Terms & Conditions (COVID-19)

ACKNOWLEDGMENT AND AGREEMENT:

  1. I acknowledge that I have read and fully understand the risks, limitations, conditions of use, and instructions for use of the selected electronic communication Services. I understand and accept the risks outlined to this consent form, associated with the use of the Services in communications with the Service Provider. I consent to the conditions and will follow the instructions, as well as any other conditions that the Physician may impose on communications with patients using the Services.
  2. I acknowledge and understand that despite recommendations that encryption software be used as a security mechanism for electronic communications, it is possible that communications with the Service Provider or its staff using the Services may not be encrypted. Despite this, I agree to communicate with the Service Provider or its staff with a full understanding of the risk.
  3. I am aware that disclosure of protected health information using electronic communication is not a secure means of transmission.
  4. I acknowledge that Service Provider will allow access to my results electronically for only 72 hours after first message of availability.
  5. I understand that although the Service Provider will use reasonable means to protect the security and confidentiality of information sent and received using the Services However; because of the risks outlined below, the Service Provider cannot guarantee the security and confidentiality of electronic communications:
  • Use of electronic communications to discuss sensitive information can increase the risk of such information being disclosed to third parties.
  • Despite reasonable efforts to protect the privacy and security of electronic communication, it is not possible to completely secure the information.
  • Employers and online services may have a legal right to inspect and keep electronic communications that pass through their system.
  • Electronic communications can introduce malware into a computer system, and potentially damage or disrupt the computer, networks, and security settings.
  • Electronic communications can be forwarded, intercepted, circulated, stored, or even changed without the knowledge or permission of the Physician or the patient.
  • Even after the sender and recipient have deleted copies of electronic communications, back-up copies may exist on a computer system.
  • Electronic communications may be disclosed in accordance with a duty to report or a court order
  • Email, text messages, and instant messages can more easily be misdirected, resulting in increased risk of being received by unintended and unknown recipients.
  • Email, text messages, and instant messages can be easier to falsify than handwritten or signed hard copies. It is not feasible to verify the true identity of the sender, or to ensure that only the recipient can read the message once it has been sent.
  1. I will inform the Service Provider of any changes in my email address, mobile phone number, or other account information necessary to communicate electronically.
  2. I may remove myself from this electronic data process at any time except to the extent that the Service Provider have already acted in reliance on the Authorization. I will provide notice of the withdrawal of consent by email at custserv@imdpath.com or other written communication to Service Providers or by sending a message thru https://www.imdpath.com/contact-us/.  For assistance in changing your statement preference, you may also contact the Service Provider at 3017 Telegraph Avenue, Suite 102, Berkeley, CA 94705 the address below at any time or by calling toll-free at (844) IMD-PATH to request paper statements and notices.  Any withdrawal of your Consent will be effective after we have a reasonable time to act on your request.  I also acknowledge that my results will only be available electronically for 72 hours after their release to protect my personal health information.
  3. I have the right to refuse to provide this authorization and I understand that this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for benefits will not be conditioned upon this authorization.
  4. I have the right to request and receive a copy of this authorization.
  5. I understand that any information disclosed pursuant to this authorization may be subject to redisclosure, and any redisclosure may not be subject to HIPAA.
  6. This Authorization automatically terminate after one (1) month from this consent and/or authorization.
  7. I acknowledge that I have read and fully understand the risks, limitations, conditions of use, and instructions for use of the selected electronic communications as described above.
  8. I agree to communicate with the Service Provider or the Service Provider’s staff using these electronic communications with a full understanding of the risks in doing so.
  9. I understand and accept the risks outlined above to this consent form, associated with the use of the electronic communications with the Service Provider and the Service Provider’s staff.
  10. I agree to hold Service Provider harmless for unauthorized use, disclosure, or access of my COVID 19 test results communicated to me electronically.
  11. I understand that this Authorization may be executed through the use of an electronic signature in accordance with the Electronic Signatures in Global and National Commerce Act (E-Sign Act), Title 15, United States Code, Sections 7001 et seq., the Uniform Electronic Transaction Act (UETA), and any applicable state law, and that any electronic signature shall be deemed an original signature for purposes of this Authorization, with such electronic signature having the same legal effect as an original signature.
  12. I fully acknowledge that sending personal health information via electronic communication is not secure and I fully accept the risks and responsibility involved with this. I understand that the information I authorize to be disclosed may no longer be protected by federal privacy regulations.