• Jersey Medical Weight Loss Center/Aparna Medical Associates

    1527,Route 27,Ste 2100,Somerset,NJ 08873
  • TELEMEDICINE PATIENT CONSENT

    PURPOSE: The "Telemedicine Consent Form" is to get the patient's consent in order to participate in Telemedicine service.

    TELEMEDICINE INFORMATION: Telemedicine involves the practice of healthcare delivery, diagnosis,consultation,treatment, transfer of medical data and education using interactive audio, video and data communication. Telemedicine-based visits may not be as complete as face-to-face encounters. Hence the benefit cannot be guaranteed or assured. 

    ACCESS: The patient accepts that he/she needs access to PC, laptop, or mobile device and a good internet connection in order to have an efficient telemedicine appointment.

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  • By signing this form,

    I understand that all the laws that are protecting my privacy of medical history or information are also applied to telemedicine practices.

    I understand that I'm financially responsible if not covered by my insurance or if I do not have medical insurance coverage. 

    I accept that I authorize health care professionals and use telemedicine for my treatment and diagnosis.

     

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