I authorize MyOnCallDoc’s contracted providers to provide me with their observations and recommendations regarding my medical condition and potential courses of action, using telemedicine. The use of telemedicine involves the electronic communication of my medical information. I understand that MyOnCallDoc is a Telehealth Technology Provider based in Florida and its contracted providers will not perform an in-person physical examination during the telemedicine consult. They will rely solely on the information telecommunicated. I authorize the MyOnCallDoc contracted provider to consult with any other physician specialists whom they may choose to involve in my case if necessary.
I understand that I have the following rights with respect to the telemedicine services performed by MyOnCallDoc:
I understand that there are risks from telemedicine, including but not limited to: loss of records from failure of electronic equipment; power failure with loss of communication; and invasion of electronic records from outsiders (hackers). In addition, signs and symptoms that might be detected during an in-person physical examination may not be detected through telemedicine. I understand that I have the option of seeing another physician on a face to face basis who could provide me with observations and recommendations.
I warrant that the MyOnCallDoc provider/physician observations and recommendations are limited in scope and nature to the specific issues discussed during the telemedicine consult.
I have read and understand the information provided above. I agree and all my questions have been answered to my satisfaction. I consent to receiving the telemedicine services described above.