Online Consult Patient Telemedicine Consent & Disclaimer
I hereby attest that I have requested and authorize The Treating Physician / provider for an online consult for me or for the person requested regarding the diagnosis mentioned in the conditions section.
The Treating physician or provider will reach his or her conclusions regarding my medical diagnosis based solely on the information provided by me.
I understand and agree that:
- Online consult is solely based on the information provided by me and, in the absence of a physical evaluation, the provider / treating physician may not be aware of certain facts that may limit or affect his or her assessment or diagnosis of my condition and recommended treatment.
- Online consultation is very different from a regular face-to-face examination and that the Treating physician / Provider providing the consult is limited by the written information and imaging provided by me. Accordingly, the diagnosis I will receive is limited and provisional.
- An online consult is not intended to replace a full medical face-to-face evaluation by a physician.
- The Treating physician / provider is only rendering an online consult and does not assume any responsibility for my continued medical care or treatment.
- My medical information will be handled with strict confidentiality, privacy and security; however, I understand there are risks associated with any electronic transfer process from one location to another.
- I solely assume the risk of the limitations set forth herein, and I further understand that no warranty or guarantee has been made to me concerning any particular result related to my condition or diagnosis.
Disclaimer and Release
I hereby completely and irrevocably release Meta16labs Healthcare & Analytics Private Limited and its parent and sister corporations and their respective medical staff members, physicians and other health care professionals, insurance providers, administrators, officers, employees and directors (collectively, the “Wurkwell Parties”) of any and all errors and omissions, known or unknown, foreseen or unforeseen, knowingly or unknowingly, as well as all claims, actions or damages arising from or in connection with the online consult, conclusions or recommendations provided by Wurkwell Parties or its physicians. Furthermore, I agree that the Wurkwell Parties have no liability or responsibility for the accuracy or completeness of the medical information submitted to them or for any errors in its electronic transmission.
As a condition to receiving the online consult service, I have read and acknowledge that I have given this consent of my own free will.
By accepting and agreeing to these terms, I acknowledge and agree to assume the risks of the limitations set forth herein.