Patient Consent to Use AI During Encounters

Form Submission

We are committed to providing you with the highest quality of care. As part of this commitment, we are continually seeking ways to enhance our services. One of the tools we are using to improve the patient experience is AI Scribe.

What is AI Scribe?
AI Scribe is an artificial intelligence tool that assists our clinicians during patient encounters by generating clinical notes based on the conversation. This allows your healthcare provider to focus more on you and less on typing or computer documentation.

The AI Scribe does not interact with you directly. It simply listens to the conversation during your consultation and generates a written summary or “note” based on what is said. The final note is always reviewed and approved by your provider before being included in your medical record.

Privacy and Security
Your privacy is our utmost priority. AI Scribe complies fully with the Health Insurance Portability and Accountability Act (HIPAA) to ensure that your data is secure and protected. Only authorized healthcare professionals involved in your care will have access to these notes.

Voluntary Participation
Participation is completely voluntary. You may choose not to use AI Scribe during your visits, and your care will not be affected in any way.

If you agree to the use of AI Scribe during your consultations, please sign and date the form below. If you have any questions, please feel free to ask your provider.

Consent

Please upload the AI Consent form that was provided to you below. If you have not received or completed the form, it will be given to you at your next visit to confirm your consent preference.