Individual Agreement for Email and Texting Communications

You agree that Berry Street Health, Inc. (“Company”) may communicate with you via email or text message. 

You certify the email address and/or mobile telephone number provided is accurate, and that you, or your designee on your behalf, accept full responsibility for messages sent to or from this address or number.

You have received a copy of the attached IMPORTANT INFORMATION ABOUT PROVIDER/INDIVIDUAL EMAIL OR TEXTING form, and you have read and understand it.

You understand and acknowledge that communications over the Internet or via email or text message may not be encrypted and are inherently insecure and that there is no assurance of confidentiality of information communicated through these means.

You agree to hold Company and individuals and affiliates associated with Company harmless from any and all claims and liabilities arising from or related to my request to transmit PHI to me insecurely via email or text message.

Please be advised that:

(1)       Company will only communicate via text message for limited administrative purposes, such as confirming or arranging appointments or deliveries. Company will NOT communicate with you via text on Individual care-related matters or include information that must be contained in your medical record unless you use a secure messaging platform provided and approved by Company.

(2)       Company will not communicate PHI that is specially protected under state and federal law (e.g., HIV/AIDS information, substance abuse treatment records information, mental health information) via email or text message even if we agree to communicate with you via email or text message.

 
Important Information About Provider/Individual Email or Texting

As a patient of Berry Street Health, Inc. (“Company”), you have the right to request that we communicate with you by email or text message.  It is also your right to be informed in sufficient detail about the risks of communicating via email or text message with Company.

PLEASE READ THIS INFORMATION CAREFULLY

Email communications and text messages are two-way communications.  However, responses and replies to emails or texts sent to or received by either you or Company may be hours or days apart.  This means that there could be a delay in receiving information concerning your condition or medication.  If you have an urgent or emergency situation, you should not rely on provider/Individual email or text messages to request assistance or to describe the urgent or emergency situation.  Instead, you should act and seek assistance by means consistent with your needs.

Email messages on your computer, your laptop, etc., have inherent privacy risks.  Unencrypted email or text messages sent over an unsecure platform or network do not provide adequate privacy and security protections under HIPAA.  You should not communicate PHI to Company through these means if you would not want anyone else to potentially have access to such information.

Email messages may be inadvertently missed or sent to the wrong email address.  To minimize this risk, Company requires you to respond appropriately to a test email message before we will allow PHI about you to be communicated via email.  You can also help minimize this risk by using only the email address that you are provided at the successful conclusion of the testing period to communicate with Company.

Email is sent at the touch of a button.  Once sent, an email message cannot be recalled or cancelled.  Errors in transmission, regardless of the sender’s caution, can occur.

Generally, text messages are not sent over a secure platform or network.  Therefore, Company will only communicate about administrative matters (such as appointments) and will not communicate about your health condition or other Individual-care related matters through text messages unless you use a secure platform provided and approved by Company. If you wish to communicate with Company on those matters, please contact Company’s Privacy Officer at privacy@berrystreet.com.

In accordance with HIPAA, your email messages and any and all responses to them may become part of Company’s medical record.