Terms and conditions

TERM OF DECLARATION OF AWARENESS AND AUTHORIZATION

I give full authorization to Dr. Jaroslav Duchnicky Junior, enrolled in the CRM under number 32397 - SC to perform the service through electronic remote consultation services, hereinafter “Telemedicine”.

WHEREAS:

(The)

On August 26, 2002, the Federal Council of Medicine published Resolution No. 1643, which governs the provision of services through Telemedicine;

(B)

The referred resolution defines Telemedicine as the practice of Medicine through the use of interactive methodologies of audio-visual and data communication, with the objective of assistance, education and research in health;

(w)

The Federal Government, through the Ministry of Health, published Ordinance No. 467, of March 20, 2020, which provides, on an exceptional and temporary basis, for Telemedicine actions, with the aim of regulating and operationalizing measures to combat the public health emergency of international importance provided for in art. 3 of Law No. 13,979, of February 6, 2020, resulting from the COVID-19 epidemic;

(d)

Article 2, of Ordinance 467/2020, discipline that Telemedicine actions of distance interaction can include pre-clinical care, assistance support, consultation, monitoring and diagnosis, through information and communication technology, within the scope of SUS , as well as in supplementary and private health;

(It is)

Distance care must be carried out directly between doctors and patients, using information and communication technology that guarantees the integrity, security and secrecy of information;

(f)

The care provided by the doctor to the patient through information and communication technology must be recorded in the clinical record, which will contain (i) clinical data necessary for the proper conduct of the case, being completed in each contact with the patient; (ii) date, time, information and communication technology used for the service; and (iii) number of the Regional Professional Council and its state.

I declare that I am aware that:

(i)

remote care can include pre-clinical care, care support, consultation, monitoring and diagnosis;

(ii)

instability and/or unavailability of the system may occur as a result of technical problems in the services provided by the telecommunications and Internet access service providers of either party;

(iii)

for the good use and analysis of the Doctor I must inform all possible data, not omitting any information about my symptoms;

(iv)

the responsibility and veracity of the information provided to the Doctor rests entirely with the Patient;

(v)

the accuracy of my information is necessary due to the absence of a face-to-face clinical evaluation by the Doctor;

(saw)

it may be necessary to complement it with exams for a better diagnosis;

(vii)

even after the consultation, it may be necessary for me to be present at the office or, eventually, I will have to go to some public service depending on the diagnostic hypothesis;

(viii)

I may be referred, according to the doctor's assessment, to a face-to-face consultation or health service;

(ix)

all information and data obtained during the service will be entered in the Patient's medical record;

(x)

the electronic consultation is punctual and does not guarantee the Patient the right to care for an indefinite period or the availability of the doctor at other times not previously agreed between the parties.

Through this instrument, I authorize:

(i)

Recording of care provided through Telemedicine actions;

(ii)

I authorize the capture of my image and voice during pre-clinical care, assistance support, consultation, monitoring and/or diagnosis, as well as, but not limited to, fixing, editing and using them to allow the issuance of the report doctor and/or carrying out any technical-professional procedure;

(iii)

I authorize the sharing of my image and voice with other professionals for support and assistance in the diagnosis.

Finally, I declare that I have read the information and guidelines contained in this instrument, which I fully understand and accept.

Thus, I express my full consent to carry out the teleconsultation

ACCEPT THE TERMS

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