Agreement To Establish Email and SMS (Text) Correspondence Between Patient And Provider

Email and SMS are convenient ways for patients to communicate with their health care providers, but there are risks and responsibilities that need to be understood before they can be used safely. By signing this agreement you acknowledge that you have understood these points, discussed any questions with your provider, and agree to observe these guidelines for using email.

Email travels over the internet, and SMS via your provider network; and because they are not encrypted, they are not secure. They can be intercepted and read by other people, much like a postcard. If you are using an email account at work, the emails may be read by your employer. If you have emails or text messages on your computer or phone and it is stolen or "hacked", others may get access to your private health information that is contained in emails.

Guideline: Do not use email to discuss sensitive health information that you would regret if it became known to others.

Email and SMS are also "asynchronous" - that is, it is like playing phone tag. You can never be sure when someone is going to read a message, and when they may respond. For example, if your provider is away for a few days your email may go unread until they return. Therefore it is very important to use other ways of communication for anything urgent. Our expectation is that providers will respond to emails within 48 hours (72 if a weekend is included). If you don't hear within that time you should take other steps.

Guideline: Use the telephone or emergency room for emergencies. Never rely on email for urgent or sensitive communications. The expected response time for emails is 48 to 72 hours. If you have not received a response by that time please contact your provider's office by telephone or in person.

Your provider may feel that some email or sms communications should become part of your medical record, and print them out for the chart. However, not all emails or sms will be put in your record. Your provider may also choose to share an email or message with another member of your care team, such as a consultant or a nurse. For administrative issues, your provider may ask a staff member to respond.

Guideline: If you do not want information recorded or shared, do not include that information in an SMS or email.

Although we wish it were not so, sometimes providers get more requests for communication than they can respond to easily. To help your provider be more efficient in answering emails, you can observe some simple steps.

Guideline: Put the type of email/SMS in the subject line (for example: appointment request, or clinical question, or refill request). Be as brief and concise as possible. And use email sparingly.

Email addresses can change, and you may decide to discontinue your email correspondence with your provider. It is essential that you notify your provider of any such change that would affect the use of email to communicate.

Guideline: Notify the provider or their office of any change that will affect their use of email or SMS with you.

Some of our patients have very similar names. We need to make sure we keep your information in your record. Therefore, we need to check your full name and birth date on correspondence.

Guideline: Include your full name and birth date in all emails.

Although email/SMS correspondence between patients and their providers is very convenient, it is also new. We want to be very clear about the responsibilities and risks that it may entail. Therefore we have spelled them out here.

No Liability:

I agree that e-mail communications with Cambridge Health Alliance and any of its providers is offered as a convenience to me, and I shall not hold the Cambridge Health Alliance or its providers responsible for any expense, loss, or damage caused by, or resulting from:

-  a delay in Cambridge Health Alliance’s or its providers’ response to me, or any damage resulting from such delay, due to technical failures, including, but not limited to, technical failures attributable to the Cambridge Health Alliance internet service provider, power outages, failure of the electronic messaging software, failure by Cambridge Health Alliance, its providers or me to properly address e-mail messages, failure of the Cambridge Health Alliance's computers or computer network, or faulty telephone or cable data transmission;

- any interception of the e-mail communications by a third party; or

-  my failure to comply with the guidelines regarding use of e-mail communications set forth above.


The Cambridge Health Alliance and its providers shall exercise reasonable efforts to ensure the confidentiality of e-mail communications, however, I understand that e-mail communications to the Cambridge Health Alliance or its providers are not secure, and there is therefore some possibility that the confidentiality of such communications will be breached by a third party. Communication regarding highly confidential or sensitive medical matters should therefore be reserved for other forms of communication (e.g., telephone, personal visit).


I understand that I may withdraw my consent to use e-mail for communication with my Cambridge Health Alliance provider(s). I must do this by notifying my provider in writing. I understand that Cambridge Health Alliance may notify me at any time that my provider will no longer accept email communications.


I have read and understand this consent and hereby give permission for all my present and future Cambridge Health Alliance providers and other staff involved in my care to reply to my messages via email, including any information that my provider deems appropriate, that would otherwise be considered confidential. I agree that Cambridge Health Alliance and any employees or agents of Cambridge Health Alliance shall not be liable for any breach of confidentiality that may result from this use of e-mail via the Internet.

________________________________________          _________________

            Patient’s Signature                                     Date 

________________________________________            _________________            _____________

Patient’s name, (please print)                                    Date of Birth     Medical Record Number


Patient’s E-mail Address: __________________________________________


Cambridge Health Alliance Provider’s name: Center for Mindfulness and Compassion

                                                                                    (Please print)


I agree to use email and SMS as methods of communication with _______________________________________.

                                                                                                              Patient’s name

___________________________________________     _____________

            Provider Signature                                      Date

                        Provider email address, signed on behalf of the Center for Mindfulness and Compassion