Eastern Shore Children’s Clinic is now offering the option of telemedicine for some office visits. When you agree to a visit of this type you are agreeing to the following:
- NATURE OF TELEMEDICINE CONSULT: During the telemedicine consultation:
- Details of your child’s medical history will be discussed through the use of interactive video, audio, and telecommunication technology.
- A physical examination of your child may take place.
- A non-medical technician may be present in the telemedicine studio to aid in the video transmission.
- Video, audio and/or photo recordings may be taken of you and/or the patient during the procedure(s) or service(s).
- MEDICAL INFORMATION & RECORDS: All existing laws regarding your access to medical information and copies of your medical records apply to this telemedicine consultation. Please note, not all telecommunications are recorded and stored. Additionally, dissemination of any patient-identifiable images or information for this telemedicine interaction to researchers or other entities shall not occur without your consent. Details of the telemedicine visit will be documented in your child’s chart.
- CONTINUITY: If you are disconnected and/or have a bad connection during the consult, please call our main office immediately and inform the receptionist that you are in the middle of a telemedicine visit and need to be reconnected to the doctor.
- BILLING: Your insurance company will be billed for this telemedicine visit. Your insurance company may not cover telemedicine services. Your acceptance of these Terms of Service signifies your acceptance of financial responsibility for any services billed for this telemedicine visit that are not covered by your insurance.
- CONFIDENTIALITY: Reasonable and appropriate efforts have been made to eliminate any confidentiality risks associated with the telemedicine consultation, and all existing confidentiality protections under federal and Alabama state law apply to information disclosed during this telemedicine consultation.
- RIGHTS: You may withhold or withdraw consent to the telemedicine consultation at any time without affecting your right to future care or treatment.
- DISPUTES: You agree that any dispute arriving from the telemedicine consult will be resolved in Alabama, and that Alabama law shall apply to all disputes.
Your acceptance of these Terms of Service indicate that you have had the opportunity to ask questions about the information presented on this form, and the telemedicine consultation, and that you understand the written information provided above.