10. Declaration of consent for ATC
I have been informed and explained about the procedures of this ATC. Also, the treating doctors have discussed with me about my participation and have taken my permission. Possible risks too have been explained to me as stated in the information in a language understandable by me. I also understand that physical examination (for examining drug side-effects and other findings) are not part of ATC.
I understand that I have the right to withhold or withdraw my consent for ATC sessions at any point of time, without affecting any of my future treatment. I may revoke my consent in writing at any point of time by contacting my consultants. As long as this consent is in force (has not been revoked by me or by the doctor), Athma Hospital doctors may provide health care services to me via ATC clinic without the need for me to sign another consent form.
I have been explained that in case I require certificates/ documents/ medical record pertaining to my treatment, I will have to visit Athma Hospitals in person to apply for and receive the same. I understand that I will be responsible for payments of data charges (from my side). I am also aware about data security and encryption risks as per service provider/s. I also understand that the treating team has the right to terminate ATC, whenever he/she feels that in-person face to face consultation is needed or any other reason/s where ATC is not possible. I also understand that, I shall maintain privacy/confidentiality of the doctor’s consultation at my end.
I am also aware that Athma Hospitals team will contact me or my family member over my/their phone for various reasons including but not limited to fixing video consultation appointment, during and after ATC (if required). I am also aware that there may be a non-medical person (i.e., tele-technician) in the ATC studio during my ATC.
I clearly understand that Athma Hospitals, ATC, Consultants or therapists will not hold any responsibility for any adverse effects or situations occur.
In case the consultant advices to do consultation along with a caretaker, spouse, sibling in the best interest of care I will abide by it.
I, hereby undersigned, give my consent to be a participant of tele-after care consultation.