INFORMED CONSENT FOR AI-ASSISTED CLINICAL DOCUMENTATION
Practice Name: [Practice Name]
Clinician Name: [Clinician Name]
Date: _______________

ABOUT THIS CONSENT
[Practice Name] uses Scriber, an AI-powered documentation tool, to assist with
clinical note-taking during sessions. This form explains how the tool works and
your rights as a patient.

WHAT IS SCRIBER?
Scriber is an AI-powered clinical documentation assistant. During your sessions,
Scriber may transcribe our conversation and generate draft clinical notes. These
notes are always reviewed and edited by your clinician before being finalized.

HOW YOUR DATA IS HANDLED
- Session audio is processed securely and encrypted in transit and at rest.
- Transcripts and notes are stored in a HIPAA-compliant environment.
- Your information is never sold or shared with third parties for marketing.
- You may request deletion of your data at any time.

YOUR RIGHTS
- You have the right to opt out of AI-assisted documentation at any time.
- You may request a copy of any AI-generated notes or transcripts.
- Opting out will not affect the quality of care you receive.
- If you opt out, your clinician will document sessions manually.

SAMPLE CONSENT LANGUAGE
"I understand that [Practice Name] uses Scriber, an AI-powered documentation
tool, to assist with clinical note-taking during our sessions. I understand that:

1. My session may be transcribed to help generate clinical notes.
2. My information is handled in accordance with HIPAA regulations.
3. All notes are reviewed and approved by my clinician.
4. I may opt out of AI-assisted documentation at any time by informing my
   clinician, without any impact on the care I receive.
5. I may request a copy of any AI-generated notes or transcripts."

PATIENT ACKNOWLEDGMENT
I have read and understood the above information about AI-assisted documentation
at [Practice Name]. I consent to / decline (circle one) the use of Scriber for
my clinical documentation.

Patient Name (Print): ___________________________
Patient Signature: ___________________________
Date: _______________
Parent/Guardian (if minor): ___________________________

Clinician Name: ___________________________
Clinician Signature: ___________________________
Date: _______________

NOTE: This template is provided as a starting point. Please have it reviewed by
your legal counsel and tailored to your state's requirements before use.

STATE-SPECIFIC CONSIDERATIONS
Requirements vary by state. Some states have additional requirements for:
- Telehealth consent
- Audio/video recording consent
- AI-generated documentation disclosure
Consult with a healthcare attorney in your jurisdiction for guidance.

For questions about this form, contact: support@scriberapp.com