, etc. do not provided a secured or encrypted means of communication. Consequently, there is a risk that any protected health information (PHI) contained in an email may be disclosed to, or intercepted by, unauthorized third parties. Email messages accessible through personal computers, laptops, or smart phones have inherent privacy risks especially when the email account is provided by an employer, when the account is not password protected, or if it is an account shared with another person. Therefore, the use of more secure communications such as a phone, fax, or traditional mail may be preferred as a better alternative for PHI. Communication through our website or via email is not encrypted and not necessarily secure. Use of the internet or email is for convenience only and by using them, you assume the risk of unauthorized use.

Responsibility

When consenting to the use of email through such unsecured or unencrypted systems, you are accepting responsibility for any unauthorized access or disclosure of PHI contained within the message. Capital Laser and Skin Care LLC. is not responsible for unauthorized access of PHI while in transmission and will not be responsible for safeguarding information once it is delivered to you. Capital Laser and Skin Care LLC. will take steps to ensure that any email with PHI is protected prior to being sent to the requested address.

Emails will not be used to replace private communications between you and your provider at Capital Laser and Skin Care LLC. Furthermore, since email communications may be viewed by other staff members at Capital Laser and Skin Care LLC. (for example: with administrative staff for scheduling purposes or nursing staff for prescriptions) these are not to be considered private communications. There is no guarantee that inboxes are actively monitored and therefore a return response may take hours or days. Email messages may be missed or errors in transmission may occur and Capital Laser and Skin Care LLC. will not be responsible for any issues caused by delays in communication. For any skin condition in an existing patient that requires immediate attention, you must contact Capital Laser and Skin Care LLC. by telephone or call 911 if applicable. I acknowledge that I have read and understood all of the information outlined in this consent form. You hereby agree to hold Capital Laser and Skin Care LLC., its doctors, employees and affiliates, harmless from any hacking or other unauthorized use of your personal information by outside parties obtained via email. You acknowledge you may withdraw this consent at any time by written notice to Capital Laser and Skin Care LLC.