This form outlines your consent for the use of Telehealth services, Artificial Intelligence (AI), and recording of your healthcare visits at Community Medical Centers (CMC).I, First and Last Name, hereby consent to the use of Telehealth services, Artificial Intelligence (AI), and the recording of my healthcare visits at Community Medical Centers (CMC). Telehealth, AI, and Recording: Telehealth involves electronic communication for remote healthcare services, while the use of AI aims to enhance efficiency and quality of care, including diagnostic assistance, treatment planning, and data analysis. Recording of healthcare visits is related to the use of AI by CMC. During this process: • I understand that AI may assist in various aspects of my healthcare, including but not limited to diagnostic assistance, treatment planning, and data analysis. • I acknowledge that AI use aims to enhance the efficiency and quality of healthcare delivery. • I recognize that my participation in AI use is voluntary, and I have the right to opt out at any time. • I have been informed of the potential risks and limitations associated with Telehealth, AI use, and recording, including:ο Delays in medical evaluation and treatment.ο Insufficient information transmission for appropriate medical decision-making.ο Lack of access to complete medical records. ο Data privacy and security concerns.ο Potential inaccuracies or errors in AI-driven analysis.ο Limited availability of AI-generated insights for certain conditions or scenarios.• I understand that audio of my visit will be recorded for AI use, quality assurance and healthcare improvement purposes. • I understand that the laws protecting privacy and confidentiality apply to Telehealth, the use of AI, and the recording of my visit. • I have the right to withhold or withdraw consent for Telehealth, AI, and recording without it affecting my future care at CMC. • I understand my right to inspect information obtained during my visit and may receive copies according to the patient medical records policies set by Community Medical Centers. • I acknowledge that alternative methods of medical care are available, and I may choose them at any time. • I understand the potential benefits of Telehealth and AI, but no results are guaranteed. By signing this form, I certify that: I have read and understood the contents of this form. I have been given the opportunity to ask questions, and all questions have been answered to my satisfaction. I hereby authorize Community Medical Centers, Inc. (CMC) and its medical staff to use Telehealth services, Artificial Intelligence (AI), and recording, in the course of my diagnosis and treatment.