Patient Information and Acknowledgment Form
PLEASE READ THE FOLLOWING INFORMATION CAREFULLY. YOUR CONTINUED USE OF THIS
SITE AND RELATED SERVICES WILL INDICATE YOUR UNDERSTANDING OF THIS INFORMATION,
YOUR AGREEMENT THAT YOU WILL FOLLOW ALL INSTRUCTIONS GIVEN, AND YOUR ACCEPTANCE
OF THE RISKS AND TERMS OUTLINED BELOW. IF YOU DO NOT AGREE TO BE BOUND BY THESE
TERMS PLEASE PROMPTLY EXIT THIS SITE.
Risks of Using Electronic Communication Systems, including Email
The University of Texas MD Anderson Cancer Center (hereafter "MD Anderson")
offers patients the opportunity to use the my.mdanderson.org
website to view general information, to view certain personalized information,
to refer to patient education materials, to conduct selected transactions
(e.g., refill a prescription with the MD Anderson pharmacy), to communicate
by secure messaging, and to receive certain notifications by email.
Secure messaging is online electronic communication that takes place between
various authorized parties within a secure website. Messages are sent, received
and archived through the website, and Internet email is not required or used.
Security and privacy are provided through encryption, the special digital
encoding of data that can prevent unauthorized persons from reading the
contents of protected messages. (Internet email is usually not encrypted and
therefore is inherently not secure.)
MD Anderson is using industry-standard encryption technologies to protect
and secure the my.mdanderson.org website, including the secure messaging
function. Because of the added security of web-based, encrypted messaging,
MD Anderson strongly recommends the use of secure messaging via the
my.mdanderson.org website, instead of Internet email, for online communications
between patients and providers.
However, the use of any electronic communication system such as the World Wide
Web (including secure messaging) and email for patient-provider communications
has a number of risks that patients should consider before use. Many of these
risks apply to the use of electronic information in general; other risks apply
particularly to email communications. These include, but are not limited to,
the following risks:
Conditions for the Use of Electronic Communication Systems
- Electronic communications, including email, can be copied, circulated,
forwarded, and stored in numerous paper and electronic files.
- Electronic communications, including email, can be accidentally or
intentionally immediately broadcast worldwide and received by many unintended
- Electronic communications, including email, are easier to falsify than
handwritten or signed documents.
- Backup copies of electronic communications, including email, may exist even
after the originator or recipient has deleted his or her own copy.
- Employers and online services have a right to archive and inspect e-mails
transmitted through their systems.
- Electronic communications, including email, are discoverable and can be
used as evidence in court.
- Passwords providing access to electronic communications, including Internet
Service Provider accounts for email, World Wide Web access, etc., can be
stolen and misused, or host systems can be compromised, leading to
unauthorized disclosure of personal information.
- Email senders can easily misaddress an email.
- Email can be intercepted, altered, forwarded or used without written
authorization or detection.
- Email can be used to introduce viruses into computer systems.
- Electronic communications, including email, can be misinterpreted.
- Electronic communications, including email, may not be answered in the
time frame expected by the sender.
MD Anderson will use reasonable means to protect the security and confidentiality
of electronic information sent and received, including the use of encryption and
other security technologies. However, because of the risks outlined above,
MD Anderson cannot guarantee the security and confidentiality of web-based
communications, and will not be liable for improper disclosure of confidential
information that is not caused by MD Anderson's intentional misconduct.
It is also important to understand that mymdanderson.org
was designed primarily to supplement and support your relationship and communications
with your health care team, and to make it easier for you to conduct certain "routine",
non-urgent interactions related to your health care and treatment at
MD Anderson. mymdanderson.org is not intended to
replace or to substitute for face-to-face meetings and/or personal conversations
with your physician.
Thus, you must agree to and acknowledge the following terms when using
electronic communications systems, including mymdanderson.org,
to communicate and share your information with MD Anderson.
