PREVENE WELLBEING® TELEMEDICINE

Prevene Wellbeing® Telemed

Prevene Wellbeing® takes pride in providing the greatest care and serving our patients in a variety of ways. We are now offering telemedicine services to help us extend our reach of care and increase convenience for our patients. Telemedicine services can be used for certain types of appointments, for patients with access to the internet and a quiet, private space. To schedule your online telemedicine visit/consult, please fill in the form below and one of our staff will be in touch with you shortly to assist you. 

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SCHEDULE YOUR TELEVISIT

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    OFFICE HOURS: Monday thru Thursday 8:00AM – 5:00PM | Friday 8:00AM – 12:00PM | Office Lunch 12:30PM – 1:30PM
  • INFORMED CONSENT FOR TELEMEDICINE SERVICES

    INFORMED CONSENT FOR TELEMEDICINE SERVICES

    Introduction
    Telemedicine involves the use of electronic communications to enable health care prodders at different locations to share individual patient medical information for the purpose of improving patient care. Providers may include primary care practitioners, specialists, and/or sub specialists. 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
    Electronic systems used will incorporate network and software security protocols to protect the confidentiality of patient identifications and imaging data and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption.

    Expected Benefits
    Improved access to medical care by enabling a patient to remain in his/her office (or at a remote site) while the physician obtains test results and consults from healthcare practitioners at distant/other sites
    More efficient medical evaluation and management
    Allow patient to receive necessary care while minimizing infection exposure or other risk to patient or others

    Possible Risks
    As with any medical procedure, there are potential risks associated with the use of telemedicine. These risks include, but may not be limited to:
    In rare cases, information transmitted may not be sufficient (e.g. poor resolution of images) to allow for appropriate medical decision making by the physician;
    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.

    BY SIGNING / AGREEING TO THIS FORM, I ATTEST TO AND UNDERSTAND THE FOLLOWING:
    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 to 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 telemedicine interactions, and may receive copies of this information for a reasonable fee.

    I understand that a variety of alternative methods of medical care may be available to me, and that I may choose one or more of these at any time.

    Prevene Wellbeing has explained the alternatives to my satisfaction.

    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 it is my duty to inform Prevene Wellbeing of electronic interactions regarding my care that I may have with other healthcare providers.

    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 attest that I am located in the state of Arizona and will be present in the state of Arizona during all telemedicine encounters with Prevene Wellbeing

    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 hereby give my informed consent for the use of telemedicine in my medical care.

    I hereby authorize Prevene Wellbeing to use telemedicine in the course of my diagnosis and treatment.
WELL BEING AT ITS FINEST
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