Having a condition requiring health care, I, the Patient, hereby consent to diagnosis and the provision of such care via videoconference. I acknowledge that the treatment I receive is provided directly by the treatment provider.
I recognise that while this treatment approach provides the benefits of reduced waiting time and cost, and allows me to be treated in a location of my choosing, there are inherent limitations to this approach. I acknowledge that my treatment provider will not be examining me physically in person.
I also acknowledge that the effectiveness of this treatment interaction will depend on a full disclosure of my treatment history and symptoms to my treatment provider, and that the videoconference interface may not give my treatment provider (Irish Medical Council (“IMC”) registered General Practitioner) the same information that would be available during an in-person examination.
I understand that these limitations necessarily restrict the conditions that can be treated through VideoDoc, and that I may be referred to my primary care GP, a local accident and emergency department, or some other treatment facility prior to receiving any diagnosis or care from my treatment provider. I understand that if I am diagnosed and treated by a treatment provider via VideoDoc, I may still be encouraged to seek follow-up care from my primary care provider or a Consultant.
Our Doctors are not obligated; nor should you expect that their recommended treatment or procedure will require a prescription. If they do provide a prescription, the Doctor or Vhi Online Doctor can send it in line with local regulations by facsimile, post or email attachment to you anywhere in the World or, deliver an electronic prescription to your preferred pharmacy where you are located. You should be aware that if you are located outside the Republic of Ireland, your local pharmacy, may not be willing to dispense the prescription.
I recognise that my treatment is reliant upon a working Internet connection and computer or mobile device. In the event of an equipment or Internet failure, or if the VideoDoc treatment provider experiences an equipment or Internet failure, my consultation may be interrupted or terminated. If this occurs, I will attempt to re-establish my online connection with VideoDoc. If the online connection cannot be re-established, I will call VideoDoc to speak directly with a treatment provider.
I am responsible for preserving my personal privacy during this consultation. I acknowledge that my privacy is not assured if I choose to engage VideoDoc from a public location, or through an unsecure internet connection.
If I experience an adverse reaction to the recommended treatment or medicines prescribed during my VideoDoc consultation, I acknowledge that I will need to seek follow-up care from my primary care GP, or a local urgent care or emergency department.
I hereby authorise the Doctor I will see, and VideoDoc Limited (“VideoDoc”) to use and release the treatment information (“sensitive information”) obtained during this consultation or held by VideoDoc for the purposes of my treatment, payment, and ongoing health care. I consent that this release includes my primary GP, nominated pharmacy and any family or persons involved in my care. We will only release the minimum information necessary to your health insurer in order to assist with reimbursement. If you do not wish us to release this information, please notify the Doctor. The requirement to inform your primary care doctor of your telemedicine consultation is set out in the Republic of Ireland (“ROI”), Guide to Professional Conduct and Ethics 8th Edition, 2016.
Personal Health Information Retention
I confirm that Vhi Online Doctor or VideoDoc is not under any obligation to hold or maintain my Personal Profile, Health and Social History (collectively “Electronic Health Record”), if I have not had a VideoDoc consultation in the preceding twenty-four months, or any subscription or membership has expired more than twelve months previously.
Sharing of Information
The Republic of Ireland Medical Council, Guide to Professional Conduct and Ethics for Registered Medical Practitioners, 8th Edition 2016, guidance is to share telemedicine consultations with patient’s own General Practitioner (“GP”). I acknowledge that it is my responsibility to print off, email, or fax my Consultation Reports and share my Medical History with my own GP, and I can access that information via the Vhi Healthcare Assistant. I confirm that I will share my Electronic Health Record with my own General Practitioner.
Anonymised Data Use
I confirm that Vhi Online Doctor and/or VideoDoc may use Anonymised Data in the improvement of its Services and in the development of its business including with Vhi and third parties. In this context, Anonymised Data refers to data from which the patient cannot be identified.
Expiry or Removal of Consent
I also understand that I may revoke or discontinue my consent, other than for Anonymised Data Use, at any time by notifying VideoDoc in writing, except to the extent actions have already been taken based upon my consent, including the disclosure of information for the care and treatment provided to me. I understand and agree to the above releases, authorisations, and assignments of benefits.
This Medical Consent and the relationship between you and VideoDoc are dated 12th January, 2018 and should be construed in conjunction with Our Terms and Conditions and Privacy Policies dated 12th January, 2018.
The Vhi Online Doctor Service is provided by VideoDoc Limited. We want to improve Our products and services through your feedback. If you have any enquiries, questions, comments or even complaints please feel free to contact us at Vhi Online Doctor, VideoDoc Limited, 8 The Mall, Beacon Court, Sandyford, Dublin 18, D18 C2D0, Contact number: 01 9073400. Email: firstname.lastname@example.org
©VideoDoc Limited, 12th January, 2018