Vincent Di Carlo, M.D. & Associates, P.A. d/b/a Neurology and Physical Therapy Centers of Tampa Bay
2835 W. De Leon Street, Tampa, FL 33609
Telephone: (813) 831-6622
Telehealth Notice and Agreement for Patients of Rosanna Garner, M.D. and Kimberly Tobon, D.O.
On March 11, 2020, the World Health Organization declared the COVID - 19 (Novel Coronavirus) viral disease to be a pandemic. As a result of this emergency, a rapidly evolving situation, practice patterns for physicians, physician assistants, and nurse practitioners are shifting to accommodate the need to treat in conjunction with unprecedented guidance from federal, state, and local authorities — which include, but are not limited to, self - quarantines and/or limiting physical proximity to others under any number of circumstances.
It is within this context (and with the understanding that this method of patient encounter is in the patient’s best interest as well as the health and safety of other patients and the public) that “telehealth” is being provided for this patient encounter rather than a face - to - face visit. This patient encounter is appropriate and reasonable under the circumstances given the patient’s particular presentation at this time.
The patient agrees that they are aware of the potential risks and limitations of this mode of treatment (including, but not limited to, the absence of in - person examination) and has agreed to be treated in a remote fashion in spite of them. Any and all of the patient’s/patient’s family’s questions on this issue have been answered, and their physician has made no promises or guarantees to the patient. The patient also understands that they are to contact this office for worsening conditions or problems, and seek emergency medical treatment and/or call 911 if the patient deems either necessary.
By signing below, I am indicating that I understand and agree to all of the above.