Patient Information and Acknowledgement Form

PLEASE READ THE FOLLOWING INFORMATION CAREFULLY. YOUR CONTINUED USE OF THIS SITE AND RELATED SERVICES WILL INDICATE YOUR UNDERSTANDING OF THIS INFORMATION, YOUR AGREEMENT THAT YOU WILL FOLLOW ALL INSTRUCTIONS GIVEN, AND YOUR ACCEPTANCE OF THE RISKS AND TERMS OUTLINED BELOW. IF YOU DO NOT AGREE TO BE BOUND BY THESE TERMS PLEASE PROMPTLY EXIT THIS SITE.

Risks of Using Electronic Communication Systems. Moffitt Cancer Center offers patients the opportunity to use the MyMoffitt Patient Portal website to view general information, to view certain personalized information, to conduct selected transactions (e.g., pay a bill), and to limited communication by secure messaging and e-mail (e.g. make an appointment).

Secure messaging is online electronic communication that takes place between various authorized parties within a secure website. Messages are sent, received and archived through the website, and internet email is not required or used. Security and privacy are provided through encryption, the special digital encoding of data that can prevent unauthorized persons from reading the contents of protected messages. (Internet email is usually not encrypted and therefore is inherently not secure.) Moffitt Cancer Center is using industry-standard encryption technologies to protect and secure the MyMoffitt Patient Portal website, including the secure messaging function.

However, the use of any electronic communication system such as the World Wide Web (including secure messaging) has a number of risks that patients should consider before use. Many of these risks apply to the use of electronic information in general; other risks apply particularly to email communications. These include, but are not limited to, the following risks:

Conditions for the Use of Electronic Communication Systems
Moffitt Cancer Center will use reasonable means to protect the security and confidentiality of electronic information sent and received, including the use of encryption and other security technologies. However, because of the risks outlined above, Moffitt Cancer Center cannot guarantee the security and confidentiality of web-based communications, and will not be liable for improper disclosure of confidential information that is not caused by Moffitt Cancer Center's intentional misconduct.

It is also important to understand that MyMoffitt Patient Portal is not intended to replace or to substitute for face-to-face meetings and/or personal interaction and conversations with your health care team.

Therefore, you must agree to and acknowledge the following terms when using electronic communications systems, including MyMoffitt Patient Portal to communicate and share information with Moffitt Cancer Center.


Patient Acknowledgement and Agreement
I acknowledge that I have read and fully understand the information provided in this form. I understand the risks associated with using electronic systems to contact and receive information from Moffitt Cancer Center. I agree to the terms listed above, in addition to all the terms and conditions of the Moffitt Cancer Center Legal Statements, including the Terms of Use and Privacy Policy. In addition, I agree to the instructions outlined herein, as well as any other instructions that any Moffitt Cancer Center representatives may create pertaining to electronic communications between Moffitt Cancer Center and its patients. I understand that Moffitt Cancer Center may discontinue this service at any time. Any questions I may have had were answered.