Consent for AI-Assisted Medical Documentation

Private Psych MD — New York State

Understanding AI-Assisted Documentation

Private Psych MD uses NextVisit AI, a HIPAA-compliant artificial intelligence platform, to assist with clinical documentation during your psychiatric appointments.

How it works:

With your consent, your appointment conversation may be recorded and transcribed by AI
The AI generates a draft clinical note summarizing the encounter
Your provider reviews, edits, and approves all documentation before it becomes part of your medical record
Audio recordings are encrypted and deleted after processing

Your rights:

You may decline AI documentation at any time without affecting your care
You may request traditional documentation methods instead
You may withdraw this consent at any time

First Name *

Last Name *

Date of Birth *

Phone Number *

Email Address *

* Required fields

I have read and understand how AI-assisted documentation technology is used at Private Psych MD, including how my information is collected, processed, and protected.

I understand that NextVisit AI is HIPAA-compliant and that my protected health information will be safeguarded according to federal and New York State privacy laws.

I understand that all AI-generated documentation will be reviewed and verified by my provider before becoming part of my official medical record.

I understand that this consent is voluntary and that I may withdraw it at any time without affecting my treatment or the quality of care I receive.

I consent to the use of AI-assisted documentation during my psychiatric appointments at Private Psych MD.

Electronic Signature

By typing my name below and submitting this form, I acknowledge that this constitutes my legal electronic signature under New York State Electronic Signatures and Records Act (ESRA) and that I am providing informed consent for AI-assisted medical documentation.

Type Your Full Legal Name *

Today's Date *

A copy of this consent will be sent to your email address for your records.
Questions? Contact us at contact@privatepsychmd.com