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Peirson Center for Children Informed Consent for Telehealth free printable template

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9820 E Burnside St. Portland, OR 97216(971) 2027356 www.peirsoncenter.comInformed Consent for Telehealth Consultations Introduction Telemedicine involves the use of electronic communications to enable
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How to fill out peirson telehealth consultations pdf

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How to fill out Peirson Center for Children Informed Consent for Telehealth Consultations

01
Begin by reading the introductory section to understand the purpose of the consent form.
02
Fill in the child's full name and date of birth in the specified fields.
03
Provide the name of the parent or guardian who will be signing the consent form.
04
Review each section carefully, noting any key information about telehealth services and potential risks.
05
Sign and date the consent form at the designated area.
06
Ensure that you receive a copy of the signed consent form for your records.

Who needs Peirson Center for Children Informed Consent for Telehealth Consultations?

01
Parents or guardians of children who are seeking telehealth consultations at the Peirson Center.
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The Peirson Center for Children Informed Consent for Telehealth Consultations is a document used to inform patients and their guardians about the nature, risks, and benefits of receiving telehealth services for children.
Parents or legal guardians of the child receiving telehealth services are required to file the Informed Consent for Telehealth Consultations.
To fill out the consent form, you need to provide the child's information, your relationship to the child, confirm understanding of the telehealth process, and sign the document to indicate consent.
The purpose of the consent form is to ensure that parents or guardians are fully informed about the telehealth process, including potential risks and benefits, to protect the legal rights of both the provider and the patient.
The information that must be reported includes the child's name, date of birth, the nature of the telehealth services, the potential risks, benefits, and alternatives, as well as the consenter's signature and date.
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