Patient Consent Template (Chinese Version)

Patient Consent Form

Healthcare Institution Name:

Empathia AI is a technology solution software powered by advanced AI (artificial intelligence) to assist your Healthcare Provider in capturing the important details of your visit.

Empathia strictly complies with US and Canadian privacy laws, including the Personal Information Protection and Electronic Documents Act (PIPEDA) or applicable provincial legislation such as Ontario’s Personal Health Information Protection Act (PHIPA), British Columbia’s Personal Information Protection Act (PIPA).

By signing this form, you provide voluntary consent for the recording and processing of your conversations to create accurate medical documents for your doctor. You retain the right to withdraw consent at any time, with alternative documentation methods available.

患者同意书 （简略文字版）

医疗机构名称：

Empathia AI 是一款由人工智能（AI）技术驱动的医疗助手软件，旨在协助您的医生记录您就诊过程中的重要信息。

Empathia 严格遵守美国和加拿大隐私法律，包括《个人信息保护和电子文档法案》（PIPEDA）或适用的省级法律，例如安大略省的《个人健康信息保护法案》（PHIPA）和不列颠哥伦比亚省的《个人信息保护法案》（PIPA）。

签署本表格即表示您自愿同意录音并处理您的对话内容，以便为您的医生生成准确的医疗文档。您保留随时撤回同意的权利，并可选择其他记录方式。

Patient Consent Form

I’m using a medical scribe powered by AI (artificial intelligence). It's a software program that listens and captures our encounter privately and securely. It takes accurate and highly detailed notes during our visit so I can focus more on our conversation than having to write notes and create referrals etc. It’s helping me be more efficient and allows patients to have better care.

By verbally consenting you provide voluntary consent for the recording and processing of your medical conversations to create accurate medical documents for your medical service providers. Your data's privacy and security are prioritized, adhering to local and national privacy laws. You retain the right to withdraw consent at any time, with alternative documentation methods available.

Do you consent?

患者同意书（口头版）

我正在使用由人工智能（AI）驱动的医疗记录助手。这是一款软件程序，可以私密且安全地记录我们的就诊过程。它在我们会面期间记录准确且详细的笔记，让我可以更专注于我们的交流，而不是忙于记笔记或创建转诊等文书工作。这帮助我提高效率，同时让患者能够获得更好的护理。

通过口头同意，您即自愿同意录音并处理您的医疗对话内容，以便为您的医疗服务提供者生成准确的医疗文档。您的数据隐私和安全是我们的优先事项，完全符合当地和国家隐私法律。您保留随时撤回同意的权利，并可选择其他记录方式。

您同意吗？