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TELE-DERM CONSENT

Coastal Skin Surgery and Dermatology, PLLC

CONSENT TO PARTICIPATE IN TELEDERMATOLOGY

TeleDermatology (Telemedicine) is a VERY POSITIVE ADVANCE IN MODERN MEDICINE enables patients to get dermatologic medical care by electronic means.  Due to the Covid-19 outbreak, many insurance carriers (to include Medicare and most commercial companies) approve of this modality and approve it to be billed as a routine office visit.  Normal charges and/or co-pays do apply as would for a face-to-face visit.

Expected Benefits:

  • Improved access to a dermatologic specialist by enabling a patient to remain in his/her local site (i.e. home) while the dermatology provider consults at another location.
  • More convenient and efficient medical evaluation and management without the risk of travelling to see the provider.

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, the consultant may determine that the transmitted information is of inadequate quality, thus necessitating a face-to-face meeting with the patient, or at least a rescheduled video consult;
  • Delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment;
  • Coastal Skin Surgery and Dermatology uses HIPAA compliant, secure software specifically designed to safeguard your healthcare information. In very rare instances, security protocols could fail, causing a breach of privacy of personal medical information;

By checking the box associated with “Informed Consent”, You acknowledge that you understand and agree with the following:

  • 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 written consent.
  • 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 treatment.
  • I understand the alternatives to telemedicine consultation as they have been explained to me.
  • I understand that telemedicine may involve electronic communication of my personal medical information to other medical practitioners, such as a nurse or medical assistant, who may also be located in another area. I further understand that I will be informed of their presence in the consultation and thus will have the right to request the following: (1) omit specific details of my medical history/physical examination that are personally sensitive to me; and/or (2) terminate the consultation at any time.  All parties will maintain confidentiality of the information obtained.
  • 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.
  • I understand that my healthcare information may be shared with other individuals for scheduling and billing purposes, but only to the extent necessary to complete these tasks.

Patient Consent To The Use of Telemedicine

  • I have read and understand the information provided above regarding telemedicine.
  • I have read this document, and understand the risks and benefits of the teleconferencing consultation and have had my questions regarding the procedure explained and I hereby give my informed consent to participate in a telemedicine visit under the terms described herein.
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