PATIENT PORTAL/TELEHEALTH/VIRTUAL CHECK-IN CONSENT
PATIENT PORTAL is a web-based system that serves as a secure, encrypted communication link between you and Maryland Pain Specialists. When you log in to the Portal with your private user name and password, you can see information that is pulled from your electronic medical record and displayed on the web page. The Patient Portal is an optional service, and we reserve the right to suspend or terminate it at any time; we will alert you to any changes as promptly as possible.
This form is intended to give you the facts and risks surrounding the use of the web portal. By signing this document, you confirm that you have read, understand, and agree to comply with our procedures and guidelines for using the Patient Portal. You also agree not to hold Maryland Pain Specialists or any of their staff liable for network infractions beyond their control.
The Patient Portal has a secure tunnel connection with our office that uses encryption to keep unauthorized persons from being able to access and read your health information or your communications with us. To help insure that the tunnel remains secure, we need to have your current (private) email address and be informed if it ever changes. Keep your Portal User ID and password secure so only you can gain access to patient information. If you think someone has learned your password, immediately go to the portal site and change it. We will protect your email address as we do your medical and other personal information.
TO REQUEST ACCESS TO THE PATIENT PORTAL:
- Read and sign the Consent at the end of this document.
- Send, fax, or deliver this document to Maryland Pain Specialists
- Once we receive this consent, we can authorize you as a user and you will receive a welcome email with your login and temporary password. We do NOT keep a record of this information.
- The welcome email will contain a link to our portal.
- Please review the Patient Portal Instructions found on the site.
Do not use email to communicate if there is an emergency or urgent need for communication—call 911
- Proper Subject Matter : Lab results, referral requests or billing questions
- Sensitive subject matter: (HIV, mental health, work excuses, etc) is not permitted
We do not refill medications through the PORTAL - please contact the office 410.825.6945
TELEHEALTH/VIRTUAL CHECK-IN - You are consenting to receive care through the use of telemedicine/virtual check-in (non-face to face treatment/exchange of medical information in response to patient message received via any modality). These modalities enable health care providers at different locations to provide safe, effective, and convenient care through the use of technology. As with any health care service, there are risks associated with the use of technology, including equipment failure, poor image resolution and information security issues.
I have read and fully understand the Patient Portal/Telehealth/Virtual Check-In Consent described above. I further understand that my signature signifies that I accept the terms as set forth in this agreement.