Informed consent and Treatment Authorization for Telemedicine Services
- I understand that Harmic Inc/Delaware Paediatrics offers the opportunity for me to connect with my Paediatrician via Telemedicine.
- I understand that Telemedicine is the use of video communication and other technology from my health care provider who is at a remote/different site from my child.
- I understand that the purpose of this service is to seek medical advice and guidance for my child in NON-EMERGENCY situations. I also understand that at any time if I feel my child’s condition deteriorates or becomes an emergency, I will seek alternative care at the hospital or Urgent Care clinic.
- I understand that unlike traditional in-person medical consultations, the provider at the remote location will NOT have the ability to use senses such as touch or smell in assessing my child’s condition
- I understand that although Telemedicine provides benefits and an efficient means of assessment that there may be a number of unique situations beyond the control of the provider, that may prevent complete assessment- This may include but not limited to 1)interruption or disconnection of the audio/visual connection, or 2) disruption of communication due to equipment failure.
- This service will incur a fee, the total cost and payment method will be discussed by the office staff prior to the consultation.
- A credit card authorization can be provided for your convenience to pay remotely. Download Credit Card Authorisation Form
Dr. Paula Michele Lashley
Director Harmic Inc