Telemedicine Services
Telemedicine involves the use of electronic communications to enable Dr. Janssen's office to share individual patient medical information for patient care. The information provided during a telemedicine visit may be used for diagnosis, therapy, follow-up, and/or education, and may include any of the following:
- Patient medical records
- Medical images
- Live two-way audio and video
- Electronic systems used will incorporate network and software security protocols to protect the confidentiality of patient identification and imaging data and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption.
Expected Benefits
Expected benefits of telemedicine health services may include the following:
- Improved access to medical care by enabling the patient to communicate with Dr. Janssen at a distance.
- More efficient medical evaluation and management of health conditions.
Possible Risks
As with any health care service, potential risks associated with the use of telemedicine may exist. These risks include, but may not be limited to:
- In rare cases, information transmitted may not be sufficient (e.g. poor image or video resolution) to allow for appropriate medical decision-making by Dr. Janssen, which may necessitate an in-person medical evaluation.
- Delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment. In the event of an equipment failure, Dr. Janssen will determine whether or not the visit can be continued via telephone.
- If Dr. Janssen determines that a telephone call does not provide enough adequate information, she may decide to reschedule your appointment.
- In rare instances, security protocols could fail, causing a breach of privacy of personal medical information.
By Signing this Form, I Understand the Following:
- The laws that protect privacy and confidentiality of medical information also apply to telemedicine, and that no information obtained in the use of telemedicine which identifies me will be disclosed to other health care entities without my consent.
- I have the right to withhold or withdraw my consent to the use of telemedicine in the course of my care at any time without affecting my right to future care or treatment.
- I have the right to inspect all information obtained and recorded in the course of a telemedicine interaction and may receive copies of this information.
- A variety of alternative methods of medical care may be available to me, and I may choose one or more of these at any time. Dr. Janssen has explained the alternatives to my satisfaction. Dr. Janssen may require that I schedule an in-person medical evaluation to follow up in certain circumstances.
- I may expect the anticipated benefits from the use of telemedicine in my care, but recognize that no results can be guaranteed or assured.
Notice Concerning Complains
Complaints about physicians, as well as other licensees and registrants of the Texas Medical Board, including physician assistants, acupuncturists, and surgical assistants may be reported for investigation at the following address:
Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018. Assistance in filing a complaint is available by calling the following telephone number: 1-800-201-9353. For more information, please visit the Texas Medical Board's website at www.tmb.state.tx.us.
Patient Consent to Use of Telemedicine
I have read and understood the information provided above regarding telemedicine, have discussed it with Dr. Janssen's office, and all of my questions have been answered to my satisfaction. I hereby give my informed consent for the use of telemedicine in my medical care.
I hereby authorize Dr. Janssen to use telemedicine in the course of my diagnosis and treatment.