PATIENT CONSENT ｜患者同意書
PURPOSE: The purpose of this form is to get the patient's consent in order to conduct teleconsultation. The patient understands and agrees that:
目的：“遠程會診表”的目的是為了進行遠程會診獲得患者的同意。患者理解並同意：
1. The Patient hereby authorize Marina Medical to use the teleconsultation practice platform for telecommunication for evaluating, testing and diagnosing my medical condition.
患者特此授權海灣醫療使用遠程會診平台進行遠程評估、測試和診斷他/她的健康狀況
2. Technical difficulties may occur before or during the teleconsultation sessions and his/her appointment cannot be started or ended as intended. The information transmitted may be of insufficient quality to allow for appropriate medical or health care decision making.
在遠程諮詢會議之前或期間可能會出現技術困難，並且他/她的任命無法按預期開始或結束。傳輸的信息可能質量不足，無法做出適當的醫療或保健決策。
3. The professionals can conduct interactive sessions with video call; however, The Patient understood and accepted that the sessions can be conducted via regular voice communication if the technical requirements such as internet speed cannot be met.
醫生可以通過視頻通話進行互動會話；但是，患者同意，如果無法滿足互聯網速度等技術要求，可以通過常規語音通信進行會話。
4. The Patient's current insurance may not cover the additional fees of the teleconsultation practices and the patient may be responsible for any fee that the insurance company does not cover.
患者當前的保險可能不涵蓋遠程會診的額外費用，並且需為該保險公司未涵蓋的任何費用負責。
5. The Patient's medical records on teleconsultation can be kept for further evaluation, analysis and documentation, and in all of these, his/her information will be kept private. Reasonable and appropriate efforts have been made to eliminate any confidentiality risks. The electronic systems, in some instances, may fail and cause a breach of privacy and/or personal health information.
患者的遠程會診醫療記錄將會保存以供進一步評估、分析和歸檔，在所有這些過程中，他/她的信息將被保密。亞洲專科醫生已作出合理和適當的努力以消除任何保密風險。在某些情況下，電子系統可能會出現故障並導致侵犯隱私和/或個人健康信息。
6. In certain situation, his/her condition cannot be diagnosed by the mean of teleconsultation and he/she might need to further arrange another face-to-face consultation to properly assess the condition. This current teleconsultation will still be considered as a completed consultation.
在某些情況下，他/她的病情無法通過遠程會診方式診斷，他/她可能需要進一步安排另一次面對面會診以正確評估病情。當前的遠程諮詢仍將被視為已完成的諮詢。
7. If a further face-to-face consultation is needed, the patient understand it is solely up to his/her own decision whether should continue.
如果需要進一步的面對面諮詢，患者明白這完全取決於他/她自己的決定。
8. If the patient is under 18 years old, an accompanying adult (parents, guardians or next of kin) must be present with the patient during the consultation and the accompanying adult must sign on the form as well.
如果患者未滿 18 歲，諮詢期間必須有陪同成人（父母、監護人或近親）在場，並且陪同成人必須在表格上簽字。