AI Consent

We are informing you about your intention to utilize AI technology as part of your healthcare treatment. This technology is intended to improve clinical note-taking and improve patient care by reducing time spent on computer-related tasks. The software works by capturing and converting conversations into text, which is then summarized into a clinical note.

The medical record remains confidential and is only shared with authorized parties.

Your personal health information will be handled with strict confidentiality according to HIPAA regulations, and access to your data will be restricted to authorized healthcare professionals only.

By signing below, you acknowledge that:

You have read and understood this consent form and have had the opportunity to ask questions about the use of AI technology in your care.
You voluntarily agree to allow us to use AI technology to support your treatment documentation.
You understand that you have the right to withdraw your consent at any time by notifying your healthcare provider.

Patient Name*

Patient Date of Birth*

Patient Signature

Minor Consent:

By signing below, you acknowledge, for your minor child, that:

You have read and understood this consent form and have had the opportunity to ask questions about the use of AI technology in your care.
You voluntarily agree to allow us to use AI technology to support your treatment documentation.
You understand that you have the right to withdraw your consent at any time by notifying your healthcare provider.

Parent Signature

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