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GIBSON O'CONNOR DERMATOLOGISTS

TELEMEDICINE DISCLOSURE

Introduction

Telemedicine involves real-time consultations with patients including evaluation of symptoms, diagnosis and recommendations for treatment using telecommunications technology which includes the use of interactive audio, video or other electronic media. Telemedicine allows the Dermatologist to see and communicate with the patient in real time.

 

Consent to Telemedicine Consultation

By agreeing to a telemedicine consultation I acknowledge that:

1. I may withdraw consent at any time without affecting my right to future care

2. The laws that protect the confidentiality of my medical information also apply to telemedicine

3. I understand that a telemedicine consultation is not as satisfactory as a face to face consultation and as such carries limitations with regard to some diagnoses. This may occur due to poor resolution of video or distortion of images resulting from electronic transmission. Your Dermatologist may suggest a follow up face to face consultation.

4. I understand that electronic transmission of data, video images and audio is a new technology and while all efforts are made to ensure security this could be compromised by a failure in security systems or illegal or improper tampering.

5. I understand that my consent will be recorded in the medical record

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