For many years patients and physicians have engaged in contact for medical decision making via telephone or face to face. Because patient and physician could not see each other, however, the advantages of telephone communication have not outweighed the disadvantages sufficiently to justify substitution for routine face to face contact. The availability of communication technology providing for visual as well as sound communication has altered the balance; however the patient must understand the relative risks and benefits, advantages and disadvantages, as well as procedures, to allow for safe and effective use for medication management.
Dr. Edwards may provide medication management contacts in selected situations via Internet audio/video connection. This document spells out the terms under which he provides this service. Please note that use of this technology will be at Dr. Edwards’ discretion and with the patient’s consent and that the patient may choose a face to face visit at Dr. Edwards’ office, schedule permitting.
The fee of $90 is payable at the time of service. A “no show” fee of $50 will apply if the appointment is not cancelled in advance but may be credited if the contact is rescheduled for later the same day.
The patient must have use of a computer with broadband Internet connection with microphone, headphones or speaker(s), and Web camera. If any equipment does not function adequately, the contact will be rescheduled. Quality of connection must be adequate for Dr. Edwards to visually identify the patient.
In determining whether a given contact may take place via telephone, via Internet or in the office, Dr. Edwards will weigh several factors. These include but are not limited to:
Dr. Edwards and the patient agree that neither will record contacts via telephone or Internet connection without written consent from the person(s) to be recorded, except that the patient gives Dr. Edwards permission to make a snapshot (still image) during the session for identification purposes. Any such images will become part of the medical record. The patient assumes responsibility for security of digital files or other media containing recordings of sessions.
Security and privacy:
The patient understands that security and privacy can never be absolute and may be difficult to assess reliably, even for office visits. The patient accepts the risk that hacking or eavesdropping may occur and agrees to transmit critical private information via separate telephone, mail, or fax communication. The patient assumes full responsibility for assuring privacy of communication at the patient’s location. The patient understands that privacy can be enhanced by using headphones instead of loudspeakers, by considering who may be listening from adjacent rooms, by closing doors or windows, and by speaking softly during the contact.
The patient understands that insurance may not reimburse for contacts via the Internet.
Although Internet audio/video services may include text communication capabilities the patient agrees to use them only during sessions and with Dr. Edwards’ explicit authorization. The patient agrees he or she will never attempt to contact Dr. Edwards via associated text or email at other times since Dr. Edwards does not monitor such communications.
The patient understands that Dr. Edwards does not provide emergency services, except to the extent described in the table below, and agrees to call 911 for all emergencies.
The patient agrees to obtain recommended laboratory testing locally or to travel to Dr. Edwards’ office for specimen collection.
Unless Dr. Edwards objects the patient is permitted to have other persons present at the patient’s location during the contact. The patient agrees to provide Dr. Edwards with the identity of any such person(s) at his request.
Internet Connection Procedure:
All Internet contacts must be scheduled in advance. Either Dr. Edwards or the patient may initiate the contact. If the patient attempts to contact but Dr. Edwards does not respond, the patient may wait for Dr. Edwards to initiate the contact or try again every 5 minutes until 15 minutes after the scheduled time. If Dr. Edwards still does not respond, the patient should call Dr. Edwards’ office and leave a voice mail message.
If either party is unable to establish contact, or in the event of interruption of contact, both the patient and Dr. Edwards agree to attempt contact by telephone to establish alternate plans. However, telephone contact or Internet contact without video will not be considered adequate to replace office visit or audio/video contact. Dr. Edwards may ask you where you are located and to participate in a simple test to determine that you can see him adequately at the start of a session.
I have read and understand the terms outlined above and have discussed them with Dr. Edwards who has answered all of my questions to my satisfaction. I agree to abide by these terms in accepting medication management service provided by Dr. Edwards.