Get Patient Request For Email Communications
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How to fill out the Patient Request For Email Communications online
Filling out the Patient Request For Email Communications form online is a straightforward process that ensures you receive important health communications via email. This guide provides step-by-step instructions to help you complete the form accurately and efficiently.
Follow the steps to successfully complete your request for email communications.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- In the designated fields, enter your full name as the patient. This is crucial for identifying your records.
- Fill in your date of birth to verify your identity. This helps ensure that the information is protected and correctly associated with your medical records.
- Provide your phone number to facilitate communication with your healthcare provider if needed.
- Enter your email address in the appropriate field. Ensure that this email is accurate, as it will be used for future communications.
- Select a question to use for a test email. Mark the checkbox next to your chosen question (e.g., mother’s maiden name, middle name, or street number) and provide the answer in the space provided.
- Review the statements regarding confidentiality and security of email communications. Make sure you understand these points before continuing.
- Affirm your understanding of the risks associated with email communications by checking the boxes next to each statement.
- Sign the form where indicated to certify that the information provided is accurate and authorize email communications.
- If you are a personal representative filling out this form on behalf of the patient, provide your authority to act and add your signature.
- Finally, enter the date of completion and register the name of the physician or program you are requesting to contact you via email.
- Once all sections are filled out correctly, save your changes, and either download, print, or share the completed form as needed.
Complete your request for email communications online to ensure timely updates regarding your health.
Yes, email communication is covered by HIPAA when it involves protected health information (PHI). Providers must implement the same safeguards for email as they do for other forms of communication. This includes both data security measures and obtaining patient consent. Using a Patient Request For Email Communications can clarify and formalize how providers handle such communications.
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