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Telemedicine Informed Consent

Senter Dermatology Telemedicine Informed Consent

Effective April 2020

Telemedicine is defined as the delivery of health services via electronic communications. In it, I will not be in the same physical location as you are. Instead, our visit will be held via an internet-based interactive communications technology. I am using the platform, Doxy.me (www.doxy.me) for this technology. Doxy.me maintains the network and security software protocols necessary to protect your confidentiality. It has certified that it complies with regulations contained in the Health Insurance Portability and Accountability Act (HIPAA) of 1996.


The laws and professional standards that apply to in-person medical services also apply to telemedicine.  This document does not replace other agreements, contracts, or documentation of informed consent.


Technology Requirements

For our sessions, you must have a high speed internet connection. You will need access to a smart phone, tablet, or computer that has a camera, speakers, and microphone. The camera must be positioned in a place where we can see each other. You must also be in a well-lit environment.


The same rules and expectations concerning confidentiality exist for telemedicine as they do for in-office consultations. However, in this case, you are responsible for conducting the session in a secure, quiet, space where your confidentiality will be maintained. I will inform you if there are any observers to our session, and I expect that you will inform me if you have any observers present as well.

You must use your own equipment to communicate and not equipment owned by another, and specifically not using your employer’s computer or network. Any information you enter into an employer’s computer can be legally considered to belong to your employer, compromising your rights to privacy.

Risks and Benefits

Telemedicine has unique risks and benefits. Benefits include making access easier, especially for people who live far from the office or who do not have reliable transportation. It is also beneficial for people whose physical, emotional, or cognitive conditions may make it difficult for them to leave their home for appointments.

The technology does, however, have some limitations and therefore some additional risks. In particular, you may have difficulty maintaining privacy (and having a session free of interruptions) in your session if there are other people in the area. There may also be problems with failures in technology, such as slow connections or equipment failure on either end leading to interruptions in internet access. If you experience a medical or emotional crisis during a session, I will be unable to render immediate assistance.

Finally, it is possible that security protocols could fail, leading to a breach of privacy.

Disruption of Services

In the event that a failure of technology or other event disrupts our video visit, I will call you on the telephone to discuss what, if anything we will do in response to the failure. Options include, but are not limited to: (a) stopping the session; (b) transferring to in-person treatment; or (c) discontinuing treatment and arranging for a referral to a different practitioner.


Your participation in telemedicine services indicates you accept the permissions, risks, and responsibilities outlined above and freely agree to accept care via this service.