During a dermatology video telehealth visit, details of your medical history and personal health information will be discussed. Additionally, a physical examination of you may take place. Please set up your visit in a private space where an examination of your skin will be possible.
By accepting this invitation you consent to hold this visit by video. A video visit is billed in the same way as an in-person clinic visit. The terms of your deductible and copay still apply.
CONSENT TO PARTICIPATE IN TELEMEDICINE VISIT:
1. NATURE OF TELEMEDICINE VISIT. Telemedicine involves the use of audio, video or other electronic communications to interact with you, and/or review your medical information for the purpose of diagnosis, therapy, follow-up and/or education. During your telemedicine visit, details of your medical history and personal health information will be discussed through the use of interactive video, audio and telecommunications technology. Additionally, a physical examination of you may take place and photos may be taken.
2. RISKS, BENEFITS AND ALTERNATIVES. The benefits of telemedicine include having access to medical care without having to travel to a healthcare facility. A potential risk of telemedicine is that because of your specific medical condition, or due to technical problems, a face-to-face consultation still may be necessary after the telemedicine appointment. Additionally, in rare circumstances, security protocols could fail causing a breach of patient privacy. The alternative to a telemedicine visit is an in-person visit with a physician.
3. MEDICAL INFORMATION AND RECORDS. All laws concerning patient access to medical records and copies of medical records apply to telemedicine. Dissemination of any patient identifiable images or information from the telemedicine consultation to researchers or other entities shall not occur without your consent.
4. CONFIDENTIALITY. All existing confidentiality protections under federal and California law apply to information used or disclosed during your telemedicine consultation.
5. RIGHTS. You may withhold or withdraw your consent to a telemedicine consultation at any time before and/or during the consult without affecting your right to future care or treatment, or risking the loss or withdrawal of any program benefits to which you would otherwise be entitled.