Patient Acknowledgement and Agreement
- I understand that electronic communications will be read and responded to
as promptly as possible; however, a specific turnaround time is not
guaranteed. Thus, I will not use electronic communications for medical
emergencies or other time-sensitive matters.
- I acknowledge that some or all electronically transmitted information
concerning my diagnosis and/or treatment may be made part of my medical
record, and that it is up to my health care team to decide when this will
happen. Because these communications become part of the medical record,
other individuals authorized to access the medical record, such as my
health care providers, other MD Anderson staff, or others to whom I
specifically authorize disclosure of my medical record, will have access
to my electronic information.
- I am aware that my electronic information may be forwarded internally to
other MD Anderson staff and agents as necessary for diagnosis, treatment,
reimbursement and other business purposes. Electronic information will
not, however, be forwarded to independent third parties without my written
consent, except as authorized or required by law.
- I understand that it is my responsibility to protect passwords or other
means of access to electronic information. It is also understood that
MD Anderson and its representatives are not liable for breaches of
confidentiality caused by any third party or myself.
- I acknowledge that it is my responsibility to follow up and/or schedule an
appointment if warranted.
- I acknowledge that it is my responsibility to follow up with a person to
whom I have sent a secure message or email, if I have not received a
response in a time frame that is acceptable to me.
- I acknowledge that it is my responsibility to read and appropriately follow
all communications sent to me by MD Anderson representatives.
- I acknowledge that it is my responsibility to provide MD Anderson with
accurate information about me, and that my health care team at MD Anderson
will use some or all the information I provide, as they see fit, to make
decisions about my diagnosis and treatment.
- I understand and acknowledge that I may not receive a response from my
health care team each time I communicate with them via electronic
communication systems, including email; it is up to them to decide whether
and when to send me a response.
- I acknowledge that neither my.mdanderson.org
nor any other use of MD Anderson's web site is a substitute for appropriate
and timely contact with my health care team
- I acknowledge that MD Anderson may discontinue this service at any time
- I acknowledge that I will follow the instructions listed below, and other
instructions that I may receive from MD Anderson from time to time,
when I communicate by secure messaging or email with MD Anderson.
I agree that I will:
- Use secure messaging or email only to send messages regarding the
- care information
- clarification of patient instructions
- information related to clinical trials
- prescription re-fills
- scheduling requests for follow-up clinic visits
- billing and insurance questions.
- Include key words relating to the subject of the communication
in the electronic message's subject line.
- Avoid or minimize use of computers widely accessible by others, such
as an employer's computer.
- Keep electronic messages short.
- Review the electronic message before I send it to make sure it is
clear and that all relevant information is provided
- Review any email message before I send it to make sure that the "TO"
field is properly completed.
- Acknowledge receipt of an electronic message from the physician by
sending a brief reply.
- Take precautions to preserve the confidentiality of secure messages and email.
- Not use secure messaging or email to transmit information or questions
of an urgent nature, and in an emergency I will go to an Emergency
Room and/or contact my health care team as I have been instructed in
I acknowledge that I have read and fully understand the information provided in
this form. I understand the risks associated with using electronic systems to
contact and receive information from MD Anderson. I agree to the terms
listed above, in addition to the terms and conditions of the
Legal Statement and the
mymdanderson.org Privacy and Security Policy.
In addition, I agree to the instructions outlined herein, as
well as any other instructions or that any MD Anderson representatives may
create pertaining to electronic communications between MD Anderson and its
patients. I understand that MD Anderson may discontinue this service at any
time. Any questions I may have had were answered.
UNAUTHORIZED ACCESS TO THIS NETWORK DEVICE IS PROHIBITED.
This system is for the use of authorized users only. Individuals using
this computer system without authority, or in excess of their authority,
are subject to having all of their activities on this system monitored
and recorded by system personnel. In the course of monitoring individuals
improperly using this system, or in the course of system maintenance, the
activities of authorized users may also be monitored. Anyone using this
system expressly consents to such monitoring and is advised that if such
monitoring reveals possible evidence of criminal activity, system
personnel may provide the evidence of such monitoring to law enforcement