I, the Patient/ Parent/ Guardian hereby agree:
- To be serviced by the Practitioner from this Practice, with whom I have established a practitioner-patient relationship, or as a new patient, by means of electronic media (Zoom or similar; and/or by telephone and/or by WhatsApp Call or FaceTime call )as authorised by the Health Professions Council of South Africa (HPCSA) for the period of the Covid-19
- I understand that this platform will be used to render healthcare services to me, and that the usual consent processes 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 therefor release the Practitioner form being legally liable for
- 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 suchservice being rendered
e.g. the data used, telephone and/or computer, etc.
- That the Practitioner may encourage me to present myself for a face-to-face consultation at a healthcare facility close to me, if he/she is in doubt that the telehealth consultation is in my best interest, provided that it would be safe for me, the Practitioner and others, to do
- That I will be billed for a consultation at the rate of R900 for 25 minutes or any part thereof. I also understand that, due to the nature of the current pandemic, that the Practitioner may have to give urgent attention to their patient, and/or have to move my appointment to a later or earlier time or day.
- That my medical scheme may or may not cover the costs of this care. I undertake to cover any shortfall that my scheme does not cover, which may be the full amount. However, I understand that the HPCSA allows such care during the time of the Covid-19 Pandemic, and that certain services must be funded by my scheme in
- To record-keeping of the sessions, i.e. the Practitioners notes, which are required by law, and with my prior consent, to the recording of the live sessions as video and sound
- That the service may have limitations relating to technology, such as data and internet failures (e.g. dropped calls or badreception).
- That, although the Practitioner will adhere to the existing rules relating to confidentiality:
- I understand that I must take the necessary precautions at home to ensure my confidentiality during telehealth service
- I understand that, should I want a family member, caregiver, parent or other person to attend the sessions with me (in person or through remote internet connection), I will provide my written consent to such attendance prior to the consultation. I understand that without this, should such a person be in attendance, the engagement may be cancelled or
- I understand that, and agree that, should the practitioner believe that I may have been exposed to Covid-19 and/or do have Covid- 19, he/she 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
I, therefore, freely and voluntarily consent to this service, and I understand the implications thereof, including the costs related to it.