Autorización para correo electrónico (Email Consent) – Multnomah County

The Autorización para correo electrónico (Email Consent) is the Spanish-language version of Multnomah County's Email Consent Form, headed "FORMULARIO DE CONSENTIMIENTO DE CORREO ELECTRÓNICO / EMAIL CONSENT FORM", on which a client or guardian acknowledges the risks and conditions of email contact with the county.

The form has three parts. The first, RIESGO DE USAR EL CORREO ELECTRÓNICO (risk of using email), lists risks such as emails being forwarded and stored, reaching unintended recipients, being intercepted or altered, carrying viruses, and being used as evidence in court. The second, CONDICIONES PARA EL USO DEL CORREO ELECTRÓNICO (conditions for using email), states that the county cannot guarantee the security and confidentiality of email, that email is not suitable for emergencies, that emails containing protected health information are printed and become part of the person's record, and that county staff may receive and read the messages. The third, RECONOCIMIENTO Y ACEPTACIÓN DEL CLIENTE (client acknowledgment and acceptance), is where the client or guardian signs.

The revision code printed on the form is BHD 05.01.22. The county's New Client Forms page at https://multco.us/info/new-client-forms lists this Email Consent form alongside Consent for Treatment, Release of Information and the Text Message Consent form, and offers Email Consent in English and in other languages, including Amharic, Simplified Chinese, Korean, Somali and Vietnamese. This form is not a tax document: it concerns email communication only.

Clients of Multnomah County, and the guardians who act for them, who want the county to communicate with them by email sign this form. The county lists it among the forms to complete and sign before a first visit.

The form has a signature line for the cliente / tutor (client or guardian) and asks for that person's email address and phone number, so a guardian may sign and give their own contact details. A county staff member's name and program are also entered on the form.

Points that apply to everyone who signs:

• Email is not suitable for emergency situations.
• Your email messages may be received and read by county staff.
• You are responsible for protecting your password or other means of access to your email.
• You should avoid using your employer's computer to send or receive email with the county.

The form does not say who may decline or what happens if you do. For a version in another language, the county page asks you to contact the county.

Complete and sign the form before your first visit: Multnomah County's New Client Forms page lists the Email Consent form among the documents to complete and sign at that point. No separate due date is printed on the form itself.

Later notices are tied to the conditions you accept when you sign. You must tell the county in writing if your email address changes, and in writing when you no longer want to receive email from the county. The form also says the county may impose other conditions on email use in the future.

The form prints no mailing address, portal or fax number, so follow the county's instructions on its New Client Forms page at https://multco.us/info/new-client-forms, which says to complete and sign the forms before your first visit.

• Before your first visit: complete and sign the form, then provide it to the county as the page directs.
• Other languages: for documents in another language, the county asks you to contact it.
• Staff entries: the bottom of the form has lines for BHD Staff Member Name and BHD Program, which are filled in by the county side rather than by you.

Keep a copy for yourself. To change or end email contact later, send the county written notice. FillingPDF lets you fill out and download the PDF; submission follows the county's channels above.