|I accept the fact that in case this statement is untrue, neither this hospital nor the doctors are responsible for the caused consequences||I understand I may withhold or withdraw consent to teleconsultation at any time without affecting my right to future care or treatment|
|I agree to give my consent by ticking the below box knowingly, freely and voluntarily and agree to bind by its terms||In rare instances, security protocol could fail causing a breach of privacy of personal medical information d|
poor resolution of images to allow appropriate decision making by the consulted physician b.20
|I understand there are possible risks of an incomplete or ineffective consultation because of the technology, and that if any of the risks occur, the consultation may terminate||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|
|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||I understand the risks, consequences, benefits, and alternatives of the telemedicine consultation|
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.
|Dissemination of any patient identifiable images or information for this telehealth interaction to other entities will not take place without my consent|
|I acknowledge I have read the guidelines on how the video conferencing technology will be used||The nature during the teleconsultation: a|
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.