I consent to engaging in telehealth with Believers Church Medical College Hospital - "BCMCH" as a part of the therapy process and my treatment goals. I understand that telehealth services may include assessment, consultation, treatment planning, mental health evaluation and therapy.

Telehealth will occur primarily through interactive audio and video communications.

By agreeing to this consent, I am verifying that I understand the following:

1. I have the right to withhold or remove consent for telehealth services at any time without affecting my right to future care or treatment, nor endangering the loss or withdrawal of any program benefits to which I would otherwise be eligible.

2. The laws that protect the confidentiality of my personal information also apply to telehealth. As such, I understand that the information released by me during the course of my sessions is confidential, just as it would be if I were in the clinic. I understand that the visit is transmitted over dedicated lines and cannot be accessed by any unauthorized individuals.

3. I give my consent to be interviewed by the consulting healthcare provider. I also understand that other individuals may be present to operate the video equipment and that they will take reasonable steps to maintain confidentiality of the information obtained.

4. For Medical I understand that a limited examination may take place during the videoconference and that I have the right to ask my healthcare provider to discontinue the conference at any time. I understand that some parts of the exam may be conducted by individuals at my location at the direction of the consulting healthcare provider.

5. I agree that certain situations including emergencies and crises are inappropriate for telehealth services. If I am in crisis or in an emergency, I should immediately contact the nearby hospital and not continue with the telemedicine interview

6. I understand I should have the clinical history and relevant investigations including radiology with the doctor. If inaccurate details are furnished I am aware that the advices may be inadequate.

7. Understand that this modality is no replacement for direct consultation. I am aware that I can avail this facility in the jurisdiction of TCMC (travancore cochin medical council).

8. I understand that i will let my doctor to consult with other doctors about my condition

9. I understand telemedicine is used only for general problems, refill of medications and to get appointment

10. Minor should only avail this facility in the presence of guardian or parent

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