Details of medical history, examination, x-rays and tests may be discussed with other healthcare professionals with interactive videos, audio and telecommunication technology | I have been provided with enough information in a language that I can understand, to make an informed decision and I agree to have the Telehealth consultation Services |
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poor resolution of images to allow appropriate decision making by the consulted physician b | I understand the risks, consequences, benefits, and alternatives of the telemedicine consultation |
Information transmission may not be sufficient e.
3I acknowledge I have read the guidelines on how the video conferencing technology will be used | I agree to give my consent by ticking the below box knowingly, freely and voluntarily and agree to bind by its terms |
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I also acknowledge this consultation is limited to certain medical conditions for which the telehealth consultation services can be obtained and the proper procedures that shall be applied in emergency cases | Delays in medical evaluation and treatment could occur due to deficiencies or failure of equipment c |
I understand the benefits of the telemedicine consultation such as Improve access medical care by enabling a patient to remain in their home, more efficient medical evaluation and access to expertise from distant specialist | In rare instances, security protocol could fail causing a breach of privacy of personal medical information d |
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Dissemination of any patient identifiable images or information for this telehealth interaction to other entities will not take place without my consent | In rare cases, a lack of access to complete health records may result in adverse drug interaction, allergic reactions or other judgement errors I shall not hold the Medcare medical center authorities legally or financially responsible for any kind of loss or damage sustained by the procedure |
I accept the fact that in case this statement is untrue, neither this hospital nor the doctors are responsible for the caused consequences.
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