Consent Template

Patient Consent Form

Template consent form for specialist clinic intake and clinical documentation workflows.

Patient Informed Consent Form

We use Dorsum to support medical documentation by processing consultation information into structured notes. Your consent is required before this workflow is used, and your information is protected at all times.

What you need to know

1. Purpose of Dorsum

Dorsum records the audio of your consultation and transforms it into structured clinical notes and/or letters for your care team.
Dorsum supports but does not replace the professional judgement of your clinician.
All medical decisions are made solely by your healthcare professional.

2. Privacy and Data Protection

Your data is processed and stored in accordance with applicable privacy protection laws.
Data undergoes a de-identification process to reduce personal identifier exposure.
Data is used only to create clinical documentation for your healthcare professional.
Your data is not used to train a general-purpose artificial intelligence model.
Conversation recordings are not stored as permanent files and are deleted in workflow processing.

3. Your choice

You may refuse the use of Dorsum at any time.
You may withdraw your consent at any time without affecting quality of care.
You have the right to be informed about how this technology is used and why.

By signing this consent form, you acknowledge that:

You have been informed about the use of Dorsum and its purpose.
You agree that your healthcare professional may use Dorsum to document your consultation.
You understand that data is processed and stored in accordance with applicable privacy protection laws.
You understand that you can withdraw consent at any time without affecting quality of care.

Name

Date

Signature

For more information visit dorsum.ai or contact support@dorsum.ai