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    Consent

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    bipin
    This document provides an informed consent for a patient to undergo remote patient care or telemedicine with ATHS. The patient consents to having their health information used for telemedicine consultations and understands that telemedicine is meant to supplement, not replace, in-person consultations. The patient also acknowledges limitations in technology and agrees not to hold healthcare providers at ATHS liable for expected or unexpected outcomes from remote care. Signatures from the patient, witnesses, and consent obtainer are required.

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    Consent

    Uploaded by

    bipin
    69 views2 pages
    This document provides an informed consent for a patient to undergo remote patient care or telemedicine with ATHS. The patient consents to having their health information used for telemedicine consultations and understands that telemedicine is meant to supplement, not replace, in-person consultations. The patient also acknowledges limitations in technology and agrees not to hold healthcare providers at ATHS liable for expected or unexpected outcomes from remote care. Signatures from the patient, witnesses, and consent obtainer are required.

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    Consent.docx

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    This document provides an informed consent for a patient to undergo remote patient care or telemedicine with ATHS. The patient consents to having their health information used for telemedicine consultations and understands that telemedicine is meant to supplement, not replace, in-person consultations. The patient also acknowledges limitations in technology and agrees not to hold healthcare providers at ATHS liable for expected or unexpected outcomes from remote care. Signatures from the patient, witnesses, and consent obtainer are required.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    69 views2 pages

    Consent

    Uploaded by

    bipin
    This document provides an informed consent for a patient to undergo remote patient care or telemedicine with ATHS. The patient consents to having their health information used for telemedicine consultations and understands that telemedicine is meant to supplement, not replace, in-person consultations. The patient also acknowledges limitations in technology and agrees not to hold healthcare providers at ATHS liable for expected or unexpected outcomes from remote care. Signatures from the patient, witnesses, and consent obtainer are required.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    Informed Consent

    .,

    having

    ATHS

    UHID

    in my full senses, without any coercion and


    unreservedly do hereby give my informed consent and execute informed choice to
    undergo

    submit

    my.

    Mr.

    Mrs.

    /Mast.

    /Miss, to undergo Tele Medicine (TM) / Remote Patient Care


    (RPC) with ATHS and declare as follows

    That the contents of this document are explained to me in my preferred

    language _____________, which I understand well.


    That I have right to withdraw this consent at any time during the process of
    TM / RPC, without giving any explanation and without affecting my right to

    future care or treatment, as that existed before withdrawing this consent.


    That the healthcare services provided herein comply with laws and
    regulations concerned with privacy and confidentiality of Health Information

    (HI).
    That my HI will be used for research, analysis and publication without

    identifying my individual/ personal details.


    That TM / RPC cannot be compared with comprehensiveness and outcomes of
    physical consultation with HCP. TM / RPC is used as an supplement rather
    than replacement of physical consultation. TM / RPC is used in situations
    where timely and cost effective accessibility to appropriate HCPs is a

    challenge and I am in such a situation.


    That TM / RPC is a process wherein HI / video conferencing (VC) is made
    available to remotely located Health Care Professionals (HCPs) through new
    technologies for providing healthcare services. Provision of healthcare

    services is entirely in accordance with such HI / VC.


    That The HCP may contact / consult me through telephone / VC.
    That the liability of TM / RPC service provider is limited to appropriate

    interpretation of HI / VC that is presented to that HCP.


    That service provider is not liable for complete, partial loss of HI/VC and/or
    distortion of the same during the transfer / presentation, due to technology

    failure.
    That submitting this informed consent online is equivalent to my
    signing this informed consent document.

    That after understanding the contents of this informed consent and after
    clarifying all my doubts, I have signed / submitted this informed consent to
    execute my informed choice. At any point of time, now and/or in future, I will
    not hold and/or caused to be held the concerned HCPs, staff of ATHS and/or
    ATHS responsible/liable for not achieving the expected outcome(s) of the TM
    / RPC and/or for achieving undesired complications and I do hereby relieve
    them of all such liabilities.

    Sig. Of the witness

    Sig. of patient/patients representative

    1. Name
    Name..

    Date.

    2. Name
    .
    Date.

    Sig. Of the person obtaining the consent

    Name .

    Date ..

    Date

    Relationship

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