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Telemedicine Care

We at Alliance Retina have responded quickly to protect you during the current Coronavirus threat while also continuing your necessary retinal care. Telemedicine support has changed dramatically from the old days of expensive, slow meetings at facilities away from your home to new technology-driven solutions. During this time, we will offer an online video visit option from the comfort and safety of your home. If you need imaging, injections, laser, or other "in person" services, we will arrange and expedited office visit to meet such needs.

The Telemedicine Process

Scheduling the visit is the same as with other visits.
Giving Consent (See below)
At the visit time, a technician will call you and , as with any visit, will collect initial information on how you are doing and review your medical history and medications.
After this, the technician will advise Dr. Rosenthal that you are ready to be seen, and he will either call you for a "FaceTime" visit (if you have an Apple phone) or email you a link for a video chat. You can make this choice at the time your visit is scheduled.
If you have neither an Apple Phone or access to email, we will make other arrangements.
If you have a routine visit coming up and are having no new problems, we can reschedule your visit for May or after, when hopefully, the pandemic crisis will be under better control.
If you are sick or in distress, you should call 911 or call an Emergency Room or your PCP.

ALLIANCE RETINA, LLC
TELEMEDICINE PATIENT CONSENT

PURPOSE: The purpose of this form is to obtain your consent to participate in a telemedicine visit for ongoing retinal care.

NATURE OF TELEMEDICINE VISIT: During the telemedicine visit: a. Details of your medical history, examinations, x-rays, and test may be discussed with other health professionals through the use of interactive video, audio, and telecommunication technology. b. A physical examination of you may take place. c. A non-medical technician may be present in the telemedicine studio to aid in the video transmission. d. Video, audio and/or photo recordings may be taken of you during the procedure(s) or service(s).

MEDICAL INFORMATION & RECORDS: All existing laws regarding your access to medical information and copies of your medical records apply to this telemedicine visit. Please note, not all telecommunications are recorded and stored. Additionally, dissemination of any patient identifiable images or information for this telemedicine interaction to researchers or other entities shall not occur without your consent.

CONFIDENTIALITY: Reasonable and appropriate efforts have been made to eliminate any confidentiality risks associated with the telemedicine visit, and all existing confidentiality protections apply to information disclosed during this telemedicine visit.

RIGHTS: You may withhold or withdraw consent to the telemedicine visit at any time without affecting your right to future care or treatment.

Your health care practitioner has discussed with you the information provided above. You have had the opportunity to ask questions about the information presented on this form and the telemedicine visit. All your questions have been answered, and you understand the written information provided above.

I agree to participate in a telemedicine visit for the procedure(s) described above.

NAME:

Date of Birth

EMail:

Cell Phone with Area Code

Do you have an iPhone

Yes No

Do you want to FaceTime or Video Chat.

FaceTime Video Chat on Computer

Consent

ALLIANCE RETINA, LLC
TELEMEDICINE PATIENT CONSENT
PURPOSE: The purpose of this form is to obtain your consent to participate in a telemedicine visit for ongoing retinal care.
NATURE OF TELEMEDICINE VISIT: During the telemedicine visit: a. Details of your medical history, examinations, x-rays, and test may be discussed with other health professionals through the use of interactive video, audio, and telecommunication technology. b. A physical examination of you may take place. c. A non-medical technician may be present in the telemedicine studio to aid in the video transmission. d. Video, audio and/or photo recordings may be taken of you during the procedure(s) or service(s) 
MEDICAL INFORMATION & RECORDS: All existing laws regarding your access to medical information and copies of your medical records apply to this telemedicine visit. Please note, not all telecommunications are recorded and stored. Additionally, dissemination of any patient identifiable images or information for this telemedicine interaction to researchers or other entities shall not occur without your consent.
CONFIDENTIALITY: Reasonable and appropriate efforts have been made to eliminate any confidentiality risks associated with the telemedicine visit, and all existing confidentiality protections apply to information disclosed during this telemedicine visit. 
RIGHTS: You may withhold or withdraw consent to the telemedicine visit at any time without affecting your right to future care or treatment.
Your health care practitioner has discussed with you the information provided above. You have had the opportunity to ask questions about the information presented on this form and the telemedicine visit. All your questions have been answered, and you understand the written information provided above. 
I agree to participate in a telemedicine visit for the procedure(s) described above.

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