WEBINAR: Stanford Myasthenia Gravis Online Support Group

Confidentiality & Participation Agreement 

This form is a confidentiality and participation agreement. As a candidate of this Online Group, the following information must be agreed and adhered to in order to participate in the Online Group: 

• You are participating in this group voluntarily.
  • You may stop attending this group at any time.  
  • Please provide ample notice to the group leader, if you choose to discontinue attendance. 
  • If you violate any of the terms of this agreement, as deemed by the group leader(s), Stanford School of Medicine’s Neuromuscular Program (SoM), or its affiliates, it shall be grounds for expulsion from the Online Group.
• In the event the format of the online meeting allows for group sharing, sharing of information is also voluntary. 
  • The group format may involve sharing information to help yourself and others in the group. 
  • You may choose to share as much or as little as you feel comfortable with during each session. 
  • Any information shared by you and others is confidential.
    • Do not share this information outside of the group setting, except in an individual meeting with your group leader.
• As a participant, you agree to not disclose any information to those outside of the group that may reasonably be used to identify another member of the group. 
• You agree to not record any voice conversations, videos, and/or create still images (e.g., take pictures) of any information shared in the Online Group by the use of any recording device, application, or otherwise.
  • Any member discovered to have any such recordings will be asked to delete those recordings. Additionally, any member discovered to begin, or have in their possession, any such recordings will be removed from participating in the Online Group. 
  • If in the future, group leader(s), SoM and/or its affiliates, chooses to record group sessions, you shall:
    • Receive reasonable notice of SoM’s intent to record group sessions; and 
    • Be given an opportunity to opt out of the Online Group, so as to not be recorded. 
• The leader(s) of this Online Group, as well as SoM and its affiliates, must adhere to professional and ethical guidelines related to confidentiality, as well as state and federal laws governing confidentiality and patient privacy. SoM and its affiliates reserve the right to make disclosures of any information gathered in the Online Group in a manner that is consistent and/or otherwise required by applicable state and federal laws. 
• You agree to hold harmless SoM, and its affiliates, in any and all claims related to misuse and/or misappropriation of your personal and/or protected health information shared during Online Group sessions, by another group member or persons who obtain your information through another group member. 
• You are voluntarily enrolling and participating in an online support group hosted by SoM’s Neuromuscular Program. 
• You understand that SoM, in an effort to provide you with the latest updates on Myasthenia Gravis, will communicate with you by email. At any time, you may change your communication preferences by contacting Stanford's Neuromuscular Program.