Email Consent | Davis Speech-Language-Hearing Center

164 Pillsbury Drive SE 115 Shevlin Hall Minneapolis, MN 55455 | Office: 612-624-3322 | FAX: 612-624-7586

Email Risks

You have requested that we communicate with you by email in regard to your private health information. Due to the risk that electronic messages can be misdirected or intercepted by unintended parties, the University of Minnesota can not and does not guarantee the confidentiality of messages sent over the Internet. In addition, messages sent to or received from work email accounts also may be monitored or viewed by your employer. We do not believe that we should communicate private health information with you via email unless you agree to do so, after you have considered these risks.

E-mail Use

IN A MEDICAL EMERGENCY, DO NOT USE EMAIL. CALL 911.
In most cases you must be 18 years or older or an emancipated or self-sufficient minor before your provider can send your e-mail about your or your child’s personal health information.

Creating a Message

On the “Subject” line, include the general topic of the message, for example, “Appointment” or “Advice.” In the body of the message, include your name/client name and contact information.

Privacy and Confidentiality

Consider e-mail like a postcard that can be viewed by unintended persons. The content of e-mail may be monitored by the University/your employer to ensure appropriate use. Discuss with your provider who will process your e-mail messages during business hours, vacations or illness. All e- mails regarding your care will be included in your clinical record.

Content of the Message

E-mail should be used only for non-sensitive and non-urgent issues. Types information appropriate for e-mail include:

Routine follow-up inquiries
Appointment scheduling
Reporting of self-monitoring measurements, such as carry-over treatment plans

E-mail will not be used to communicate to you test and other related results concerning HIV, sexually transmitted disease, hepatitis, drug abuse or presence of malignancy, or for alcohol abuse or mental health issues.

Response Time

Discuss with your provider the expected time in which to receive a response. If the expected time is exceeded, call your provider at the phone number listed above.

Changes to Email

Either you or your provider may request to discontinue using e-mail as a means of communication, via either e-mail or letter. Additionally, if you wish to change email addresses that you use with your provider, you agree to notify him/her in writing.

I have read and understand the information above, and had any questions answered to my satisfaction.

My Current Email Address:

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Date:

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