• Teleconsultation appointment form

    Asia Medical Specialists
  • PATIENT CONSENT

    PURPOSE: The purpose of "Teleconsulation appointment form" is to get the patient's consent in order to conduct teleconsultation. The patient understands and agrees that:

    1. The Patient hereby authorise Asia Medical Specialists to use the teleconsultaiton practice platform for telecommunication for evaluating, testing and diagnosing his/her medical condition.

    2. Technical difficulties may occur before or during the teleconsultaiton sessions and his/her appointment cannot be started or ended as intended. The information transmitted may be of insufficient quality to allow for appropriate medical or health care decision making.

    3. The professionals can conduct interactive sessions with video call; however, The Patient is informed that the sessions can be conducted via regular voice communication if the technical requirements such as internet speed cannot be met.

    4. The Patient's current insurance may not cover the additional fees of the teleconsultaiton practices and may be responsible for any fee that that insurance company does not cover.

    5. The Patient's medical records on teleconsultaiton can be kept for further evaluation, analysis and documentation, and in all of these, his/her information will be kept private. Reasonable and appropriate efforts have been made to eliminate any confidentiality risks. The electronic systems, in some instances, may fail and cause a breach of privacy and/or personal health information.

    6. In certain situation, his/her condition cannot be diagnosed by the mean of teleconsultation and he/she might need to further arrange another face-to-face consultation to properly assess the condition. This current teleconsultation will still be considered as a completed consultation.

    7. If a further face-to-face consultation is needed, the patient understands it is solely up to his/her own decision.

    8. If the patient is under 18 years old, an accompany adult (parents, guardians or next of kin) must be present with the patient during the consultation and the accompany adult must sign on the form as well.

  • By signing this form,

    The patient understands that all the laws that are protecting his/her privacy of medical history or information are also applied to telemedicine practices.

    The patient understands that the preferred date and time is not a guaranteed time commitment. The clinic will liaise with the patient to confirm the final date and time of the teleconsultation.

    For special requests, please directly contact our staff through email: info@asiamedical.hk, or call us at 2521 6831.

  • Clear
  • Guardian Information (fill in if patient is under 18)

  • Clear
  • Should be Empty: