This Telemedicine Disclosure and Consent ("Consent") is provided to you in compliance with the Telemedicine Practice Guidelines, 2020, issued by the Board of Governors in supersession of the Medical Council of India. By using our telemedicine services, you acknowledge and agree to the following:

1. Telemedicine Services: Our telemedicine services involve the use of electronic communications to enable healthcare providers at different locations to share individual patient medical information for the purpose of improving patient care. The information may be used for diagnosis, therapy, follow-up and/or education, and may include any of the following:

• Patient medical records
• Medical images
• Live two-way audio and video
• Output data from medical devices and sound and video files

2. Benefits and Limitations:

Benefits: Telemedicine services can provide improved access to medical care and enable you to be followed from your home or office, reducing travel time and related expenses.

Limitations: As with any medical procedure, there are potential risks associated with the use of telemedicine. These risks include, but are not limited to:

• In rare cases, information transmitted may not be sufficient to allow for appropriate medical decision making by the physician and consultant(s)
• Delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment
• In very rare instances, security protocols could fail, causing a breach of privacy of personal medical information
• In rare cases, a lack of access to complete medical records may result in adverse drug interactions or allergic reactions or other judgment errors

3. By consenting to telemedicine services, you acknowledge and agree that:

• I understand that the laws that protect privacy and the confidentiality of medical information also apply to telemedicine, and that no information obtained in the use of telemedicine which identifies me will be disclosed to researchers or other entities without my consent
• I understand that I have the right to withhold or withdraw my consent for the use of telemedicine in the course of my care at any time, without affecting my right to future care or treatment
• I understand that I have the right to inspect all information obtained and recorded in the course of a telemedicine interaction, and may receive copies of this information for a reasonable fee
• I understand that telemedicine may involve electronic communication of my personal medical information to other medical practitioners who may be located in other areas, including out of state
• I understand that I may expect the anticipated benefits from the use of telemedicine in my care, but that no results can be guaranteed or assured
• I understand that my healthcare information may be shared with other individuals for scheduling and billing purposes
• I understand that I will be informed of their presence in the consultation and have the right to request the following: (1) omit specific details of my medical history/examination that are personally sensitive to me; (2) ask non-medical personnel to leave the telemedicine examination room; and/or (3) terminate the consultation at any time

4. Patient Consent to the Use of Telemedicine: I have read and understand the information provided above 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 have read this document carefully and understand the risks and benefits of telemedicine and have had my questions regarding such procedure explained and I wish to proceed with the telemedicine consultation.

5. Emergency Situations: I understand that telemedicine is not appropriate for emergency situations. In case of an emergency, I will immediately call emergency services or go to the nearest emergency room.

6. Technical Requirements: I understand that I need to have appropriate technology and internet connectivity to participate in telemedicine consultations. I will ensure that my equipment is properly maintained and that I have a private, quiet space for consultations.

7. Payment and Insurance: I understand that telemedicine services may not be covered by all insurance plans. I will verify my insurance coverage and understand my financial responsibility for these services.

8. Changes to This Consent: We reserve the right to modify this telemedicine consent at any time. Any changes will be effective immediately upon posting to our website. Your continued use of our telemedicine services after any such changes constitutes your acceptance of the new consent.

9. Contact Information: If you have any questions about this telemedicine consent or our telemedicine services, please contact our Grievance Officer: