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MJIA MedPro Telemedicine RRG Form

MedPro Telemedicine RRG Form

Physician Online Communication with Patients Underwriting Questionnaire

RRG Telemedicine Form

Email address(Required)
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1. Does your practice engage in electronic communications with patients
A. If Yes is it only through a secure Internet based communication system (ie. Patient Portal)
2. Is your electronic communication with: (select all that apply)
3. Is electronic communication with patients limited to patients 18 or older
4. Which of the following transactions do you/the group conduct electronically with patients (please check all that apply)
A. Administrative uses
B. Education and health promotion
C. Patient Care
5. Do you have a written email policy?
A. If “Yes”, does your email policy include provisions to address at least the following issues: (please check all that apply)
6. Does your system meet HIPAA privacy and security rules
7. Will you be referring patients to other web sites
8. Are you/will you engage in any medically- related commercial activity on the internet?
9. Are you/will you be posting all email correspondence (sent and received) to the patient record?