Proving consent: opt-in and STOP records

Why the record matters

Sooner or later someone asks whether a patient agreed to get texts from your office. It might be the patient, a phone carrier reviewing your number, or whoever is looking into a complaint. The answer you want is a record with a date and time on it, not a staff member’s memory.

Several sets of rules can apply to texts: federal law (the Telephone Consumer Protection Act, or TCPA), the rules phone carriers set for business texting, and sometimes state law. Which apply, and what they require, depends on what you send and to whom. Your compliance adviser is the one to answer that. Whatever the answer, a clear record helps.

What a good consent record holds

• The phone number.
• When consent was given, to the minute.
• Where it came from: an intake form, the front desk, or a text.
• What the patient agreed to, such as appointment reminders and messages about their visits.
• Each STOP, with its date and time, and any later opt-in.
• Each HELP request.

A signed form in a chart is a start, but it is hard to search and easy to misplace. A log tied to the phone number is easier to check before a text goes out, and easier to show afterward.

Asking in the first place

The natural moment is when the patient gives you a mobile number. Ask plainly, and say what they will get: "Can we text this number about your appointments?" Record the answer and when it was given.

If you add a line to the intake form, keep it apart from other agreements, and say what kind of texts the patient will receive and how to stop them. Keep marketing out of it. Appointment texts and promotional texts are different things, and asking for both in one line muddies the consent for each.

STOP and HELP

A patient who texts STOP should get no more texts from that number. SMSWell logs every STOP with the time it arrived, and every HELP the same way.

Patients do not always use the keyword. "Please stop texting me" and "take me off your list" mean the same thing. Treat them as an opt-out, and make sure the record shows it.

If the patient later wants texts again, record the new opt-in with its own date and time. The earlier STOP stays in the history. A record that only shows the current state cannot tell you what was true last spring.

Showing it when asked

When the question comes, you want an answer in minutes. One patient’s history might read like this:

In SMSWell, the opt-in and STOP log is on every plan, with the number, the event, and the time for each entry. The Group plan adds a consent export, so a practice with several locations can pull its records into one file.

Numbers from somewhere else

Two situations catch practices off guard. The first is switching texting systems. Before you cancel the old one, export its consent and opt-out records, and keep them. A patient who texted STOP to the old system has still asked you to stop.

The second is a list of numbers that did not come from your own patients, such as a purchased list or one passed on by another business. Do not text it. Consent has to come from the person, given to your practice, and a bought or shared list does not have it.

Mobile numbers also change hands. When a text bounces or a stranger replies, mark the number as wrong and ask the patient for a current one at their next visit.

A ten-minute monthly check

• Pick five patients who were texted this month and confirm each has an opt-in on record from before the first text.
• Check that nobody who texted STOP received a text afterward.
• Look for opt-outs written in plain words, and make sure they were recorded.
• Confirm that staff who have left no longer have a seat.

Write down the date you did it, so the checks are on record too.