Request for Activation and Use of the Internet Patient Portal

Your Family Medical Home now has online access to our office, available through the internet 24 hours per day. Appointments can be scheduled or requested. Referrals and medication refills can be requested. Messages can be sent. Registration and medical information can be reviewed and updated. Reminders can be transmitted. Very soon, computerized lab results will be reviewed.

However, there are limitations that must be understood.

•  The patient portal is NEVER to be used for emergent or urgent medical questions or problems. If there is a serious medical condition or emergency call 911 or go directly to the emergency room.

•  THIS IS IMPORTANT- Only one message, the very first email message with your sign-on name and initial password is sent to your regular email, which is not secure. Once you get this message, you should immediately sign on and change your password so that nobody else can sign on to your account and have access to your medical and personal information.

•  Once “inside” the patient portal, all communication and information is encrypted and secure as it is transmitted. All messaging needs to be done this way. No medical information should ever be sent via common email. Common email will be used to send messages to patients to sign on to the secure patient portal for messages and reminders. (This is similar to medical offices sending reminder postcards through the regular mail.)

•  The typical response time on the patient portal will be less than 24 hours, but it could be longer. Though the patient portal will very commonly be monitored on weekends, holidays, and vacations, response times may be longer, even up to several days. If responses are not received in a time frame that is going to work for your medical condition, please call the office. If the call is made when the office is closed, registered nurses are available to take the call and, if needed, contact the physician on call.

I have read and understand the information printed above and would like for my personal access to the patient portal to be activated.

______

Printed name Signature Date

Steven E. Ryan, M.D.,Your Family Medical Home, 6011 E. Woodmen Rd., Suite 300, Colorado Springs, CO, 80923