Patient Consent Form for AI Documentation
Multiple consent form options including comprehensive, short-form, digital, and verbal consent scripts.
Patient Consent Form Template for AI-Assisted Documentation
Document Type: Consent Form Template
Version: 1.0
Usage: Customise for your organisation
This template provides sample patient consent forms for AI-assisted clinical documentation. Customise the sections in [BRACKETS] for your organisation.
Important:
- Have legal/compliance review before use
- Ensure forms meet your jurisdiction's requirements
- Train staff on consent process
- Document consent in patient records
Option A: Comprehensive Written Consent Form
[PRACTICE NAME] — Consent for AI-Assisted Clinical Documentation
Patient Name: _________________________ Date of Birth: _______________
Date: _________________________
What is AI-Assisted Documentation?
[PRACTICE NAME] uses advanced artificial intelligence technology to help create accurate and comprehensive medical records from your consultations.
How it works:
- During your appointment, the conversation between you and your healthcare provider is recorded
- AI technology transcribes the conversation and creates structured clinical notes
- Your healthcare provider reviews and approves all documentation before it becomes part of your medical record
Important: Your healthcare provider always reviews and takes responsibility for all documentation.
What Information is Captured?
The AI system may capture:
- Spoken conversation during your consultation
- Clinical information discussed (symptoms, medical history, treatment plans)
- Provider assessments and recommendations
The AI system does NOT:
- Make clinical decisions about your care
- Replace your healthcare provider's judgement
- Store audio recordings permanently
- Share your information for purposes other than your care
How is My Information Protected?
- Encryption: All data is encrypted during transmission and storage
- Access Controls: Only authorised healthcare staff can access your records
- Compliance: Our systems comply with [HIPAA / Australian Privacy Principles]
- Audit Trails: All access to your records is logged and monitored
- Secure Vendors: Our AI provider has signed agreements protecting your information
Your Rights
You have the right to:
- Decline AI documentation — Request traditional documentation methods at any time
- Access your records — Request copies of AI-generated documentation
- Request corrections — Request amendments to your medical records
- Withdraw consent — Withdraw this consent at any time for future appointments
- Ask questions — Ask your healthcare provider if you have concerns
Declining AI documentation will not affect the quality of your care.
Consent Statement
I have read and understood the information above about AI-assisted clinical documentation.
Please select one:
☐ I CONSENT to AI-assisted documentation for my consultations.
☐ I DO NOT CONSENT to AI-assisted documentation. I request alternative documentation methods.
Patient Signature: _________________________ Date: _______________
Print Name: _________________________
Option B: Short-Form Consent (Check-In)
[PRACTICE NAME] — AI Documentation Acknowledgment
Patient Name: _________________________ Date: _______________
[PRACTICE NAME] uses AI technology to help create accurate medical records. During your visit:
✓ Your conversation with your provider may be recorded
✓ AI creates draft notes that your provider reviews and approves
✓ Your information is encrypted and protected
✓ You may decline at any time—just let us know
For more information, please ask for our detailed information sheet.
☐ I acknowledge and consent to AI-assisted documentation.
☐ I prefer traditional documentation methods.
Signature: _________________________ Date: _______________
Option C: Digital/Tablet Consent
[Display on tablet/screen at check-in]
Welcome to [PRACTICE NAME]
We use AI technology to help create accurate records of your visit.
Quick Facts:
- 🎙️ Your conversation may be recorded
- 🤖 AI helps create your clinical notes
- 👨⚕️ Your doctor reviews everything
- 🔒 Your data is encrypted and protected
- ❌ You can say no—just let us know
Do you consent to AI-assisted documentation today?
[YES, I CONSENT] [NO THANK YOU]
By selecting "Yes," you confirm you have read and agree to AI-assisted documentation. You may change your preference at any time.
Option D: Verbal Consent Script
Reception/Check-In Script
"At [PRACTICE NAME], we use AI technology to help create accurate records of your appointments. The system records your conversation with your provider and creates clinical notes, which your doctor reviews before they're added to your record. Your information is kept secure and confidential.
Would you like us to use this technology for your appointment today? You can say no if you prefer, and it won't affect your care in any way."
If patient consents: "Great, thank you. Your provider will confirm this at the start of your appointment."
If patient declines: "No problem at all. I'll note that in your record, and your provider will use traditional documentation."
Provider Script (Start of Consultation)
"Before we begin, I want to confirm—are you comfortable with me using our AI documentation assistant today? It records our conversation and helps me create thorough notes. I review everything before it goes in your record, and you can say no if you prefer."
If patient consents: "Thank you. Let me start the recording, and we'll get started."
If patient declines: "That's completely fine. I'll make notes the traditional way."
Option E: Information Sheet (Patient Handout)
[PRACTICE NAME] — Understanding AI-Assisted Documentation
What is it?
We use advanced artificial intelligence (AI) technology to help create your medical records. When you have an appointment with your healthcare provider, the AI:
- Listens to your conversation with your provider
- Creates a written record of what was discussed
- Helps ensure nothing important is missed
Your healthcare provider always reviews the notes before they become part of your record.
Why do we use it?
- Better accuracy: Important details are captured during the conversation, not from memory later
- More face time: Your provider can focus on you, not on typing
- Faster records: Your documentation is ready quickly, sometimes before you leave
Is my information safe?
Yes. We take your privacy seriously:
- All recordings and notes are encrypted
- Only your healthcare team can access your records
- We follow all privacy laws (HIPAA/Australian Privacy Principles)
- Audio recordings are not kept permanently
Can I say no?
Absolutely. You can decline AI documentation at any time. Just tell our staff or your provider. It won't change the quality of care you receive.
What if I have questions?
Please ask! Our staff are happy to explain more or address any concerns you have.
Supporting Materials
Consent Status Quick Reference Card
| Status | Action | EHR Code |
|---|---|---|
| ✅ Consented | Proceed with AI documentation | AI-CONSENT-Y |
| ❌ Declined | Use traditional documentation | AI-CONSENT-N |
| ❓ Unknown | Ask patient before starting | (none) |
| 🔄 Withdrawn | Previously consented, now declined | AI-CONSENT-W |
Remember: Always confirm consent before recording!
Frequently Asked Questions
Q: Is my conversation recorded permanently?
A: Typically, audio is processed in real-time and not stored permanently. Only the final clinical notes are retained.
Q: Can I get a copy of what the AI created?
A: Yes, you can request copies of your medical records, including AI-assisted documentation.
Q: What if the AI makes a mistake?
A: Your healthcare provider reviews all documentation before it's finalised. If errors are found later, you can request corrections.
Q: Who can access my AI-documented records?
A: The same people who can access any of your medical records—your care team and authorised healthcare staff.
Q: Can I consent for some visits but not others?
A: Yes, you can make a different choice at any appointment. Just let us know your preference.
Legal Notices
Disclaimer: These templates are provided for informational purposes and general guidance. Healthcare organisations should:
- Consult with legal counsel to ensure compliance with applicable laws
- Review state/territory-specific consent requirements
- Adapt forms to meet organisational policies
- Ensure translations are accurate if serving non-English speakers
- Regularly review and update forms as regulations change
Download Formats:
- Word Document — All Forms (.docx)
- PDF — All Forms
- Individual Forms (ZIP)
Related Resources: