PATIENT INFORMED CONSENT FORM FOR TELECONSULTATION
Teleconsultation is the remote consultation between the doctor and the patient through which not all pathologies can be resolved by the distance itself. The physical examination of the patient will be limited to the observation and hearing of the images, videos, audios that online tools allow. Which could limit the capacity for diagnosis, generating involuntary errors, for which new Teleconsultations or referral of the patient to a face-to-face consultation may be necessary, as determined by the doctor.
Patients who request teleconsultation through THE DOCTOR’S MEDICAL SERVICE website. They will have the opportunity to access a doctor from our organization to manage acute health problems, existing problems, as well as other topics such as medical prescriptions, etc. The teleconsultation is configured to comply with the recommended regulations to guarantee the privacy of the data for you as an individual patient.
In accordance with the provisions of the New Regulation (UE) 2016/679 of the European Parliament and of the Council of April 27, 2016 (RGPD) we inform you that, in order to provide the contracted services, your data are included in a file that is owned by THE DOCTOR’S MEDICAL SERVICE. We request your express consent to manage your data, according to the above stated purpose. You are informed that you may exercise your right of access, rectification, treatment limitations, deletion, portability, and opposition to the handling of your data, by writing to THE DOCTOR’S MEDICAL SERVICE, by email to email@example.com
• I understand that the privacy and confidentiality policies and procedures of THE DOCTOR´S MEDICAL SERVICE related to medical information also apply to Teleconsultations.
• I understand that the Skype or video technology used by the doctor is encrypted to prevent unauthorized and illegal access to my confidential personal data.
• I have the right to withdraw my consent to use Skype or video (exclusion) at any time.
• I understand that the clinician has the right to withdraw (opt in) his consent for the use of Skype or video consultation at any time.
• I understand that the remote query will not be recorded.
• I understand that the Physician's Medical Services will not allow anyone else who is not directly involved in my care to hear or view the teleconsultation session.
• I have read and understand the patient information provided regarding Teleconsulation. I have had the opportunity to discuss this information and all my questions have been answered with satisfaction.
• I hereby give my explicit consent to the Teleconsultation for my medical care and authorize THE DOCTOR´S MEDICAL SERVICE to make remote consultations. Your data will be incorporated into our files under the name of THE DOCTOR´S MEDICAL SERVICE.