NotifiUs SMS Opt-In Process: Verbal Consent with Script and Documentation
SECTION 1: DETAILED VERBAL CONSENT SCRIPT for Opting-In and Documenting the the NotifiUs SMS Text Program
Required Script for Treatment Center Staff
Staff Member must follow this exact script for TCPA compliance:
STEP 1: Introduction and Service Overview
Staff: “Hello [Patient Name], I’d like to tell you about an optional text messaging service called NotifiUs that can help support your recovery journey between our appointments.”
Staff: “NotifiUs sends secure text messages to help you stay connected with your treatment plan. These messages include daily wellness check-ins, medication reminders, appointment notifications, and motivational support. The service also allows your care team to monitor your progress and provide immediate help if you’re struggling.”
STEP 2: Detailed Service Description
Staff: “Here’s how it works: You would receive text messages from NotifiUs on behalf of our treatment center. As an example, these messages may ask you simple questions like ‘How are you feeling today?’ and you can respond with 1.for good, 2.for okay, or 3.if you’re struggling. You might also get task completion messages like ‘Did you remember to take your medication today – reply 1. Y , 2. N, 3. Help when completed.'” The specific selections and final messages will be agreed upon by you and your counselor.
Staff: “You would typically receive 3 to 8 messages per day during your active treatment phase. All messages are sent between 8 AM and 9 PM unless there’s an emergency situation.”
STEP 3: Privacy and Security Information
Staff: “Your privacy is completely protected. All messages are HIPAA-compliant and encrypted. Your substance use disorder treatment information has extra federal protections under a law called 42 CFR Part 2, which means it has even stronger confidentiality than regular medical information.”
Staff: “Only your authorized care team can see your responses. We will never sell your information or use it for marketing. These messages are strictly for your treatment and recovery support.”
STEP 4: Cost and Carrier Information
Staff: “The NotifiUs service is free – our treatment center pays for it. However, standard text messaging rates from your mobile carrier may apply. If you have unlimited texting, there’s no additional cost to you.”
Staff: “This service works with all major cell phone carriers like Verizon, AT&T, T-Mobile, and others.”
STEP 5: Voluntary Participation
Staff: “I want to emphasize that this SMS service is completely voluntary. You will receive the same excellent treatment here whether you choose to participate in text messaging or not. There are no penalties for declining, and you can opt out at any time without it affecting your treatment.”
STEP 6: Opt-Out Information
Staff: “If you decide to participate and later want to stop receiving messages, you can opt out immediately by replying ‘STOP’ to any text message. You’ll get a confirmation that you’ve opted out. You can also call us or call NotifiUs directly to stop the messages. You can restart the service anytime by asking me or another counselor.”
STEP 7: Phone Number Verification
Staff: “To participate, I need to confirm your mobile phone number. What is your current cell phone number?”
[Patient provides number]
Staff: “Let me read that back to you: [repeat phone number]. Is that correct?”
[Wait for confirmation]
Staff: “Is this your personal phone that you carry with you and check regularly?”
[Patient confirms]
Staff: “Can this phone receive text messages?”
[Patient confirms]
STEP 8: Consent Request
Staff: “Now I need to ask for your consent. By saying yes, you’re giving us permission to send you text messages from NotifiUs about your treatment and recovery support.”
Staff: “Do you give your verbal consent to receive text messages from NotifiUs at [phone number] for substance use disorder treatment support?”
[CRITICAL: Wait for clear verbal response – must be “Yes” or equivalent affirmative response]
STEP 9: Consent Confirmation and Documentation
If Patient Says YES:
Staff: “Thank you. I’m documenting in your record that you gave verbal consent to receive NotifiUs SMS treatment messages at [phone number] on [today’s date] at [current time]. Your consent has been recorded.” Additionally, you will receive a text message that confirms that you have verbally opted-in for this service and the message will state that you “verbally opted-in” to receive sms text messages as part of this service. At any time you decide to opt-out you may do so my replying STOP to any message.
Staff: “You should receive your first welcome text message within 24 hours to confirm the service is working. Your regular treatment messages will begin after that.”
