Tandem Informed Consent
Telemedicine/Tele-triage is the delivery of health care services using email, text messaging, interactive audio or video technology, where the pet and the veterinary professional are not in the same physical location.
I, the undersigned, being 18 years of age or older, am the owner or authorized representative of the owner of the animal(s) described and I am authorized to make decisions regarding its/their care.
I understand the potential benefits of using telemedicine consultation for my pet(s) as well as the potential risks of a treatment and/or procedure recommended based on telemedicine consulting, as a thorough physical examination may not be possible at all times using this mode of medical management and treatment for my pet(s). Limitations of telemedicine include inability to see the pet in person first-hand, inability to palpate body organs, inability to perform diagnostic tests that may usually be undertaken, and raises possible risks related to assessments and treatment decisions in case there is insufficient information available or provided to the veterinarian and/or veterinary team. I understand I may be required to schedule an in-clinic visit if it is felt that the information obtained via telemedicine was not sufficient to make a diagnosis.
These risks include but may not be limited to: Information transmitted may not be sufficient (e.g. poor resolution of images) to allow for appropriate health care decision making by the Veterinarian or Veterinary Technician. Use of electronic communications to discuss sensitive information can increase the risk of such information being disclosed to third parties. Despite reasonable efforts to protect the privacy and security of electronic communication, it is not possible to completely secure the information. Electronic communications can introduce malware into a computer system, and potentially damage or disrupt the computer, networks, and security settings. Electronic communications can be forwarded, intercepted, circulated, stored, or even changed without the knowledge or permission of the Veterinarian or the client. Delays in evaluation or treatment could occur due to failures of the electronic equipment or clinic staffing. Lack of access to all your health records may result in adverse drug interactions or allergic reflections or other judgment errors, including incomplete or inaccurate diagnosis of pets.
While risks of misdiagnosis and inappropriate treatment decisions resulting from incomplete information are higher with telemedicine, I understand that treatment decisions will be made with best available resources, including need for a possible in-clinic assessment directed by the veterinarian whenever deemed necessary. There exist potential risks of health and outcome if a telemedicine consultation was obtained without following up on the treatments and/or diagnostic tests advised during the consultation.
If my pet is experiencing an emergency, I will visit an emergency animal hospital immediately. Telemedicine consult will not be used for an emergency condition.
I consent to obtaining telemedicine veterinary consultation(s) and am aware that this method of consultation is not identical to an in-clinic patient visit for physical examination of my pet, including follow up or recheck consultations.
Prior to using these services, I understand that the veterinarian must have a valid veterinarian-client-patient-relationship (VCPR) to perform telemedicine. If you are only seeking veterinary advice, and there is not a valid VCPR established with the veterinarian, you will not be receiving a diagnosis, treatment, prognosis, or prescription medication.
I assume complete financial responsibility associated with costs of travel, medications, treatments, diagnostics, and additional evaluations (in person or via telemedicine) inclusive, outside of the cost of the telemedicine consultation. Informed consent is an ongoing process that requires continued discussion and consultation between the client and a veterinarian; and either may withdraw consent for further care or treatment at any time it deems necessary. I will be responsible for payment of services I have obtained until the time of such consent withdrawal.
By providing consent, you acknowledge that you understand and agree with the following: you may expect the anticipated benefits from the use of telemedicine, but that no results can be guaranteed or assured. Withdrawal of consent may occur at any time and must be submitted by email or written communication to Tandem.