Authority to Release Medical Information via Email Form

By signing the “Authority to release medical information via email” form, you are giving Angaston Medical Centre consent to release medical records, reports and/or statements from your treating medical practitioner via an insecure communication platform.

Date of Birth (dd/mm/yyyy)

Understand the following:

An email can be forwarded or changed without the knowledge or permission of the original sender.
The email is not encrypted.
Exchanging records by unencrypted email is vulnerable to interception and hacking by unauthorised third parties.
Emails can be accessed on portable devices
The email service may not be able to handle the file sizes these images require.
I have considered communicating any sensitive information by telephone, fax, or mail.
There is the possibility of human error when manually typing in e-mail addresses.

I hereby authorise Angaston Medical Centre to provide my medical records via email and I only need to fill this form out once as blanket consent. I will notify Angaston Medical Centre when I wish to cease my health information being sent by email.

Date

Signature (Use your mouse or touchscreen)

Email address you would like the document sent to

The document you would like sent

Sending Health Information via Email

Email is one of the most prevalent and convenient forms of communication. GPs and general practices often receive requests from patients, other clinicians and third parties to send health information via email.
As all health information is sensitive by nature, all communication of health information, including via electronic means, must adequately protect our patient’s privacy.

What are the risks of using email to send healthcare information?

All forms of written communication involve an element of risk that information could be read by someone other than the intended recipient. The risks of using unsecured or unencrypted email include:

emails can easily be sent to the wrong recipient
email is often accessed on portable devices, such as smart phones, tablets and laptops, which are easily lost or stolen
emails can be forwarded or changed without the knowledge or consent of the original sender
email is vulnerable to interception.

To provide consent to receive health information electronically, patients are required to fill out the ‘Authority to release medical information via email’ form and return to The Privacy Officer or administration@angastonmedical.com.au.