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CONSENT TO TELE-CONSULTATIOn
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כותרת ללא שם
כותרת ללא שם
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Full name: Le Thi Phuong Thao
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כותרת ללא שם
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I, the undersigned state and confirm that, in my full understanding that a tele-consultation is a medical consultation that implies the same input in terms of competence, expertise, time and support by the providing Medical Doctor as an in-person, I consent to comply with the provisions of the procedure for tele-consultation of Hanoi French Hospital (herein referred to as “the Hospital”), more specifically:
1. I confirm that I am the same person who is requesting the tele-consultation and it will be me, as patient that the doctor will actually be talking to. I understand that the doctor will not accept to perform a tele-consultation with anybody but the identified patient present. I have the right to have a third party present, if so announced to the doctor prior to the consultation.

2. I confirm that, I, as the patient for the tele-consultation am over 16 years old and that any patient under 16 years old will be redirected to an in-person consultation. 

3. I hereby consent to the processing of my personal data for the purposes of tele-consultation and any following medical treatment and related processing, administrative and other. I agree that HFH may collect, store, process and use the personal data I have provided within the legal boundaries of the Vietnamese law on Personal Date Protection. I can withdraw my consent to the processing of my personal data at any time via e-mail to contact@hfh.com.vn. 

4. The Hospital’s doctor of my choice performs tele-consultation following the process set by the Hospital of which I have been duly informed by the said doctor and per the information available at the Hospital’s website: https://www.hfh.com.vn/vi/node/730

5. I accept the conditions and to make payment in advance (online or by bank transfer) for the tele-consultation, and for, if any, medications and medical consumables as prescribed by the doctor, and for transportation for delivery of medication and/ or consumables, if any.

6. I fully understand that tele-consultation is a not substitute for a regular, in-person consultation with a doctor, made available to me at my request for a limited scope of follow-up to my treatment or convalescence. In case of any uncertainty of my physical or health condition, the doctor may request the patient come the Hospital for a full physical consultation, which will be free of charge if it takes place at the decision of the doctor and in less than one week from the date of the tele-consultation.

7. I fully consent to comply with the doctor’s advice and instructions on treatment and use of medications, and completely exempt the Hospital from any responsibility for all frequently occurring risks and potential risks relating to the use of medications

8. I will inform the Hospital of my choice of telecommunications (telephone, video link, …), which the Hospital will endeavor to accommodate and I accept that the security and possible risks of this link are my full and sole responsibility.

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