PATIENT INFORMED CONSENT FOR TELEMEDICINE SERVICES
DFW Kidney Care Clinic has implemented an electronic health record (EHR) in part to meet the U.S. Department Health and Human Services initiative to improve health information technology, toward the goal of improving quality of health care. Our EHR integrates your clinical record with appointments, registration, and billing and makes this information available to the clinicians who are involved in your health care.
In connection with its electronic communication systems, DFWKCC has also implemented and has in place privacy and security policies and procedures to minimize risk of inadvertent or unauthorized disclosure, corruption and/or loss or distortion of data, but as with all record keeping systems, whether paper or digital, some risks remain of loss, inadvertent disclosure or errors in the recorded data.
I have read and understand the information provided regarding telemedicine, have discussed it with my physician or such assistants as may be designated, and all of my questions have been answered to my satisfaction. I hereby give my informed consent for the use of telemedicine including electronic transfer of medical data to other medical practitioners participating in my medical care.
I hereby authorize DFWKCC to use telemedicine in the course of my diagnosis and treatment and consent to the electronic communication ofmy personal health care information to other entities for treatment, payment or health care operations.
INFORMED CONSENT FOR PRESCRIPTIONS
DFWKCC continues its position as the network exchange for the flow of vital patient information to physicians and other health care providers.Itis essential to improve patient safety and the continuity of care with electronic connectivity between payers, physicians and pharmacists. DFWKCC electronic health record (EHR) provides secure access for patients with prescription coverage in the United States.
Prescription eligibility, benefit, formulary and medication history information is provided for consenting patients to authorized physicians at the point of care. Electronic prescriptions are delivered in real-time to pharmacists in the retail and mail order settings.
I consent to electronic prescriptions and acknowledge that DFWKCC will use electronic connectivity between payers, physicians and pharmacists.
DFWKCC is offering the patient portal as a convenience to you. The patient portal is a secure web portal that allows you, as a patient, to view your medical chart and to access our online bill pay via the internet. It also allows you to communicate with our office via secure messaging. You may request appointments, schedule changes, and medication refills (not including controlled substances
DFWKCC reserves the right to suspend or terminate the patient portal at any time and for any reason. I understand that the patient portal will be offered at no charge and acknowledge that communications over the internet using the portal is secure. I also, agree to the policy defined herein for suspension or termination of portal access.