Telemedicine is the delivery of healthcare services through the use of technology when the healthcare provider and patient are not in the same physical location.
Electronically transmitted information may be used for diagnosis, therapy, follow up and/or patient education, and may include any of the following:
- Patient medical records.
- Medical images.
- Interactive audio, video, and/or data communications.
- Output data from medical devices and sound and video files.
- Improved access to medical care by enabling a patient to remain at home or a site remote from the physician office.
As with any medical procedure, there are potential risks associated with the use of telemedicine. These risks include, but may not be limited to:
- Information transmitted may not be sufficient (e.g., poor resolution of images) to allow for appropriate medical decision making by the provider(s).
- The provider(s) are not able to provide medical treatment to the patient through the use of telemedicine equipment nor provide for or arrange for any emergency care that the patient may require.
- Delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment.
- Security protocols could fail, causing a breach of privacy of personal medical information.
- A lack of access to complete medical records may result in adverse drug interactions or allergic reactions or other medical judgment errors.
- Seek in-person medical care.
I agree that I have received an explanation of how the video and audio technology will be used to conduct the telemedicine health service and have had all my questions answered to my satisfaction. I understand there are limitations to the technology and process of telemedicine, including the potential for incomplete exchange or loss of information. I understand and consent to participate (and have my child participate) in the telemedicine health service. I understand the written information provided above and I hereby voluntarily and freely agree and give my consent for my child to take part in the telemedicine service and to any related evaluation, assessment, and diagnosis as the consulting health care provider deems appropriate to my child’s current medical condition. I understand that I have the right to withhold or withdraw consent at any time without affecting my child’s right to future care and treatment.