By uploading information to the Montfort Academic Family Health Team, please take note that you understand, agree and consent to the following:

• I have been specifically instructed by my provider to submit the information I am uploading, and only that information.
• I am submitting information about myself; about a minor in my capacity as their legal guardian; or about an individual in my capacity as their substitute decision maker.
• I will not upload further information unless specifically instructed to do so.
• I am not sending questions, requests or any other communications that have not yet been discussed with my provider.
• I understand that by uploading information, I am sending personal health information across the internet.
• I understand that once received by the Montfort Academic Family Health Team, the information I am submitting will be added to the electronic medical record in question and will subsequently and systematically be deleted from any intermediary transactional servers.
• I understand that although the Montfort Academic Family Health Team has taken special precautions in protecting the information I am sending, such as automating encryption and limiting the ability to identify the source of submission, that there are inherent risks in submitting information in this manner. This information may be intercepted by a third party which is outside of my control and outside the control of the Montfort Academic Family Health Team. I therefore hold harmless the Montfort Academic Family Health Team, its agents and its affiliates, against any claims resulting from an interception of this nature.
• I understand that confidentiality will be respected at all times and my information will be not be released to a third party without my explicit informed consent.
• I understand that exceptions to confidentiality include the legal and/or ethical obligations for my provider to:
• Inform a potential victim of a patient’s intention to harm
• Inform an appropriate family member, care giver, health care professional, or police if necessary, of a patient’s intention to end his or her life.
• Release my file if there is a court order to do so.
• Inform the Children’s Aid Society if there is suspicion of a child being at risk or in need of protection due to neglect, or physical, sexual or emotional abuse.
• Report a health professional who has sexually abused a patient
• I understand that Montfort Academic Family Health Team may discontinue this service without prior notice.
• I understand that my failure to comply with these instructions will result in the Montfort Academic Family Health Team revoking my privilege to electronic communications.