AI-Assisted Services Consent Form

Information Officer: Elonie de Klerk

Why the practice use AI

The practice sometimes uses verified AI tools (like secure speech-to-text and note-drafting software) to make my work more accurate and efficient. These tools help with admin, record-keeping, and clinical care, but never replace clinical judgment. Elonie de Klerk reviews all AI outputs and makes every decision about your care.

What information is used

The AI tools may process:

• Your contact and identifying details (such as name or file number)
• Health information you share with us during care (for example, case history, notes or voice recordings)
• Billing or scheduling details, where needed

We only use what is necessary for the stated purpose.

How your information is protected

We follow the Protection of Personal Information Act (POPIA), HPCSA ethical guidelines, and healthcare confidentiality rules.

• Our service providers act as operators under POPIA and are bound by written contracts to keep your data secure.
• We do not allow your information to be used to train public or general AI models.
• Some tools may store data outside South Africa. Where this happens, we make sure your information has adequate protection or we’ll ask for your explicit consent.
• If a data breach ever affects you, we will notify you as soon as reasonably possible and help you understand the next steps.

Your rights and choices

You have full control over how your data is used. You may:

• Ask questions or request more information about these tools
• Access or correct your information
• Withdraw your consent to AI-assisted processing at any time
• Request human review or contest any AI-assisted assessment that concerns you
• Complain to our Information Officer or to the Information Regulator if you believe your rights were not respected

How long we keep your information

We keep records in line with HPCSA rules:

• At least 6 years after they become dormant
• Until age 21 for minors
• For the lifetime of users who lack capacity

We may retain records longer if the law requires it.

List of AI tools used

• Heidi Health. Heidi stores transcripts and any notes or letters generated from your sessions and nothing else. No audio recordings are saved. The audio is used only to create the transcript, then it’s deleted.

Contacts

• Information Officer: Elonie de Klerk
• Information Regulator (SA): PAIA Information Regulator South Africa. www.inforegulator.org.za. Telephone number: +27 80 001 7160

Consent statement

I understand that AI tools are used only to support, not replace, my care. I know what information is processed, how it’s protected, and my rights under POPIA. I consent to the AI-assisted processing described above.