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Jenny Hague - Physiotherapy

CONSENT TO TELEHEALTH CONSULTATION

  1. To receive a physiotherapy consult from <insert therapists name> from Jenny Hague - Physiotherapy, by means of electronic media, preferably Medici Web MD, Telehealth application..

  2. If for some reason, the Medici TeleHealth service is not available then, the patient agrees to use an alternative electronic medium such as Zoom or Microsoft Teams.

  3. It is specifically agreed that private medical data will only be shared over the Medici Web MD app or a similar medium that is compliant with the provisions of the PoPi Act

  4. 2. There is no subscription required when using the electronic platforms mentioned above, such as costs for the Applications (“Apps”) used, but I understand that I will carry my own costs of any infrastructure and/or running costs associated with such service being rendered e.g. the data used, the telephone and/or computer, etc.

  5. That this platform will be used to render healthcare services to me, and that the usual consent processes (required from me in writing) will be followed (i.e. I will be informed of my health status, as well as the benefits, risks and implications of the care). I understand that I can opt out of receiving care, at any stage, but acknowledge that it may not be in my best interest and I therefore release Jenny Hague Physiotherapy from legal liability for this.

  6. That I have to disclose all health information to my Physiotherapist, such as other health conditions or ailments I have, and all medicines I am taking (including supplements and any “natural” remedies). I understand that these aspects influence the treatment and care options.

  7. To make an appointment prior to each contact where Telehealth will be provided. Please contact us on 731 1027, stevejm@jhiphysio.com, or WhatsApp on 0713023300.

  8. That my Physiotherapist reserves the right to NOT consult over (or reply to) e-mail, WhatsApp chat, SMS.

  9. That I may be billed for a Telehealth consultation session at the rates prescribed by the South African Society of Physiotherapists and the Medical Schemes.

  10. Your Physiotherapist will inform you of any applicable billing prior to the session.

  11. I acknowledge that I am aware that I can contact the practice to ascertain the specific tariff applicable to me, which is determined by the service rendered and my status as either a patient with or without membership to a medical scheme (please call the practice directly the cash rates applicable)

  12. To reduce the risk of missed appointments or last- minute cancellations, the usual cancellation/missed appointment fee will apply (you have signed accordingly in your original Doctor-Patient contract at the first appt). That document will apply in full, except for the interim measures detailed here.

  13. That my medical scheme may not cover the costs of this care.

  14. That I understand the Physiotherapist is by law obliged to take notes during the Telehealth session. The session may be recorded as a video or audio file and in this case the transcript will be attached to my Electronic Patient Record.  

  15. I understand that my Physiotherapist may wish to consult or refer me to another health professional for input/advice.

  16. My Physiotherapist will always inform me of such referral and get my specific consent to do so.

  17. The Physiotherapist will devote his/her full attention to the session.

  18. That the service may have limitations relating to technology, such as data- and internet failures (e.g. dropped calls or bad reception). I understand that I am responsible for a secure and stable connection as far as possible.

  19. To dress appropriately for the Telehealth interaction, I will devote my full attention to the session, and not do anything else, e.g. receive phone calls, answer SMS’s, reply to WhatsApp messages, read emails, cook, care for children or the likes.

  20. That, although the Physiotherapist will adhere to the existing rules relating to confidentiality

  21. I understand that I must take the necessary precautions at home to ensure my confidentiality during telehealth service provision, and, where I wish for another person to be present during the Telehealth engagement, I will forward a written and signed consent for that person’s presence, clearly indicating the person’s details, the date(s) and time(s) of the consultation(s);

  22. I understand that, and agree that, should the Psychiatrist believe that I may have been exposed to Covid-19 and/or do have Covid-19, s/he would refer me for tests, and I understand that the results of such tests must be reported, by law, to the NICD – National Institute of Communicable Diseases.

  23. In the event of an emergency, I may not be able to contact my Physiotherapist immediately. I absolve her of any medicolegal responsibility in such an event, and should report myself to my GP and/or neares casualty.

  24. The link attached can be used to get more information about Telehealth, its benefits and implications https://www.jennyhague.com/forum/members-discussion-forum/what-is-telehealth-and-what-does-it-mean-for-you