• TeleDermatology Consent

  • About Telemedicine

    Telemedicine is the practice of caring for patients remotely, without the patient and provider needing to be physically present in the same location.

    Confidentiality

    The medical information, history, and condition of the patients will not be shared and kept private. The medical condition can be discussed for further scientific purposes and studies; however, the patient information will be kept anonymous.

    Records

    Virtual visits use teleconference technology and will be conducted via interactive video calls and audio. Patients must have access to a laptop, tablet, smartphone, or desktop computer with camera and audio.

    Possible Risks

    As with any medical procedure, there are potential risks associated with the use of telemedicine. These include, but may not be limited to:

    ·         Information transmitted may not be sufficient (e.g. poor resolution of images) to allow for appropriate medical decision making by the physician and consultant(s);

    ·         Delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment;

    ·         In very rare instances, security protocols could fail, causing a break of privacy of personal medical information;

    Rights

    Patients can withhold and withdraw the consent at any time and can end the video teleconference with the healthcare consultants. This will not affect the further treatment processes of patients. 

    By signing this form, patients accept all the potential risks and give permission to the healthcare center to evaluate his/her medical condition through telemedicine services.

  •  - -
    Pick a Date
  •  -
  • Browse Files
    Cancelof
  • Browse Files
    Cancelof
  • Clear

  • prevnext( X )
    USD

    loading smart payment buttons...
    The payment is ready! It will be completed once you submit the form.
  • Should be Empty: