I, above mentioned in form, hereby give my express consent engage in telemedicine with CONSULTANT DOCTOR in K K hospital (hereinafter referred to as “Medical Practioner”) through the “I ACCEPT” button.

• I acknowledge and understand the following;
1. I acknowledge and understand that telemedicine is the use of electronic communication to practice health care delivery, diagnosis, consultation, treatment, transfer of medical data, and education using interactive audio, video, or data communications to deliver the same to a patient/individual who is located somewhere other than where the Medical Practioner is located.
2. I acknowledge and understand that unlike other technologies, the technology used for telemedicine has someb. I acknowledge and understand that unlike other technologies, the technology used for telemedicine has some risks, drawbacks & limitations and the examination is not possible and there can be judgemental error’s.
3. I acknowledge and understand that Government of India has allowed to prescribe only limited medicines. In view of the narrow margin safety, it is not allowed to prescribe schedule H drugs via telemedicine.


• I acknowledge and understand that I have following rights under this agreement;
1. I acknowledge and understand that I have the right to withdraw my consent with respect to the telemedicine and the Medical Practioner shall not be liable if my withdrawal has any adverse effect on my health.
2. I understand that all the information provided by me during the Telemedicine is protected by the laws of confidentiality.
3. I understand and acknowledge that person examination and diagnosis is the gold standard and telemedicine consists of risks and its own limitation. In view of the same, I hereby give my express consent for the telemedicine.
4. I acknowledge and understand that I may benefit from telemedicine, however the result is not guaranteed.


• I further acknowledge and warranty as follows;
1. I acknowledge and warrants that all the information provided by me is true and correct and I have not hidden any material facts with respect to my health. I further acknowledge and warrant that in case it is found that the information provided by me is not true, correct or I have hidden material facts relating to my health then the said agreement is terminated and the Medical Practioner shall not be held liable.
2. I acknowledge and warrant that I have read and understood the information provided above regarding telehealth, have discussed it with my counselor, and all of my questions have been answered to my satisfaction.
3. I acknowledge and warrant that I have read this document carefully and understand the risks and benefits related to the use of telemedicine services and have had my questions regarding the procedure explained. I hereby give my informed consent to participate in the use of telemedicine services for treatment under the terms described herein.

By clicking the “I ACCEPT” button I hereby state that I have read, understood, and I agree to the terms of this document.

For patient below 16 years of age, parent or guardian has given and confirmed consent.

Contact Us: In case of any feedback/complaints/queries relating to this telemedicine consent form please contact us on email ID: kkhospital2020@gmail.com