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MyChart ® Epic Systems Corporation

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Sansum Clinic is pleased to offer you member information via a Web-based version of our electronic health record system called MyChart.

Your Personal Account - To set up your MyChart account, request an activation code letter at any Sansum Clinic branch and follow the instructions on the letter. Completion of the activation process indicates that you have read this Terms & Conditions statement. We think it is important for you to know and understand how we handle information we communicate via the Internet. This Terms & Conditions statement outlines our practices and our sensitivity to your right to privacy. Please note that we reserve the right to revoke access at any time and for any reason.

Identity Verification and Protection - For routine requests for any access to medical information, Sansum Clinic requires verification of patient identification. This verification, which is intended to protect patient identity and to assist in preventing identity theft or potential identity theft, is accomplished by utilizing two of the following distinct identifiers in addition to your full name (including middle name): date of birth; last 4 digits of your Social Security Number; current street address; postal zip code of your residential address; home telephone number; medical record number; name of your physician; home fax number; e-mail address; Sansum Clinic account number; health plan beneficiary number; license number (i.e. California driver's license number); professional association membership number; vehicle serial number; license plate number; medical device identifier or serial number; Web Universal Resource Locator (URL) associated with the patient's Internet name and address; Internet Protocol (IP) address number; biometric identifier (i.e. fingerprint or voice print); full-face photographic image; or any other identifying number or characteristic (e.g. scar, tattoo) unique to the patient. For purposes of establishing your identity and safeguarding it against identity or potential identity theft, Sansum Clinic requires that the MyChart consent is documented in written form.

No Medical Advice - MyChart does not provide medical advice. Nothing you learn on MyChart can be considered as medical advice. The information you obtain from MyChart might be inappropriate for your own situation, or might be misinterpreted. Sansum Clinic assumes no responsibility for how you use the information you obtain from MyChart. Also, please note that although we strive to keep our information up to date, medical information changes rapidly, and some information may be out of date. For advice about your own situation, please ask your doctor.

No Medical Assistance - MyChart does not provide any medical assistance nor emergency care. Do not attempt to access any medical assistance nor emergency care through MyChart. If you think you need immediate medical or psychiatric assistance or emergency care, call 911 or go to the nearest hospital.

Response to Electronic Communication - Sansum Clinic will make its best effort to provide a timely response to electronic inquiries via MyChart. In some cases, the Clinic staff that needs to respond to an electronic inquiry or other communication may not be immediately available. As a result, a patient should allow at least two (2) business days for a response, however it could take longer particularly if your provider is out of the office. Emergency situations requiring immediate attention should not be submitted electronically.

Furthermore, with respect to any electronic communications sent by the patient using MyChart, we are only able to respond to such communications based on the information provided by the patient. If there is insufficient information given, we will be unable to respond with appropriate and reliable services.

Access - Sansum Clinic does not guarantee users permanent or continuous access to MyChart. As a computer-based service, MyChart may require repair, maintenance, adaptations, upgrade or modifications temporarily denying access to the services. Sansum Clinic is not liable towards MyChart users or third parties, for damages caused by any mechanical, electronic or communications failure of MyChart.

Users Submissions - Subject to compliance with Health Insurance Portability and Accountability Act of 1996 (HIPAA), Public Law 104-191, and Standards for Privacy of Individually Identifiable Health Information at CFR Part 160 and Part 164, Subparts A and E, any material, information, or other communication you transmit or post to MyChart will be considered as non-confidential and non-proprietary to the extent the same is used on a de-identified basis and is not to be linked to you in any way. Sansum Clinic and its designees are free to copy, disclose, distribute, incorporate and otherwise use the communications and all data therein for any and all non-commercial purposes.

Web Site Links - MyChart may offer links to related medical Web sites not managed by Sansum Clinic. These Web site links are for the patient's informational purposes only. Sansum Clinic does not endorse and has not verified the accuracy of the information accessible through these Web sites, and the patient should not rely on any of the information found on the Web sites for purposes of treatment or diagnosis.

Minor Eligibility

Patient Representative - Sansum Clinic recognizes the circumstantial need of the patient to be represented by a designated person. As defined by HIPAA, a patient representative is any individual designated by an adult or emancipated minor patient to act or make healthcare decisions on the patient's behalf. In California, this individual may be a conservator of the patient or an agent under a durable power of attorney for healthcare. It also includes a parent, guardian, or other person acting with authority to make healthcare decisions on behalf on an un-emancipated minor, unless the minor lawfully consented to the healthcare. Hence, any and all provisions contained in this Terms and Conditions that are applicable to the patient are equally applicable to the patient representative.

Proxy Access - A patient representative or a parent or legal guardian of a minor child may request proxy access to another individual's MyChart account by completing the Proxy Access portion of the MyChart Consent Form and submitting it in person to:

Sansum Clinic Health Information Services, Release of Information (ROI) Department
317 West Pueblo Street
Santa Barbara, CA 93105

With respect to minors, such access will only be granted to parties with parental rights or legal guardianship over the MyChart account holder and only to the extent that the party requesting proxy access can demonstrate the legal right to the account holder's medical information.

**NOTE**This form must be completed and presented in person to our Release of Information Department window.

Sansum Clinic's identity verification and protection requirements apply to the patient representative and to both the proxy and the patient. (Please see preceding section concerning "Identity Verification and Protection."). The MyChart account will be activated for both the proxy and the account holder (assuming the account holder is not a minor). If the proxy's legal relationship with the account holder changes, the proxy must inform the Clinic immediately by contacting:

Sansum Clinic Health Information Services, Release of Information (ROI) Department
317 West Pueblo Street
Santa Barbara, CA 93105

Sansum Clinic reserves the right to revoke proxy access at any time and for any reason.

