Description of Derm Engine:
Derm Engine is computer imaging program where images are taken of your skin as a tool to identify any changes over time. This is a decision support tool and is meant to go along with your annual skin cancer screening exams with a dermatologist or primary care physician.
Risks Defined:
Derm Engine is not a diagnostic tool, which means you may still have skin cancer that is not identified by the program or the provider during your exam. It is a screening tool that maps your skin lesions over time to see if there are any changes as compared between your yearly exams and it is important that you still go for your annual skin cancer screening exams with a dermatologist or primary care physician.
Confidentiality:
The information obtained from the test will be created as privileged and confidential.
I have received and read the above information and understand the benefits and risks of the procedure.
I fully understand and accept that participation in all such activities will be at my own risk.
I release Health by Design, its physicians, employees, and my current employer from all liability for any act/omission or an adverse event that may occur because of this test or any participation in terms hereof.
I hereby undertake to and hereby do, indemnify absolve and hold harmless Health by Design, its physicians, employees, any person acting on its behalf and my current employer against any loss in respect of all claims, proceedings, damages, costs and expenses whatsoever that may arise in the course of, or in connection with, such activities, howsoever arising and whether as a result of negligence or otherwise
I have had my questions answered to my satisfaction.
I give my consent to proceed with the test.