Informed Consent

Informed Consent of Services Performed by Cancer Expert Now

Teleconferencing education involves the use of electronic communications to enable oncology experts at different locations to share individual patient health information for the purpose of improving patient care. Providers may include multiple forms of specialists, and/or subspecialists. The information may be used for providing relevant information to you, and may include any of the following:

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

Electronic systems used will incorporate network and software security protocols to protect the confidentiality of patient identification and imaging data and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption.

Responsibility for the patient care should remain with the patient’s local clinician, if you have one, as does the patient’s medical record.

Expected Benefits:

  • Improved and rapid access to expert practitioners by enabling a person to remain in his/her local healthcare site (i.e. home) while the expert provides information to patients.
  • Clear evaluation of therapeutic options.
  • Confidence in understanding options and implications of those options.

Possible Risks:

As with any medical procedure, there are potential risks associated with the use of teleconferencing education. These risks include, but may not be limited to:

  • In rare cases, the educator may determine that the transmitted information is of inadequate quality, thus necessitating a face-to-face meeting with the customer, or at least a rescheduled video session;
  • Delays in sessions 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 health information;
  • In rare cases, a lack of access to complete records may result in judgment errors;

By checking the box associated with “Informed Consent”, you acknowledge that you understand and agree with the following:

  1. I understand that the laws that protect privacy and the confidentiality of medical information also apply to teleconferencing sessions, and that no information obtained in the use of teleconferencing sessions, which identifies me, will be disclosed to researchers or other entities without my written consent.
  2. I understand that I have the right to withhold or withdraw my consent to the use of teleconferencing sessions in the course of my service at any time, without affecting my right to future services.
  3. I understand the alternatives to teleconferencing sessions as they have been explained to me, and am choosing to participate in a teleconferencing session.
  4. I understand that teleconferencing sessions may involve electronic communication of my personal health information to other medical practitioners who may be located in other areas, including out of state.
  5. I understand that I may expect the anticipated benefits from the use of teleconferencing session, but that no results can be guaranteed or assured.
  6. I understand that my healthcare information may be shared with other individuals for scheduling and billing purposes. Others may also be present during the session other than my Cancer Expert Now Expert Educator in order to operate the video equipment. The above-mentioned people will all maintain confidentiality of the information obtained. I further understand that I will be informed of their presence in the session and thus will have the right to request the following: (1) omit specific details of my medical history/physical examination that are personally sensitive to me; (2) ask non-medical personnel to leave the session; and/or (3) terminate the session at any time.

Customer Consent To The Use of Teleconferencing Session

I have read and understand the information provided above regarding teleconferencing session, 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 the teleconferencing sessions and have had my questions explained and I hereby give my informed consent to participate in session under the terms described herein.

By checking the Box containing “INFORMED CONSENT FOR TELECONFERENCING SESSION SERVICES” I hereby state that I have read, understood, and agree to the terms of this document.

 


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