Staff: “Remember, you can opt out anytime by replying STOP to any message, and this won’t affect your treatment here.”
If Patient Says NO:
Staff: “That’s perfectly fine. I’m documenting that you declined SMS messaging services. You’ll receive the same excellent treatment, and you can change your mind anytime by asking me or another counselor to set up the messaging service.”
SECTION 2: CONSENT DOCUMENTATION PROCESS
Immediate Documentation Requirements
Staff must document the following immediately in the patient record:
- Date and Time: [MM/DD/YYYY at HH:MM AM/PM]
- Staff Member: [Full name and title]
- Patient Name: [Full legal name]
- Phone Number: [Complete phone number as verified]
- Consent Response: [Exact verbal response – “Yes, I consent” or “No, I decline”]
- Witness: [If present, name and title]
- Documentation Completed: [Staff initials and timestamp]
Electronic Record Entry Template
SMS CONSENT DOCUMENTATION
Date/Time: [MM/DD/YYYY at HH:MM AM/PM]
Patient: [Patient Full Name]
Staff: [Staff Name, Title]
Phone: [Patient Phone Number – Verified]
CONSENT SCRIPT COMPLETED: ✓ Yes
SERVICE EXPLANATION PROVIDED: ✓ Yes
PRIVACY INFORMATION GIVEN: ✓ Yes
VOLUNTARY PARTICIPATION EMPHASIZED: ✓ Yes
OPT-OUT PROCEDURES EXPLAINED: ✓ Yes
PHONE NUMBER VERIFIED: ✓ Yes
PATIENT CONSENT RESPONSE: “[Exact verbal response]”
CONSENT STATUS: ☐ GRANTED ☐ DECLINED
ADDITIONAL NOTES: [Any questions asked by patient, concerns expressed, etc.]
STAFF SIGNATURE: [Digital signature]
DATE: [MM/DD/YYYY]
Storage and Record Keeping
Primary Storage: Patient’s official treatment record in secure, HIPAA-compliant electronic health record system
Backup Documentation: Separate SMS consent log maintained by treatment center with following information:
- Patient ID number
- Consent date and time
- Phone number
- Staff member name
- Consent status (granted/declined)
Retention Period: 6 years minimum as required by federal healthcare regulations
Access Controls: Only authorized treatment center staff involved in patient’s direct care
SECTION 3: SIMULATED CONVERSATION
Complete Conversation Example
Setting: Private counseling office during regular treatment appointment
Participants: Sarah Johnson (Licensed Counselor), John Doe (Patient)
Date: January 15, 2025, 2:30 PM
Sarah: “Hi John, how are you feeling today?”
John: “I’m doing okay, had a good week overall.”
Sarah: “That’s great to hear. Before we continue with today’s session, I’d like to tell you about an optional text messaging service called NotifiUs that can help support your recovery journey between our appointments.”
John: “What kind of text messages?”
Sarah: “NotifiUs sends secure text messages to help you stay connected with your treatment plan. These messages include daily wellness check-ins, medication reminders, appointment notifications, and motivational support. The service also allows your care team to monitor your progress and provide immediate help if you’re struggling.”
John: “How does it work exactly?”
Sarah: “Here’s how it works: You would receive text messages from NotifiUs on behalf of our treatment center. These messages will ask you simple questions like ‘How are you feeling today?’ and you can respond with 1. For good, 2. For okay, or 3.if you’re struggling. You might also get task completion messages like ‘Did you remember to take your medication today – reply 1. Y , 2. No or 3. Help, when completed.'” The exact message content will vary depending on our agreed upon Wellness Plan.
John: “How many messages are we talking about?”
Sarah: “You would typically receive 3 to 8 messages per day during your active treatment phase. All messages are sent between 8 AM and 9 PM unless there’s an emergency situation.”
John: “Is this private? I don’t want my information shared with random people.”
Sarah: “Absolutely, your privacy is completely protected. All messages are HIPAA-compliant and encrypted. Your substance use disorder treatment information has extra federal protections under a law called 42 CFR Part 2, which means it has even stronger confidentiality than regular medical information.”
Sarah: “Only your authorized care team can see your responses. We will never sell your information or use it for marketing. These messages are strictly for your treatment and recovery support.”
John: “Does this cost extra money?”
Sarah: “The NotifiUs service is free – our treatment center pays for it. However, standard text messaging rates from your mobile carrier may apply. If you have unlimited texting, there’s no additional cost to you.”
Sarah: “This service works with all major cell phone carriers like Verizon, AT&T, T-Mobile, and others.”
John: “What if I don’t want to do this? Will it affect my treatment?”
Sarah: “I want to emphasize that this SMS service is completely voluntary. You will receive the same excellent treatment here whether you choose to participate in text messaging or not. There are no penalties for declining, and you can opt out at any time without it affecting your treatment.”
John: “Okay, but what if I try it and don’t like it?”
Sarah: “If you decide to participate and later want to stop receiving messages, you can opt out immediately by replying ‘STOP’ to any text message. You’ll get a confirmation that you’ve opted out. You can also call us or call NotifiUs directly to stop the messages. You can restart the service anytime by asking me or another counselor.”
John: “That sounds reasonable. How do we set it up?”
Sarah: “To participate, I need to confirm your mobile phone number. What is your current cell phone number?”
John: “It’s 555-123-4567.”
Sarah: “Let me read that back to you: 555-123-4567. Is that correct?”
John: “Yes, that’s right.”
Sarah: “Is this your personal phone that you carry with you and check regularly?”
John: “Yes, it’s my phone.”
Sarah: “Can this phone receive text messages?”
John: “Yes, I text all the time.”
Sarah: “Perfect. Now I need to ask for your consent. By saying yes, you’re giving us permission to send you text messages from NotifiUs about your treatment and recovery support.”
Sarah: “Do you give your verbal consent to receive text messages from NotifiUs at 555-123-4567 for substance use disorder treatment support?”
John: “Yes, I consent to that.”
Sarah: “Thank you. I’m documenting in your record that you gave verbal consent to receive NotifiUs SMS treatment messages at 555-123-4567 on January 15th, 2025 at 2:30 PM. Your consent has been recorded.”
Sarah: “You should shortly receive a text message the confirms that you verbally opted-in to receive sms text messages and your first welcome text message within 24 hours to confirm the service is working. Your regular treatment messages will begin after that.”
Sarah: “Remember, you can opt out anytime by replying STOP to any message, and this won’t affect your treatment here.”
John: “Sounds good. I’m curious to see how this helps.”
Sarah: “Great! Now let’s continue with today’s session…”
[Sarah immediately documents the consent in John’s electronic record while he’s still present]
SECTION 4: CONFIRMATION TEXT MESSAGE
First Messages Sent to Patient After Consent
Sent within 1 hour of verbal opt-in
Message Content
“Hello this message is from [Treatment Center Name] and confirms that you have verbally opted-in to receive SMS text messages from NotifiUs as part of your [Treatment Center Name] Wellness Plan. Within 24 hours you will begin to receive specific messages as agreed with your counselor.”
Sent within 24 hours of verbal consent:
Message Content:
“Welcome to NotifiUs SMS Treatment Support! This confirms you’ve successfully enrolled in our text messaging service for recovery support. You’ll receive daily check-ins, reminders, and motivational messages from your care team at [Treatment Center Name]. Reply STOP anytime to opt-out immediately. Reply HELP for assistance. Standard message rates may apply. Your privacy is protected under HIPAA and federal SUD confidentiality laws.”
Follow-Up Test Message (Sent 1 hour after welcome):
“Hi [Patient Name], this is your first NotifiUs check-in! How are you feeling today? Please reply with: 1. (Great), 2. (Okay), or 3. (Struggling). Your care team at [Treatment Center] will see your response and provide support if needed.”
