I authorise the Cardiovascular Centre to release my medical information via electronic mail (email) to my email and/or the email of my family member/carer detailed above, and as necessary, any health practitioner involved in my treatment.
I am aware that the Cardiovascular Centre does not have encrypted email software and cannot guarantee that information transmitted via email will not be intercepted by other parties. By signing this form, I agree to not hold the Cardiovascular Centre or its employees responsible for any breach of confidentiality that may occur by someone else accessing the information contained in any emails sent to or from the Cardiovascular Centre regarding my personal health information.
I understand that reasonable means will be used to protect the security and confidentiality of the email. All concerns to and from me regarding my personal health information will be a part of my medical record and can be viewed by Cardiovascular Centre doctors and support staff. My email will not be forwarded outside the office without my consent or as required by law.
This release may be revoked at any time by written notice and is valid until such revocation is received by the Cardiovascular Centre.