Consent To Examination And Treatment
I understand that I may require medications, examinations, diagnostic procedures or other treatments in connection with my condition. I hereby consent to the performance of such examinations, treatments, and procedures, as appropriate personnel deem necessary or advisable.
I understand that the practice of medicine is not an exact science, and I acknowledge that no guarantees have been made to me as to the results of treatments or examinations in the hospital.
I understand that I have the right to withhold consent to any medical procedure. I realize that if I withhold consent for a recommended procedure that treatment may be rendered partially or wholly ineffective.
I understand that the visit may occur via secured video platform and there may be limitation due to this modality of medical practice that is different than in-person visits. The benefits of telemedicine include improved access and more frequent visits while the limitations include incomplete physical examination.
Personal Electronic Devices
I understand that photographing, video/voice recordings of the doctor/provider is strictly prohibited, unless permission has been granted.
Health Care Privacy
The clinician who will be rendering services will adherent strictly to HIPAA practices. The healthcare records will only be provided to me or my legally authorized representative, or for treatment or payment purposes only.
Notice To Consumers
Medical doctors are licensed and regulated by the Medical Board of California (800) 633-2322; www.mbc.ca.gov.
Right To Advance Directives
I have been given written information on my right to make medical decisions and to have advance directives (in the form of a living will or Durable Power of Attorney for Health Care). I understand that it is my responsibility to provide the clinician with a copy of my advance directive, and that failure to do so may mean my wishes are not known to my providers. I understand that my advance directive will be handled with appropriate sensitivity and confidentiality and that I will be provided with the same quality of care whether or not I have an advance directive.
Acknowledgment
I certify that I have read the above and it has been explained to me so that I understand. I certify that I am the patient the parent/guardian of the patient or am duly authorized by the patient as his/her general agent to review the above and to accept its' terms.
info@asynchealth.com
2979 Quarry Rd, Pebble Beach, CA 93953
info@asynchealth.com
2979 Quarry Rd, Pebble Beach, CA 93953
info@asynchealth.com
2979 Quarry Rd, Pebble Beach, CA 93953
info@asynchealth.com
2979 Quarry Rd, Pebble Beach, CA 93953
info@asynchealth.com
2979 Quarry Rd, Pebble Beach, CA 93953
info@asynchealth.com
2979 Quarry Rd, Pebble Beach, CA 93953