Patient Portal User Agreement & Consent Form
JIS Orhthopedics offers secure viewing and communication as a service to patients who wish to view parts of their records, communicate with our staff and physicians and shortnen their appointmet wait times by filling out forms prior to arrival. Secure
messaging can be a valuable communications tool, but has certain risks. In order to manage these risks we need to impose some conditions of participation. This form is intended to show that you have been informed of these risks and the conditions
of participation, and that you accept the risks and agree to the conditions of participation.
First Let's Go Over How the Secure Patient Portal Works: A secure web portal is a type of webpage that uses encryption to keep unauthorized persons from reading communications, information, or attachments. Secure messages and information can only be read
by someone who knows the right password or passphrase to log in to the portal site. Because the connection channel between your computer and the website uses secure socket layer technology you can read or view information on your computer, but it
is still encrypted in transmission between the website and your computer.
Protecting Your Private Health Information and Risks: This method of communication and viewing prevents unauthorized parties from being able to access or read messages while they are in transmission. No transmission system is perfect and we always do
our best to maintain electronic security and protect patient privacy. However, keeping messages secure depends on two additional factors: 1) The secure message must reach the correct email address, and 2) Only the correct individual (or someone authorized
by that individual) must be able to have access to the message. Youou can make sure these two factors are present. First, it is imperative that our practice
has your correct e-mail address and that you inform us of any changes to your e-mail address. You also need to keep track of who has access to your email account so that only you, or someone you authorize, can see the messages you receive from us.
You are responsible for protecting yourself from unauthorized individuals learning your password. If you think someone has learned your password, you should promptly go to your host and change it.
Types of Online Communication/Messaging:
Online communications should never be used for emergency communications or
Patient Acknowledgement and Agreement: I acknowledge that I have read and fully understand the Patient Portal User Agreement and Consent. I have read and understand the responsibilities and benefits of the JIS Orthopedics Patient Portal and understand
the risks associated with online communications between me and my physician’s office. I consent to the conditions outlined and I agree to keep my password confidential and notify the office if my email address changes at any time. I have had a chance
to ask any questions that I had and to receive answers. I have been proactive about asking questions related to this Agreement. All of my questions have been answered and I understand and concur with the information.