Telemedicine Informed Consent

I understand that telemedicine is the remote delivery of healthcare services by a Healthcare Practitioner (“HCP”) using information and communication technologies. 

I understand that it involves sharing my health information with the HCP via a text-based, audio-based or video-based medium, on the basis of which the HCP will arrive at a diagnosis and treatment plan (“Teleconsultation”).

I understand that there are potential risks and benefits associated with any form of treatment including homeopathy, physiotherapy and nutritional advice, and that despite my efforts and the efforts of the HCP, my condition may not be improve, and in some cases may even get worse. 

I understand that, in addition to the risks associated with the treatment itself, telemedicine also bears certain risks. These include:

• The inability to have direct, physical contact with the patient may impact the quality of service.

• In rare cases, information transmitted may not be sufficient (e.g. poor resolution of images) to allow for appropriate medical decision making by the HCP(s);

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

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

I understand that if my HCP believes I would be better served by another form of services (e.g. face-to-face services) I will be referred to an HCP who can provide such services in my area. 

I understand that I have the following rights with respect to telemedicine: 

• I have the right to withhold or withdraw consent at any time without affecting my right to future care or treatment. 

• The laws that protect the confidentiality of my medical information also apply to telemedicine. 

• As such, I understand that the information disclosed by me during the course of my therapy is generally confidential. However, there are both mandatory and permissive exceptions to confidentiality under the law.

• I also understand that the dissemination of any personally identifiable images or information from the telemedicine interaction to researchers or other entities shall not occur without my written consent. 

I hereby agree to avail of telemedicine offered by the HCP(s) and Dr. Sankaran Online Homeopathy Pvt. Ltd. for my medical care. 

I hereby clarify that I am above eighteen (18) years of age, and competent to contract. If I am agreeing to these terms for the treatment of a third-party, I represent that am authorised to consent to treatment on behalf of the patient.

BY ENGAGING IN THIS TELEMEDICINE SESSION, YOU AGREE AND CERTIFY THAT YOU HAVE READ AND UNDERSTAND THE INFORMATION PROVIDED ABOVE, AND UNDERSTAND THE RISKS AND BENEFITS OF TELEMEDICINE.  BY ACCEPTING THESE TERMS, YOU HEREBY GIVE YOUR INFORMED CONSENT TO PARTICIPATE IN A TELEMEDICINE VISIT AND FOR THE USE OF TELEMEDICINE IN YOUR MEDICAL CARE.

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