Telehealth Consent

General Consent

I give consent to participate in a teleconsultation in connection with Zone.Health which may include:

• Patient Health Records
• Medical Images
• Live audio and video interaction
• Output data from medical devices and sound and video files

Electronic Systems

I understand that Electronic systems will be used and will incorporate network and software security protocols to protect the confidentiality of patient identification and imaging data and will include measures to safeguard the data and to ensure its integrity against intentional and unintentional corruption following UAE Laws and Regulations.

Nature of Teleconsultation

I agree that during the teleconsultation:

• Details of my medical history, examinations, x-rays, and tests may be discussed with other healthcare professionals with interactive videos, audio, and telecommunication technology.
• A physical examination may need to take place.
• A non-medical technical person may be present in the telehealth studio to aid in video transmission.
• Audio and/or photo recordings may be taken for accurate diagnosis, treatment, and quality control.

Medical Information and Records

I understand that all existing federal laws and local regulations/policies/guidelines regarding access to medical information and copies of my Health Records apply to this teleconsultation. Dissemination of any patient-identifiable images or information for this telehealth interaction with other entities will not take place without my consent.

Confidentiality

I understand that responsible and appropriate efforts have been made to eliminate any confidentiality risks associated with teleconsultation and all existing confidentiality protections under UAE federal laws and local regulations apply to information disclosed during this teleconsultation.

Rights

I may withhold or withdraw consent to teleconsultation at any time without affecting my right to future care or treatment.

Disputes

I agree that any disputes that arise from the teleconsultation will be resolved as per UAE laws and regulations and will be raised with the telehealth provider in the first instance.

Expected Benefits

• Improved access to medical care by enabling me to remain in my home, office (or a remote site) while my DHA-licensed physician obtains test results and consults with other DHA-licensed physicians in distant/ other areas.
• More efficient medical evaluation and management.
• Access to expertise from distant specialists in the UAE or experts outside.

Possible Risks

As with any medical procedure, there are potential risks associated with the use of Telehealth, which may include, but are not limited to the following:

• Information transmission may not be sufficient (e.g. poor resolution of images) to allow appropriate decision-making by the consulted physician.
• Delays in medical evaluation and treatment could occur due to deficiencies or failure of equipment.
• In rare instances, security protocol could fail to cause a breach of privacy of personal medical information.
• In rare cases, a lack of access to complete health records may result in adverse drug interactions, allergic
• reactions, or other judgment errors.

Expected Benefits and Possible Risks

I have been advised of all the risks, consequences, and benefits of telehealth. My treating physician has discussed with me the information provided in a language I can understand. I have had the opportunity to ask questions about the information presented in this form and about the teleconsultation. All my questions have been answered and I understand the written information above.