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Terms and Conditions - Southeastern Health MyChart

Southeastern Health offers secure viewing and communication as a service to patients who wish to view parts of their records and communicate with our staff and physicians. 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.

How the Secure Patient Portal Works

A secure web portal is a kind 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 pass- phrase to log in to the portal site. Because the connection channel between your computer and the Web site uses secure sockets layer technology you can read or view information on your computer, but it is still encrypted in transmission between the Web site 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 will do our best to maintain electronic security. However, keeping messages secure depends on two additional factors: the secure message must reach the correct email address, and only the correct individual (or someone authorized by that individual) must be able to get access to it.

Only you can make sure these two factors are present. We need you to make sure we have your correct email address and are informed if it ever changes. 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.

If you pick up secure messages from a web site, you need to keep unauthorized individuals from learning your password. If you think someone has learned your password, you should promptly go to the web site and change it.

Patient Acknowledgement and Agreement

I acknowledge that I have read and fully understand this consent form and the Policies and Procedures Regarding the Patient Portal that appears at log in. I understand the risks associated with online communications between my physician and me, and consent to the conditions outlined herein. In addition, I agree to follow the instructions set forth herein and including the policies and procedures as set forth in the log in screen, as well as any other instructions that my physician may impose to communicate with patients via online communications. All of my questions have been answered and I understand and concur with the information provided in the answers.

Online Communications Informed Consent

Instructions for Using Online Communications

You agree to take steps to keep your online communications to and from Physician Services confidential including: Do not store message on your employer-provided computer, otherwise personal information could be accessible or owned by your employer. Use a screen saver or close your message instead of leaving your messages on the the scree for passers by to read. Also, remember to keep your password safe and private. Do not allow other individuals or other third parties access to the computer(s) upon which you store medical communications. Do not use e-mail for medical communications. Standard e-mail lacks security and privacy features and may expose medical communications to employers or other unintended third parties. Withdrawal of this Informed Consent must be done by written online communications or in writing to Physician Services.

Southeastern Health MyChart

Authorization for Proxy Access

Requirements and Procedures

This form may be used to authorize proxy access to another person's Southeastern Health MyChart account. The general requirements for proxy access to Southeastern Health MyChart account record are:

  • This Authorization for Proxy Access form must be completed, with the appropriate information below provided, and signed.
  • Each individual requesting proxy access to a patient's Southeastern Health MyChart account record must have their own Southeastern Health MyChart account. If the individual requesting access does not have an account, Southeastern Health will provide Southeastern Health MyChart Activation email or Letter with instructions on how to create one.

If the Patient is a Competent Adult:

  • Authorization/Signature. Authorization by the patient is required. The patient must sign this Authorization form.
  • Proxy Designation The patient may designate any other adult of their choosing to have proxy access.
  • Disclosure of Information.The patient understands that this will allow the person designated as proxy to have access to the patient's MyChart account including the medical and billing information contained in MyChart.The patient authorizes the disclosure of this information to the proxy as described in the Authorization section below.
  • Revocation/Termination. The patient may revoke proxy access at any time. Access may also be terminated as provided in the Terms & Conditions.

If the Patient is an Incompetent Adult:

  • Authorization/Signature. Authorization by the patient's representative is required. The representative must be the patient's Legal Guardian or designated in the patient's Durable Power of Attorney for Healthcare, and must sign this Authorization form.
  • Proxy Designation The patient's representative may designate himself/herself to have proxy access. The patient's representative may also designate any other adult to have proxy access.
  • Disclosure of Information. The patient's representative understands that this will allow the person designated as proxy to have access to the patient's MyChart account including the medical and billing information contained in MyChart. The patient's representative authorizes the disclosure of this information to the proxy as described in the Authorization section below.
  • Revocation/Termination. Proxy access of or granted by a representative is terminated if the individual ceases being the patient's representative (e.g., power of attorney is terminated). Access may also be terminated as provided in the Terms & Conditions.

