I grant my permission to Cameron Park Counseling Center to receive via unsecured email, and upload and store confidential patient information – including account information, appointment information and clinical information – for Cameron Park Counseling Center. I understand Cameron Park Counseling Center and myself are responsible for maintaining the strict confidentiality of any records assigned to me; and that Cameron Park Counseling Center is not liable for any charges, damages, or losses that may be incurred or suffered as a result of my failure to maintain confidentiality. I understand Cameron Park Counseling Center is not liable for any harm related to the theft of my ID, my disclosure of my information, or my authorization to allow another person or entity to access and use the Cameron Park Counseling Center information given. I also agree to immediately notify Cameron Park Counseling Center of any unauthorized use of my information or of any other need to deactivate my information due to security concerns. I also understand State and Federal laws, as well as ethical and licensure requirements impose obligations with respect to patient confidentiality that limit the ability to make use of certain services or to transmit certain information to third parties. I understand Cameron Park Counseling Center will represent and warrant that they will, at all times during the terms of this Agreement and thereafter, comply with all laws directly or indirectly applicable that may now or hereafter govern the gathering, use, transmission, processing, receipt, reporting, disclosure, maintenance, and storage of my patient information, and use their best efforts to cause all persons or entities under their direction or control to comply with such laws. I agree that Cameron Park Counseling Center has the right to monitor, retrieve, store, upload and use my patient information in connection with the operation of such services, and is acting on my behalf in uploading my patient information. I understand Cameron Park Counseling Center will use commercially reasonable efforts to maintain the confidentiality of all patient information.
I understand Cameron Park Counseling Center CANNOT AND DOES NOT ASSUME ANY RESPONSIBILITY FOR MY USE OR MISUSE OF PATIENT INFORMATION OR OTHER INFORMATION TRANSMITTED, MONITORED, STORED, UPLOADED OR RECEIVED USING THE SITE OR THE SERVICES.
I have read and understand the information above regarding the secured uploading of patient information to the web site and the acceptance of payments for Cameron Park Counseling Center.
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