This form is provided as a template for your clinic's use. You must customize it according to your specific needs and have it reviewed by legal counsel before implementation.
Patient Consent for AI Voice Assistant
By providing your phone number and agreeing to communicate with our clinic, you consent to the following:
1. Use of AI Technology
Our clinic uses Sectavoice, an AI-powered voice assistant, to handle phone calls and text messages. This technology may:
- Answer your calls and respond to inquiries
- Schedule, confirm, or reschedule appointments
- Provide general clinic information
- Send appointment reminders via SMS
- Route urgent matters to appropriate staff
2. Protected Health Information (PHI)
You understand that conversations with our AI voice assistant may involve Protected Health Information (PHI) as defined by HIPAA. This may include:
- Your name, date of birth, and contact information
- Appointment dates and times
- Reason for visit (general nature only)
- Insurance information
- Other information you voluntarily provide
3. Data Security and Privacy
We take your privacy seriously. All communications are:
- Encrypted during transmission and storage
- Accessible only to authorized clinic staff
- Protected by HIPAA-compliant security measures
- Retained according to legal and medical record requirements
- Never sold or shared with third parties for marketing
4. Limitations of AI Technology
You understand that:
- The AI assistant is not a substitute for medical advice
- Medical emergencies should be directed to 911
- Complex or sensitive matters will be escalated to human staff
- The AI may occasionally misunderstand or make errors
- You can always request to speak with a human staff member
5. Your Rights
You have the right to:
- Opt-out of AI interactions and speak only with human staff
- Request copies of your communication records
- Revoke this consent at any time in writing
- File a complaint if you believe your privacy has been violated
- Access, correct, or request deletion of your information
6. Business Associate Agreement
Sectavoice has executed a Business Associate Agreement (BAA) with our clinic, ensuring they comply with HIPAA requirements for handling your PHI.
7. Consent Duration
This consent remains in effect until you revoke it in writing or until you are no longer a patient of our clinic.
Patient Acknowledgment
By checking the consent box during registration or verbally confirming during your call, you acknowledge that:
- You have read and understand this consent form
- You have had the opportunity to ask questions
- You voluntarily consent to the use of AI voice technology
- You understand your rights and how to opt-out
Questions or Concerns?
If you have questions about this consent form or our use of AI technology, please contact:
Privacy Officer: [Your Clinic Name]
Email: privacy@yourclinic.com
Phone: (555) 123-4567