When scheduling a telemedicine consult, members agree to the following:
A telemedicine service means that health care services are provided by physicians and other practitioners at a distant location from the patient using interactive video and/or audio conferencing in real time with the aid of exchanged digital images of my health care data by an asynchronous means.
I also understand that:
The scope of care will be at the sole discretion of the health care professional treating me, with no guarantee of diagnosis, treatment, or prescription. The health care professional will determine whether or not the condition being diagnosed and/or treated is appropriate for a telemedicine exam.
I have read this document carefully, and all my questions were answered to my satisfaction. By acknowledging this, I confirm my review and consent to participate in the telemedicine exam.
I also acknowledge that HIPAA Notice of Privacy Practices was made available to me, and agree and authorize my health care professional to release information regarding the telemedicine exam to Telemedicine Management, Inc. and its affiliates.