E-mail Privacy - Patients who are users of MyChart should be aware that they will be notified via e-mail when there is new medical information to be viewed on MyChart. This means that any person with access to a patient's e-mail will be able to see this notification. This could include the patient's spouse, employer or anyone else that can access a patient's e-mail account. Although no private medical information will be sent, the notification that new medical information is available by accessing MyChart may be information that a patient would not want others to know. Thus, patients should take this into account when providing an e-mail address.

Please know that if you send us an e-mail communication, it may be shared with the Sansum Clinic staff that assists the physician in providing the patient's medical care. A patient's confidential medical information on MyChart will be accessible only to appropriate Clinic staff.

Security and Confidentiality - We afford the same degree of confidentiality to medical information stored on MyChart as is given to medical information stored by Sansum Clinic in any other medium. Sansum Clinic is committed to protecting the confidentiality of your medical information. We limit Sansum Clinic employees' access and ability to enter or view information based upon their role in your care. Firewalls, passwords, encryption, and audit trails are further used to safeguard your information. We shall identify the records released and note the time and date of access each time a patient or patient representative accesses MyChart. We have taken steps to make all information received from our online visitors as secure as possible against unauthorized access and use.

Visitor Chat Rooms and Other Interactive Areas - Sansum Clinic may, but is not obligated to, monitor or review any areas of MyChart where users transmit or post communications or communicate solely with each other, including, but not limited to, chat rooms, bulletin boards, and other user forums, and the content of any such communications. Sansum Clinic, however, will have no liability related to the content of any such communications, whether or not arising under the laws of copyright, libel, privacy, obscenity, or otherwise. Sansum Clinic retains the right to remove, in its sole discretion, communications that may include material deemed abusive, defamatory, obscene, or otherwise inappropriate.

Compliance with Laws - MyChart complies with all Federal, State and Local applicable laws, including but not limited to HIPAA, Public Law 104-191, and Standards for Privacy of Individually Identifiable Health Information at CFR Part 160 and Part 164, Subparts A and E.

Individual Rights - As a user of MyChart, you benefit from all the rights deriving from HIPAA, Public Law 104-191, and Standards for Privacy of Individually Identifiable Health Information at CFR Part 160 and Part 164, Subparts A and E, including the right to review, amend, restrict use or disclosure of your protected health information published on MyChart, and the right to complain to the U.S. Department of Health and Human Services and to Sansum Clinic if you believe your privacy rights have been violated.

Severability - All terms and provisions of these terms and conditions shall, if possible, be construed in a manner which makes them valid, but in the event any term or provision of these terms and conditions is found by a court of competent jurisdiction to be illegal or unenforceable, the validity or enforceability of the remainder of these terms and conditions shall not be affected if the illegal or unenforceable provision does not materially affect the intent of these terms and conditions.

Waiver - The waiver of, or failure to enforce, any breach or default hereunder shall not constitute the waiver of any other or subsequent breach or default.

Force Majeure - Neither party shall be liable for any failure to perform its obligations under these terms and conditions if such failure results from any act of God, riot, war, civil unrest, flood, earthquake, or other cause beyond the party's reasonable control (including any mechanical, electronic or communications failure).

Disclaimer - The materials provided on MyChart are provided "as is" without any warranties of any kind including warranties of fitness for a particular purpose or non-infringement of intellectual property. Sansum Clinic further does not warrant the accuracy and completeness of the materials on MyChart. Sansum Clinic makes no commitment to update the materials on MyChart, even if out of date. Information published on MyChart may refer to products, programs or services that are not available in your county or region.

Limitation of Liability - In no event will Sansum Clinic, its affiliates, suppliers, or other third parties mentioned at MyChart be liable for any damages whatsoever (including, without limitation, those resulting from lost profits, lost data, or business interruption) arising from the use, or the results of the use of MyChart, any websites linked to MyChart, or any materials or information contained at any or all such sites, whether based on warranty, contract, tort or any other legal theory and whether or not advised of the possibility of such damages.

Choice of Law and Venue - These terms and conditions are entered into in the State of California and shall be governed by and construed in accordance with the laws of California, exclusive of its choice of law rules. Each party to these terms and conditions submits to the exclusive jurisdiction of the state and federal courts sitting in California, and waives any jurisdictional, venue, or inconvenient forum objections, to such courts. In any action to enforce these terms and conditions, the prevailing party will be entitled to costs and attorneys fees.

Entire Agreement - In conjunction with the matters considered herein, these terms and conditions contain the entire understanding and agreement of the parties and there have been no promises, representations, agreements, warranties or undertakings by any of the parties, either oral or written, of any character or nature binding except as stated in these terms and conditions. These terms and conditions may be altered, amended or modified only by Sansum Clinic, and such alteration, amendments and modification may be made at any time. Please periodically review the terms, conditions, and privacy statements posted on the MyChart website. Continued usage of the MyChart website and services will be considered acceptance of any alteration, amendments and modification to these terms and conditions.

Questions, Compliments, Complaints and Contacts - For questions, compliments or complaints about MyChart, please contact the Sansum Clinic Wave Department at (805)898-3333.
For questions regarding these Terms and Conditions, including your rights as a user of MyChart or Proxy Access, please contact Sansum Clinic Health Information Services Release of Information department at at (805) 898-3188; or by U.S. mail at the following address:

Sansum Clinic
Health Information Services Release of Information Dept.
317 West Pueblo Street
Santa Barbara, CA 93105