Consent to Telehealth Dialdoc
Consent To Telehealth
Last updated: February 1st, 2017
The purpose of this particular informative document is to obtain your consent to accept general medical services through telemedicine.
Kindly take into consideration that you can only use our medical telemedicine services after you go through and read this particular information below and afterward made a complete informed decision about using our services. Also note that by clicking Accept during the registration of your account, you give your whole permission to Dialdoc to medically care for you through telehealth.
Take into consideration if by any chance you want to withdraw this particular consent and no longer want to seek care from Dialdoc you can delete your account at any time.
This electronic acceptance notice is for patients that reside in the state of Arizona. In case of any questions, kindly contact us at email@example.com or by calling us at (520) 301-1603.
I completely understand that as a patient or user of Dialdoc telemedicine system visit, consult or appointment at any giving time without affecting my rights what so ever; I can cancel my participation to go through the system and seek help somewhere else.
I complete understand and accept that any matter regarding a dispute from the telemedicine visit, consult or appointment will come into resolution or be resolved in Arizona and all the particular laws of the stat of Arizona may apply to such dispute.
I complete understand and accept that all the particular existing federal and state laws regarding my access to all my medical health information or the copies of the recordsapply to his particular telemedicine visit, consult or appointment.
I complete understand and accept that all the details of my personal medical history will be in a discussion with other medical providers as well as other professional healthcare professional through the technology software use by Dialdoc.
I complete understand and accept that videos, pictures or recording may be a requirement for me to complete the procedure and the service through the telemedicine software use by Dialdoc.
I understand and accept that perhaps a physical examination will take place for me to continue with the medical service as a patient.
I complete understand and accept that I have been informed and advised about all the potential risk, consequences and benefits about a telemedicine visit, appointment or consult.
I complete understand and accept that a health care provider has discussed with me all the particular information above regarding telemedicine.
I am full aware and complete have the understanding that even though Dialdoc as medical organization uses the best of technology to guard and secure everything about my health information and have a full comply system with HIPPA. However, Dialdoc cannot guarantee the full privacy and discretion of my personal health information.
I had the opportunity to ask any particular questions and get the answers about all the information above as well as any related topic involving my care through telemedicine consult, visit or appointment.
I completely understand that I should never use the medical services that Dialdoc provides in any sort of emergency situation. I truly understand and I am full aware that in case of emergency, I immediately should contact the right authorities such as 911 or any other emergency department.
As a patient, I fully understand that Dialdoc will only take the responsibility for my care as a patient or user, right after I create an account through our website for the medical services. Consequently, answering all the required medical question that come with registration as well as other small necessary requirements for the doctors to be able to see me as a potential patient or user.
I complete understand and full aware that Dialdoc has the absolute right at any time to refuse in any way to take responsibility for my medical care. I am also aware, to the full extent that making any particular request for treatment by visiting the website and making payment or just getting in contact through email, does not in any way or form create a medical relationship or duty of care.
I complete understanding that there may be some sort of delay when it comes to get any response back from my medical team.
I am full aware and complete understand that any type of material know as content within this particular website content is not consider any kind of medical advice.
I fully understand when I get an appointment to see my doctor through telemedicine, my medical provider relies upon the medical history I provide. Therefore, I have to be honest about all the information I release at the time.
I am full aware that I will be at risk and have negative consequence to my health, if I provide personal and health information that is not true about my medical history or current health problems.
I understand and well aware that I cannot create more than one account, since the medical providers may be confuse at the time of checking my medical history and cannot rely on it to further assist me to better my health.
It’s my understanding that by using the medical services provided by Dialdoc, I’m giving my 100% full and explicit agreement for any medical provider that is consider a member of Dialdoc to see me as a patient through telemedicine and access my personal and medical history and information about me.
I understand that members of Dialdoc team, if it is complete appropriate, may take my full medical history as well as personal to determine any sort of treatment for my illness or reason for the telemedicine visit.