Teleconsultation Patient Consent Policy



Patient Name: 





Date of consent: 


Please read through the following statements and signify your consent, if you agree with the statement: 


  1. The registered medical practitioner (RMP) performing teleconsultation is licensed to practice medicine within India. 


  1. RMP, health worker, and Intelehealth will ask for my personal data including medical history, laboratory reports, test findings, health data, and other information for teleconsultation and providing me with telemedicine and telehealth services, that I wish to undertake for my medical condition.


  1. Intelehealth, RMP, health worker may make notes during the consultation, prepare written reports and prescriptions, and other documents containing my personal data; all of such documents will be treated as my personal data.


  1. My personal data shall be processed by Intelehealth in accordance with data processing consent notice that can be accessed here . [PSA: This creates an interconnected document, as the processing consent is taken once, but still relevant considering whole ambit of how telemedicine works.]


  1. I shall have a right to withdraw my consent to teleconsultation. If I withdraw my consent, RMP, health worker, and Intelehealth shall have no obligation to provide me with teleconsultation as the same would not be possible without my consent.


  1. Health worker and RMP have explained to me the limitations of teleconsultation, and I understand that the diagnosis, treatment, and care may require in-person consultations and tests. Teleconsultation may not be optimal. No emergency care will be provided. RMP or I may decide to stop teleconsultation at any point in time. In such scenario, I have to option to avail in-person consultation.


  1. I have been made aware of the risks associated with teleconsultations and thereafter, with free consent I have decided to avail it.


  1. I have been informed of other alternative options, and thereafter, I have decided to proceed with teleconsultation.  


  1. No results can be guaranteed or assured through the teleconsultation process. 


  1. Prescription provided is only for the concerned teleconsultation session. 


  1. I will be given an opportunity to ask questions during consultation.


  1. Teleconsultation will be as per applicable law. 


  1. There may be interruptions or technical difficulties during the teleconsultation and such situations may be out of the control of the RMP, Intelehealth, or health workers, who shall not be liable for the circumstance arising thereof.




I have read and understood the notice for consent. The details have been explained to me and I am aware of the consequences. With all required information, I hereby give my explicit, free, unconditional, and informed consent to teleconsultation. 


Acceptance through tick mark to record consent