INFORMED CONSENT FOR
TELEMEDICINE SERVICES
Video, Audio, and AI-Assisted Consultations
1. Nature of Telemedicine
2. Risks & Limitations
3. Emergency Protocol
NOT FOR EMERGENCIES
RSX Hospital Telemedicine is NOT intended for medical emergencies such as:
• Chest Pain (Heart Attack)
• Severe Bleeding / Trauma
• Stroke Symptoms (Slurred speech, paralysis)
• Difficulty Breathing
ACTION REQUIRED: If you experience these symptoms, you must disconnect immediately and visit the nearest physical Emergency Room (ER) or call an ambulance.
4. Privacy & Recording
5. Mandatory PCPNDT Declaration
I, the Patient/User, hereby declare that I am not seeking, nor will I ask for, any information regarding the gender/sex of a fetus. I understand that sex selection/determination is a punishable crime under the PCPNDT Act, 1994. RSX Hospital strictly enforces a zero-tolerance policy against sex selection.
6. Billing & Withdrawal
Acknowledgement & Agreement
I have read and understood the information provided above regarding telemedicine, have discussed it with my physician or such assistants as may be designated, and all of my questions have been answered to my satisfaction.
I hereby give my informed consent for the use of telemedicine in my medical care.