Consent for Post-Operative Patient Engagement – Text Messaging
About the Pilot
Our goal is to help you recover faster and help learn about prescribing medications for pain. We will communicate with you by text message. These messages will be sent anywhere from 3 to 10 days after your surgery or hospital discharge. Some of the messages will request a text or number response. Message and data rates may apply.
If you have any questions please contact our research coordinator Jessie Hemmons: (215)-746-8255 or Jhemmons@upenn.edu
You can leave the pilot at any time for any reason with no impact on other care you receive at Penn Medicine.
Benefits and limitations of text messaging
We cannot promise that any response you send will be read and responded to within a certain time. Text messaging should never be used for urgent issues or emergencies. If you have any questions about your care or other health needs, call your doctor’s office directly. If this is a life-threatening emergency, call 911 or go to the Emergency Department.
Privacy and security
Since text messaging technology was not built for secure communication, the privacy of information sent through text message cannot be guaranteed. By participating, you are agreeing to text communications of your health information, recognizing that texting is not secure.
We will make our best effort to use the minimum information in the messages to reduce the chance of someone else seeing details about you and your health. Text message should not be your primary source of communication for your health care needs.
You can also help reduce privacy risks by putting a screen lock on your device and not sharing your "PIN" or other password to unlock it.
Agreement
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I understand it is my obligation to immediately notify my doctor if my phone number changes.
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I waive any and all claims that may arise against the University of Pennsylvania Health System or its affiliates, employees, contractors, interns, and students directly or indirectly resulting from the use or misuse of text messaging.
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I have read and understood the terms above and consent to the research team and/or their coworkers contacting me by text message. I have had the opportunity to ask any questions I might have about this pilot.
Patient First and Last Name: ____________________________ Patient E-Signature: _______________________
Date: [Auto-populated]