Central MoH makes guidelines for Telemedicine. Proforma of Telemedicine Consent Form for you. : Adv. ROHiT ERANDE

Namaste Everyone..
Greetings.

The Corona Pandemic has once again underlined the challenges in healthcare. most importantly the patients as well as Doctors are not willing to see each other personally. Plus there the Judgment of Hon.Bombay High Court in 2018 created uncertainty about Telemedicine.  
You may read the following blog relating to aforementioned Judgement.

https://advrohiterande.blogspot.com/2018/07/telephonic-consultation-will-attract.html?m=1

 Thus the Central Ministry of Health, India in partnership with NITI Ayog, has prepared the Guidelines for Telemedicine. I think it's very important and might be game-changer for Doctors. The following link would give you the complete overview of 48 pages guidelines. I request everyone to peruse the guidelines and then start TeleMedicine. Please understand that this concept and legal provisions are in its infancy and it will certainly improve as the time passes.
Doctors, if assured of no new legal problems, would also prefer Telemedicine. 
Practically it would require good net-speed. 
From patients point of view also it's beneficial. It will save your time. Only thing is in those cases where physical examination is necessary, telemedicine may not be the answer.

Let's hope  Telemedicine proves to be blessing in disguise..

The link for guidelines.

https://www.mohfw.gov.in/pdf/Telemedicine.pdf

As per requests of few medicos and to show gratitude towards Medical Fraternity, I have attempted to prepare the draft of Informed Consent in case of Telemedicine as under. I must clear here that it is just a draft and you may alter the same as per your own requirements or get totally new one. You may require to send the form to the patient and ask him/her to sign and scan the same or to simply send a message/whatsapp/email thereby giving his consent. The Guidelines have also provided for 'Caregiver' i.e. a guardian/next friend for a patient. 

With kind regards,

Adv. ROHiT ERANDE

Pune. 

Informed Consent for Telemedicine Services

Sr.No. Date :

1 Name of the Patient

2 Date of Birth

Age Proof Attached

3 Sex M/F/Others

4 Address

5 Doctor’s name

Introduction :

1. Telemedicine involves the use of various modes electronic communications to enable the Medical Practitioner /Health Care Providers at different locations to share individual patient medical information for the purpose of improving patient care. 

2. The Health Care Providers may include primary care practitioners, specialists, and/or subspecialists. 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 identification and imaging data and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption. 

3. Possible Risks: Medical science is an incomplete science . As with any medical procedure, there are potential risks associated with the use of Telemedicine. These risks include, but may not be limited to: 

a. In rare cases, information transmitted may not be sufficient (e.g. poor resolution of images for any reason) to allow for appropriate medical decision making by the physician and consultant(s); •

b. Delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment; 

c. Security protocols could fail, causing a breach of privacy of personal medical information; 

d. A lack of access to complete medical records may result in adverse drug interactions or allergic reactions or other judgment errors.

By signing this form, I (name of the Patient or the caregiver) fully understand the following: 

1. 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.

2. 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. 

3. 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. 

4. I have read /I have been made understood the possible risks involved in my treatment. 

5. 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. My Doctor has explained the alternatives, its benefits /probable risks etc. to my satisfaction. 

6. 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. 

7. I understand that it is my bounden duty to inform my Doctor of electronic interactions regarding my care that I may have with other healthcare providers. 

8. I am aware that for Indigent / Weaker / Govt Beneficiary patients, the Doctor  runs a scheme to treat patients free / at concession rates. However, even though I am eligible for the same, I have voluntarily waived the said right of concession / benefit conferred upon me. I shall not claim any such amount from my Doctor nor shall I make and complaint / grievance of any nature against the Doctor with any  of the authority. 

9. I shall strictly follow and adhere to the advise / treatment prescribed by my Doctor.

10. I am aware that the treatment may cause some adverse effects / side effects but not limited to like allergy, skin rash, headache, stomach pain, anaphylaxis etc. and in any of such case, I shall not held my Doctor liable and/or responsible. 

11. I am fully aware that treatment is being performed in good faith & that no guarantee or assurance of any nature has been given as to the result that may be obtained. 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 _______________________________ my Doctor to use telemedicine in the course of my diagnosis and treatment. 

12. I have read this entire consent / It has been read over to me & explained to me in the language that I understand and after understanding the same I hereby give my free and voluntary consent.  

Signature of Patient / Left hand thumb Impression of the Patient.

Date:

 (I have read out and explained the contents of this consent form to the Patient and he has understood the same and authorized me orally to sign on this consent form)

Signature of Parent /Care Giver /Next Friend of the Patient.  

Tele-Medicine Consent 

https://www.mohfw.gov.in/pdf/Telemedicine.pdf