COVID - 19: Words from Practitioners

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Informed Consent for Telemedicine Services

Telemedicine involves the use of electronic communication to enable healthcare practitioners the opportunity to consult with patients that are not at the same location. Electronic systems used will incorporate network and software security protocols to protect the confidentiality of patient identification and imaging data and will include measures to safeguard the data. Sound Clinic Telemedicine appointments involve video streaming that is not recorded. The practitioner documents the encounter in the electronic medical record system as a Telemedicine encounter. Orders, prescriptions, available physical exam findings and necessary instructions are all documented in the same fashion as if the patient is in the office.

Expected Benefits:

  • Improved access to medical care by negating the need for the patient to travel to the appointment
  • More efficient medical evaluation and management

Possible Risks:

  • The ability to perform a physical exam is obviously quite limited and this could contribute to an incorrect or delayed diagnosis or treatment
  • In rare cases, the consultant may determine that the transmitted information is of inadequate quality
  • Delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment
  • In rare cases, a lack of access to complete medical records may result in adverse drug interactions or allergic reactions or other judgment errors
  • In very rare instances, security protocols could fail, causing a breach of the privacy of personal medical information
  • By signing below, I acknowledge that I understand and accept the possible risks listed above. I agree to be responsible for the usual fees associated with the encounter in the unlikely event that my insurance company doesn’t treat the encounter like an office visit. 

  • Signature of patient or parent if minor
  • Date Format: MM slash DD slash YYYY