Telemedicine is the set of activities, services and methods related to health, which are carried out at a distance, with the help of information and telecommunications technologies. They are regulated by Law 1419 of 2010 and Resolutions 2694 and 3100 of 2020, issued by the Ministry of Health.
Telemedicine is the provision of remote health services by health professionals with the purpose of facilitating access and opportunity in the provision of services to the population that has limitations in movement, supply or access to services in their geographic area.
I, _________________________________, identified with the ID card/Passport/Other: ___________________, by means of this document authorize the IPS HERO Institute SAS and its specialist doctors in hair restoration, to make use of tele-health modalities for my medical care, and likewise authorize that the information that is going to be generated by any of these means is used in any of the phases of health care: promotion, prevention, diagnosis, treatment, rehabilitation or palliation.
I acknowledge that the following documents can be generated in the development of care: a) Clinical history; b) Diagnostic images; c) Audio and video recordings; d) Input and output of data from medical devices and sound files.
I have been informed that the electronic systems used incorporate security protocols and software, and have the necessary measures to protect and guarantee the authenticity, comprehensiveness, availability and reliability of all my clinical history and care in this modality.
I recognize that tele-health it is about having better access to the provision of medical care by specialists, in situations that prevent face-to-face care, giving continuity to health care and obtaining the decision of medical behaviors in a more efficient and timely manner.
I recognize that the provision of services through tele-health modalities is subject to the common system of health obligations, generating obligations of means for the health professional, based on the professional autonomy of the specialist; therefore, the effective degree of improvement cannot be predicted or guaranteed by the professional.
I have been informed of the possibility that risks may arise in health care through tele-health in addition to the normal ones that are known in face-to-face care. These risks include but are not limited to:
- In certain cases, the specialist may consider that the information provided is not sufficient and require the need for a in-person consultation.
- It's possible there could be differences in the diagnosis and/or the suggested treatment between a virtual visit and an in-person visit, since virtual care can't completely replace seeing a healthcare provider in person.
- There's risk of delays, call drops, or ending without having defined a medical course of action due to tech issues.
- Even though I have been told the specialist follows security protocols, eventually and infrequently those same protocols could fail, causing a breach of privacy of my medical information.
Under oath, I acknowledge that the information that I have delivered to the specialist and that which I will deliver in the future is true and any anomaly that arises from the incorrect or inadequate information provided by me does not compromise the responsibility of the specialist.
It has been explained to me that I may withdraw consent to the use of tele-health modalities at any time, which will not affect my future care or treatment.
The laws that protect the confidentiality of my medical information also apply to telemedicine. As such, I understand that information disclosed during the course of treatment is confidential.
Telehealth care may imply the need to carry out tests or diagnostic aids in my residence or eventually attend an IPS to carry them out, committing myself to allow the tests to be carried out or to go to the place indicated for it by the specialist.
I acknowledge that informed consent is a medical act that begins with the interaction with the specialist and is formalized with the recognition, acceptance and/or signing of the consent document.
Once everything related to care has been explained and any doubts have been cleared up, I accept and consent to the consultation being carried out through tele-health modalities by the medical staff of the IPS HERO Institute SAS.
Patient's signature:
