Teleconsultation Informed Consent

I voluntarily consent to receive medical consultation through telemedicine (video call and/or chat) from the physician I selected. I understand that: - Telemedicine has limitations: the physician cannot physically examine me and may advise an in-person visit, laboratory tests or emergency care. - In an emergency I will call 911 or go to the nearest emergency room instead of waiting for a teleconsultation. - The information I provide must be truthful and complete for my physician to give appropriate advice. - My consultation records, prescriptions and chat transcripts will be stored securely as part of my medical record. - The consultation will not be recorded without my separate consent. - I am responsible for joining from a private location and a secure device. - Payment is made directly to the physician; any refund is handled by the physician. This consent follows DOH-NPC Joint Memorandum Circular No. 2020-0001 and DOH-DILG-PhilHealth JAO No. 2021-0001 on telemedicine.