Telemedicine Use – Terms and Conditions

Telemedicine involves the use of electronic communications to enable health care providers at

different locations to share individual patient medical information for the purpose of improving

patient care. Providers may include primary care practitioners, specialists, and/or subspecialists.

The information may be used for diagnosis, therapy, follow-up and/or education, and may include

any of the following:

  • Patient medical records
  • Medical images
  • Live two-way audio and video
  • Output data from medical devices and sound and video files

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 and to ensure its integrity against intentional or unintentional corruption.

Expected Benefits:

  • Improved access to medical care.
  • More efficient medical evaluation and management.
  • Obtaining expertise of a distant specialist.

Possible Risks:

As with any medical procedure, there are potential risks associated with the use of telemedicine.

These risks include, but may not be limited to:

  • In rare cases, information transmitted may not be sufficient (e.g. poor resolution of images) to

allow for appropriate medical decision making by the healthcare provider;

  • Delays in medical evaluation and treatment could occur due to deficiencies or failures of the

Telemedicine connection;

  • In very rare instances, security protocols could fail, causing a breach of privacy of personal

health information;

  • In rare cases, a lack of access to complete medical records may result in adverse drug

interactions or allergic reactions or other judgment errors;

By continuing this Telemedicine session you understand the following:

  1. I understand that the laws that protect privacy and the confidentiality of medical information

also apply to telemedicine, and that no information obtained in the use of telemedicine which

identifies me will be disclosed to researchers or other entities without my consent.

  1. I understand that I have the right to withhold or withdraw my consent to the use of

telemedicine in the course of my care at any time, without affecting my right to future care or


  1. I understand that I have the right to inspect all information obtained and recorded in the

course of a telemedicine interaction, and may receive copies of this information for a

reasonable fee.

  1. I understand that telemedicine may involve electronic communication of my personal medical

information to other medical practitioners who may be located in other areas, including out of


  1. I understand that I may expect the anticipated benefits from the use of telemedicine in my

care, but that no results can be guaranteed or assured.

Patient Consent To The Use of Telemedicine

I have read and understand the information provided above regarding telemedicine, have

discussed it with my physician or such assistants as may be designated, and all my questions

have been answered to my satisfaction. By clicking and initiating session, I hereby give my informed consent for the use of telemedicine in my medical care.