MEDICAL VOLUNTEER FORM
Please read the Terms and Conditions below before filling out the form.
Email *
Full Name *
Country/Location(Region) *
Specialization *
PRC License No. *
Beta Sigma Medicine Chapter *
Time of Duty to DOCPH *
Mobile No. *
FB/Messenger Account *
Terms and Conditions
• I fully understand and agree that the services rendered here are strictly for information and education purposes only and does not constitute any practice of medicine.

• I agree to share my specific personal data (marked as * above) to the public as part of DOCPH Directory for the patients (online or offline) to call. If you are using your personal smartphone you can opt to use a separate SIM card number for telemedicine consultation purpose.

• I have no employer-employee relationship with DOCPH. I am doing this FREE of charge.

• I agree to abide with all the Terms and Conditions including the Standard Operating Procedures/protocols of DOCPH in all my engagements/consultations with DOCPH online or offline services.

• Medical consultation done during a DOCPH telemedicine session (whether online or offline) is private and a privilege/confidential communication/relation between a doctor and a patient. All telemedicine consultations are done and adhere/abide to the general medical ethical principle on “do no harm”. DOCPH cannot be held liable in anyway on whatever outcome it may turn out. The license medical volunteer doctor assumes full responsibility and renders free DOCPH from any liability.

• By submitting this form, I fully understand my engagement including my responsibilities as a duly license medical volunteer doctor for DOCPH and will abide/agree fully with it.

• This shall also serve as a data sharing agreement between the medical volunteer doctor and DOCPH as the medical volunteer will be receiving personal information from patients covering their name, age, sex, occupation, civil service, address, contact number, e-mail address and health information. It shall be the doctor responsibility to maintain the confidentiality, privacy and security of any data shared or transferred to the medical volunteer, including the storage, retention and disposal of the said data, in accordance to the Data Privacy Act of 2012 or RA 10173 and its Implementing Rules and Regulations.

• For your consultation, the basic SOAP (Subjective, Objective, Assessment, Plan) protocol is recommended BUT the “O” is difficult to apply in a telemedicine setup so SAP will do instead.

• A validation and instruction email reply will be sent to you. Please expect it within 24hrs.

Please DO NOT Send Message to DOCPH Messenger, wait for your Moderator request first.
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