TELEMEDICINE PATIENT CONSENT
PURPOSE: The purpose of "Telemedicine Consent Form" is to get the patient's consent in order to participate in appointments of telemedicine cares.
RECORDS: Telecommunications with patients will not be recorded and stored. I hereby authorize Hematology and Oncology Associates of Northern California to use the telehealth practice platform or telecommunication for evaluating, testing and diagnosing my medical condition.
TELEMEDICINE INFORMATION: The medical information related to history, records and tests of the patient will be discussed during the telemedicine appointment with video and audio.
ACCESS: The patient accepts that he/she needs access to PC, laptop, or mobile device and a good internet connection in order to have an efficient telemedicine appointment. I accept that Hematology and Oncology Associates of Northern California will initiate interactive sessions with video call; however, I am informed that the sessions can be conducted via regular voice communication if the technical requirements such as internet speed cannot be met.
PATIENT RIGHTS: The patient can withdraw his/her consent at any time and can ask the questions related to telemedicine appointments and technical requirements for telecommunication.