Telemedicine is the use of electronic information and communication technologies by a healthcare provider to deliver services to an individual when he/she is located at a different location than the healthcare provider. This may be for the purpose of diagnosis, treatment, follow-up and/or education. During your telemedicine consultation, details of your medical history and personal health information may be discussed with you or other health professionals through the use of interactive video, audio or Telephone. Additionally, a physical examination of you may take place, and video, audio, and/or photo recordings may be taken.
Pracdtice will be using the Doxy.me or Zoom. This network and software has security protocols to protect the privacy and security of health information and to safeguard the data against corruption. However, in order to ensure greater access to care, the mode of communication used during your telehealth consultation may not be secure and may be subject to privacy risks.
Anticipated Benefits:
- Improved access to medical care by enabling a patient to remain in his/her location while the healthcare provider provides care from a distant site
- More efficient medical evaluation and management
- Conservation of personal protective equipment such as gloves and masks to reduce shortages for healthcare providers
Possible Risks:
As with any medical procedure, there are potential risks associated with the use of telemedicine. These risks include, but may not be limited to:
- In rare cases, it may be determined that the information transmitted is of poor quality, requiring a face to face visit or rescheduled telemedicine visit. This may cause a delay in medical evaluation/treatment.
- Security protocols could fail or not be available, causing a breach of privacy of personal medical information.
- In rare cases, a lack of access to all of your medical records may result in adverse drug interactions or allergic reactions or other judgment errors.
By Signing this Form, I Understand the Following:
- I understand that I may expect the anticipated benefits from the use of telemedicine in my care, but that no results can be guaranteed.
- I understand that all efforts will be taken to protect the privacy and security of health information, and that no information obtained in the use of telemedicine which identifies me will be intentionally disclosed to researchers or other entities without my authorization.
- I understand that during a Pandemic sitiation, security measures may be lessened in accordance with U.S. Department of Health and Human Services (HHS) to ensure improved access to care.
- I understand that I have the right to withhold or withdraw my consent to the use of telemedicine in the course of my care at any time without affecting my right to future care or treatment.
- I have the right to inspect all information obtained and successfully recorded and may receive copies of this information.
- I understand that my healthcare information may be shared with other individuals for scheduling and billing purposes.
- I understand I will be responsible for any copayments, coinsurances or Deductiables that apply, and if my medical insurance coverage is not sufficient to satisfy any excess cost, I will be responsible for payment.
Patient Consents to the Use of Telemedicine
I have read and understand the information provided above regarding telemedicine. I have discussed and had an opportunity to ask my healthcare provider questions. All of these questions have been answered to my satisfaction.
I hereby authorize Advance Allergy & Asthma Associates SC to use telemedicine in the course of my diagnosis and treatment.