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Patient Consent for AI-Assisted Clinical Documentation

PodScribe by podiatry-scribe.com

Practice Information

Patient Information

Why Does My Provider Use AI-Assisted Documentation?

AI-assisted documentation allows your provider to focus on you during your visit -- listening, examining, and talking with you -- instead of typing into a computer or clicking through screens. By handling the documentation in the background, your provider can give you their full attention, spend more time addressing your concerns, and still produce thorough, accurate clinical records.

Consent for AI-Assisted Services

For each service below, please circle or check one option: I CONSENT or I DO NOT CONSENT.

1. Voice Transcription I CONSENT I DO NOT CONSENT

I consent to my healthcare provider using PodScribe's ambient AI technology to transcribe clinical conversations during my visit. I understand that:

  • No audio recording is permanently stored. Audio is used solely for transcription and is discarded immediately after the transcript is generated.
  • My personal identifiers are automatically stripped from the transcript before it is processed by AI. The AI never sees my real name, date of birth, Social Security number, insurance IDs, or other identifying information.
  • PodScribe uses an enterprise-grade, proprietary de-identification engine to protect my information during AI processing.
  • Transcripts are never used to train or improve AI models.
  • All data is encrypted with AES-256 at rest and TLS 1.2+ in transit, and processed exclusively on US-based HIPAA-compliant Azure servers.
  • My provider reviews and approves all documentation before it enters my medical record.
2. Document Analysis I CONSENT I DO NOT CONSENT

I consent to my healthcare provider using PodScribe's AI to analyze clinical documents related to my care (such as denial letters, explanations of benefits, eligibility verifications, and referral notes). I understand that:

  • No audio recording is involved in document analysis.
  • My personal identifiers are automatically stripped from uploaded documents before AI processing.
  • Documents are processed on encrypted US-based HIPAA-compliant servers.
  • Uploaded files are automatically deleted within 24 hours of processing.
  • Analysis results are reviewed by my provider before any clinical or billing action is taken.
3. AI-Assisted Note Generation I CONSENT I DO NOT CONSENT

I consent to my healthcare provider using PodScribe's AI to generate clinical notes from transcription and/or structured clinical input. I understand that:

  • No audio recording is permanently stored. Notes are generated from transcribed text and structured clinical data.
  • My personal identifiers are automatically stripped before AI processing and restored only in the final output delivered to my provider.
  • The AI never sees my real name, date of birth, Social Security number, or other identifying information during note generation.
  • My provider reviews, verifies, and approves all AI-generated content before it becomes part of my medical record.
  • AI-generated notes are a documentation aid only. My licensed healthcare provider bears full professional responsibility for all clinical documentation.
4. MIPS Quality Reporting (if applicable) I CONSENT I DO NOT CONSENT

If my physician participates in the Centers for Medicare and Medicaid Services (CMS) Merit-based Incentive Payment System (MIPS), I consent to my encounter data being used for quality measure tracking and reporting. I understand that:

  • Encounter data used for MIPS reporting may be retained for up to 18 months to meet CMS reporting requirements.
  • Data is used solely for quality measure calculation and submission to the designated quality reporting registry.
  • No data is shared with third parties beyond the designated CMS-approved quality registry selected by my provider.
  • MIPS reporting is a federal quality improvement program. My provider's participation does not affect my standard of care.

Duration and Right to Revoke

This consent remains in effect indefinitely until revoked. You may revoke or modify your consent for any or all services at any time by notifying your healthcare provider in writing (in person, by mail, or by secure email). Revocation of consent will take effect upon receipt and will not affect any documentation or processing that occurred prior to revocation. You may also reinstate consent for any previously declined service at any time by completing a new consent form.

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