Consent for Use of AI Tools in Therapy Services

Consent for Use of Artificial Intelligence (AI) Tools in Your Therapy Services

Introduction: We are committed to providing you with the best possible treatment. To help us manage our practice efficiently and enhance our services, we use technology, including certain artificial intelligence (AI) tools. This document explains how we use these tools and asks for your consent to use them as part of your treatment. Your privacy, confidentiality, and the quality of your treatment remain our highest priorities.

How We Use AI Tools

AI tools are used strictly for administrative and supplementary support tasks under the direct supervision of your therapist. These tools do not provide therapy, make independent clinical decisions, or interact with you directly. The specific purposes for which we may use AI now and in the future include:

• Assisting your therapist in drafting and organizing session notes;

• Managing appointment scheduling and/or sending reminders;

• Processing billing and insurance claims;

• Analyzing data to identify therapy trends and track progress, which is always reviewed by your therapist;

• Analyzing business information and generating reports or trends to help manage my business; or

• Helping to identify and organize external resources or referrals for your use.

How We DO NOT Use AI Tools

To be clear, we do not use AI to:

• Make independent therapeutic decisions or diagnoses;

• Communicate with you directly to provide therapeutic advice;

• Generate treatment recommendations without the direct review, approval, and input of your licensed therapist; or

• Detect or interpret your emotions or mental state.

Consent for Session Transcription

To help create accurate and detailed session notes, your therapist uses an AI tool called Note Taker that transcribes sessions and then prepares a draft progress note. Note Taker is a feature in our secure, HIPAA-compliant Electronic Health Record and practice management platform.

Please select your choice regarding transcription: * Required

I consent to the use of an AI transcription tool to record and transcribe my therapy sessions for the purpose of assisting my therapist with note-taking.I do not consent to the use of an AI transcription tool to record or transcribe my therapy sessions. I understand this will not affect the quality of my care.

Your Rights and Confidentiality

Confidentiality: All information, including any data processed by an AI tool, is treated as part of your confidential health record and is protected by the same privacy and security standards as all other aspects of your care, including HIPAA.

• Our practice platform and its Note Taker tool are HIPAA-compliant.

• All audio-recordings of therapy sessions through Note Taker are immediately deleted as soon as a transcript is created, generally within minutes of a session ending.

• Transcripts that are created through Note Taker are only retained for the shorter of 7 days or when the progress note is signed and locked by your therapist. After that, they are permanently deleted.

• During the time that transcripts are available, they always remain confidential and secure, and are only available for your therapist's use to verify the accuracy of the progress note. They are not used for any other purpose.

Right to Revoke Consent: Your consent is voluntary. You have the right to withdraw this consent at any time by notifying your therapist in writing. Revoking your consent will not affect your ability to receive therapy services.

Client Acknowledgment and Consent

Client Full Name * Required

Client Signature * Required

Signature

By signing below, I confirm that: I have read and understood this form; I have had the opportunity to ask questions about the use of AI tools in my treatment; I voluntarily agree to the use of AI tools for the purposes described above.

Consent for Use of AI Tools in Therapy Services

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