Patient Consent Form

Healthcare Institution Name:

ScribeX AI is an advanced artificial intelligence (AI) technology platform designed to assist your healthcare provider in capturing and documenting important details from your medical visit.

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

By signing this form, you voluntarily consent to the recording and processing of your conversations for the purpose of generating accurate medical documentation for your provider. You may withdraw your consent at any time, and alternative documentation methods will be made available to you.

Patient Name: ____________________________

Patient Signature: ____________________________

Date: ____________________________

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