Consent and User Agreement Sample Contracts

Patient Portal Consent and User Agreement
Consent and User Agreement • December 26th, 2022

Penobscot Community Health Care (PCHC) offers a secure way for patients to 1. view certain health information kept in an electronic health record; and 2. to communicate with PCHC providers and the care team about certain health matters. This form provides documentation of your acceptance and agreement to participation conditions including any amended or superseded conditions that occur. Please maintain a copy of your Patient Portal Consent and User Agreement. Access to PCHC’s eHealth portal is optional and allows patients to access their PCHC medical information directly.

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Patient Portal Consent and User Agreement
Consent and User Agreement • August 4th, 2016

RehabOne Medical Group, Inc. offers the patient portal website in partnership with Meditab Software, Inc. for the exclusive use of its established patients. The patient portal is designed to enhance patient communications with the practice. We strive to ensure the information in your records is accurate. If you identify any discrepancy in your records, you agree to contact us immediately. By signing this document, you agree to provide factual information.

CONSENT AND USER AGREEMENT FOR THE
Consent and User Agreement • May 22nd, 2014 • Kansas

 myViaChristi is a secure website from which selected health information from a visit to a Via Christi Clinic or Via Christi acute care hospital may be viewed on-line by a patient or the patient’s authorized representative (“Proxy”) and through which a patient or a patient’s Proxy may securely communicate in an electronic environment with a member of the patient’s Via Christi health care team. Selected health information that may be accessed may include medical history, medications, and lab results.

TEXTING/EMAIL INFORMED CONSENT AND USER AGREEMENT – CONSUMER COPY
Consent and User Agreement • October 14th, 2020

Ionia County Community Mental Health Authority (ICCMHA) provides consumers the opportunity to communicate with ICCMHA by email or text message. Transmitting confidential patient information by email or text, however, has a number of risks, both general and specific, that patients should consider.

Patient Portal Consent and User Agreement
Consent and User Agreement • January 29th, 2022 • Maine

PCHC offers a secure way for patients to: 1. view certain health information kept in an electronic health record; and 2. to communicate with PCHC providers and the care team about certain health matters. This form provides documentation of your acceptance and agreement to participation conditions including any amended or superseded conditions that occur. Please maintain a copy of your Patient Portal Consent and User Agreement. Access to PCHC’s eHealth portal is optional and PCHC offers this eHealth portal to its patients as a courtesy.

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