If the Patient is a Minor:

  • Authorization/Signature. Authorization by the minor's parent or legal guardian is required. The minor's parent or legal guardian must sign this Authorization form. For minors 15 years old and older, the minor must also provide authorization and sign this form.
  • Proxy Designation The parent/legal guardian may designate himself/herself to have proxy access. The parent/legal guardian may also designate any other adult to have proxy access. Individual requesting access as legal guardian must provide appropriate legal documentation of guardianship to Southeastern Health.
  • Disclosure of Information. The parent/legal guardian understands that this will allow the person designated as proxy to have access to the minor's MyChart account including the medical and billing information contained in MyChart. The parent/legal guardian authorizes the disclosure of this information to the proxy as described in the Authorization section below.
  • Revocation/Termination. Parent/legal guardian proxy access to a minor patient's Southeastern Health MyChart account is revoked when:
  • Parent/legal guardian submits a request to revoke proxy access.
  • A minor patient at 15 years of age submits a request to revoke proxy access.
  • Automatically when the minor patient turns 18 years old (continued access may be requested by submitting appropriate form for family/caregiver access).
  • Minor patient advises Southeastern Health of his/her status as an emancipated minor.
  • Access disputes between parent/legal guardian and minor, or between parents, cannot be resolved.

If proxy access of a parent/legal guardian is revoked, the minor patient's Southeastern Health MyChart account will be suspended/terminated (a minor may not have an independent account; parent/legal guardian is required). Access may also be terminated as provided in the Terms & Conditions.

  • Special Rules for Minors. Under state and federal law, there are certain types of medical information that a parent/legal guardian of a minor patient may not view without consent of the minor patient. Because of these requirements, proxy access of a minor over 15 years of age is restricted and Southeastern Health will use reasonable efforts to exclude such confidential information from proxy access. This restriction will occur automatically upon the minor turning 15. Additionally, a minor over 15 years of age must authorize proxy access and disclosure of such confidential information contained in MyChart to the parent/legal guardian.

Authorization

The patient or patient's representative/guardian/parent authorizes the disclosure of all medical and billing information about the patient contained in the patient's Southeastern Health MyChart account to the person granted proxy access as designated below. The purpose of the authorized disclosure is to allow the person granted proxy access as designated below to be able to have on-going access to the medical and billing information in this patient portal to allow the proxy to participate in the medical care of the patient.

The patient or patient's representative/guardian/parent understands that the person receiving proxy access is a not a health care provider or health plan covered by federal privacy regulations and the information accessed by the proxy could be redisclosed by such person and will likely no longer be protected by the federal privacy regulations.

As described above patient or patient's representative/guardian/parent understands that he/she may revoke this authorization in writing at any time, except to the extent that action has been taken by Southeastern Health in reliance on this authorization, by sending a written revocation to Southeastern Health Information Services department or the Southeastern Health location where you receive your medical care. This authorization will expire upon revocation by the patient or patient's representative/guardian/parent, upon termination of the patient's MyChart account by Southeastern Health, or as otherwise provided above.

The patient or patient's representative/guardian/parent understands that he/she is not required to sign this authorization form and that Southeastern Health will not condition the provision of treatment or payment on the signing of this authorization.

Additional Instructions and Agreement

Communications on behalf of the patient must be sent from, and responses will be received in, the patient's Southeastern Health MyChart account record. Southeastern Health MyChart email alerts will be sent to the email address entered in the patient's Southeastern Health MyChart account record.

When using proxy access to view another person's Southeastern Health MyChart record, the proxy will log into his/her account and have access from his/her account to the other person's Southeastern Health MyChart record.A visual indicator will appear to highlight that the proxy is accessing the Southeastern Health MyChart record of that person. If the proxy has access to multiple Southeastern Health MyChart records through proxy access, the proxy should verify that he/she is viewing the correct record.