SECTION 5: OPT-OUT PROCEDURES AFTER VERBAL CONSENT
Method 1: SMS STOP Reply (Primary)
Patient Action: Reply “STOP” to any NotifiUs message
Immediate Automatic Response: “You have successfully opted out of NotifiUs SMS messaging. You will no longer receive treatment text messages. Your care team at [Treatment Center Name] has been notified. To restart messages, contact your counselor.
System Actions:
- Immediately cease all SMS delivery to patient’s number
- Log opt-out timestamp and method in patient record
- Send notification to treatment center staff
- Update patient status to “SMS Opted Out”
- Retain opt-out record for compliance documentation
Method 2: Direct Contact with Treatment Center
Patient Action: Calls or visits treatment center requesting opt-out
Staff Response Process:
- Verify patient identity and phone number
- Process immediate opt-out in system
- Document opt-out request in patient record
- Confirm with patient that messages have stopped
- Explain re-enrollment process if desired
Documentation Required:
- Date and time of opt-out request
- Method of contact (phone, in-person, etc.)
- Staff member who processed request
- Patient confirmation of opt-out completion
Re-Enrollment Process After Opt-Out
If patient wants to restart SMS service:
- Patient contacts treatment center counselor
- Staff repeats full verbal consent script
- Patient provides new verbal consent
- New consent documented with fresh timestamp
- System updated to restart SMS delivery
- Welcome message sent within 24 hours
SECTION 6: COMPLIANCE VERIFICATION CHECKLIST
Pre-Implementation Requirements
Staff Training Completed: ☐
- All staff trained on exact consent script
- Documentation procedures reviewed
- Privacy requirements understood
- Opt-out procedures practiced
System Setup Verified: ☐
- Electronic records system ready for consent documentation
- SMS platform integrated with opt-out processing
- Treatment center notification systems configured
- Backup documentation procedures established
Legal Review Completed: ☐
- Consent script reviewed by legal counsel
- TCPA compliance verified
- HIPAA compliance confirmed
- 42 CFR Part 2 requirements met
Per-Patient Consent Checklist
Before Each Consent Conversation: ☐
- Private setting secured
- Patient record accessible for documentation
- Staff familiar with patient’s treatment plan
- Sufficient time allocated for full script
During Consent Process: ☐
- Complete script followed exactly
- Patient questions answered fully
- Phone number verified accurately
- Clear verbal response obtained
After Consent Obtained: ☐
- Immediate documentation completed
- Patient record updated with all required information
- SMS system updated with consent status
- Patient informed about welcome message timing
Ongoing Compliance Monitoring
Daily: ☐
- Review consent documentation for completeness
- Process any opt-out requests immediately
- Monitor system for delivery failures
Weekly: ☐
- Review staff adherence to consent script
- Audit documentation accuracy
- Address any patient complaints or issues
Monthly: ☐
- Compile consent and opt-out statistics
- Review and update procedures as needed
- Conduct staff refresher training if required
SECTION 7: LEGAL AND REGULATORY COMPLIANCE
TCPA Compliance Elements
Express Consent Obtained: ✓
- Clear verbal consent using exact script
- Specific phone number confirmed
- Patient understands message types and frequency
Opt-Out Procedures: ✓
- STOP command prominently featured
- Multiple opt-out methods available
- Immediate processing guaranteed
Record Keeping: ✓
- All consents documented with timestamp
- Opt-out requests logged and retained
- Documentation meets federal requirements
HIPAA Compliance Elements
Privacy Information: ✓
- Patient informed of privacy protections
- Use and disclosure explained clearly
- Patient rights communicated
Security Measures: ✓
- Encrypted message transmission
- Secure consent documentation storage
- Access controls for patient records
42 CFR Part 2 Compliance Elements
Enhanced SUD Protections: ✓
- Special confidentiality explained to patient
- Additional consent requirements met
- Federal criminal penalties acknowledged
Restricted Disclosure: ✓
- Information sharing limited to treatment team
- No unauthorized disclosures permitted
- Patient consent required for additional sharing
This comprehensive verbal consent documentation satisfies verification requirements while ensuring full TCPA, HIPAA, and 42 CFR Part 2 compliance for NotifiUs SMS treatment communications.