MH Scribe

Patient Consent Form

A ready-to-use authorization form for session recording and AI-assisted clinical documentation. Add it to your intake packet.

This branded, single-page PDF covers informed consent for audio recording, AI transcription, data protection, patient rights, and includes signature lines for both patient and clinician.

What's Included

HIPAA-Compliant Security

Details AES-256 encryption, SOC 2 infrastructure, and BAA coverage so patients understand how their data is protected.

AI Transparency

Explains that AI is used only for documentation, never for clinical decisions, and that clinicians review all notes.

Patient Rights

Clearly states the right to decline, withdraw consent, request unrecorded sessions, and obtain copies of notes.

Form Sections
  1. Purpose of This Form — Why the recording is being done
  2. What Will Be Recorded — Audio capture, transcription, and AI processing
  3. How Your Data Is Protected — Encryption, infrastructure, BAA, no model training
  4. Role of Artificial Intelligence — Documentation only, clinician review required
  5. Your Rights — Decline, withdraw, request copies
  6. Acknowledgment & Consent — Signature lines for patient and clinician

This form is provided as a template and starting point. Clinicians are responsible for ensuring compliance with applicable state and federal regulations. Consult your legal or compliance advisor before use.