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TEXAS PHYSICIANS GROUPPrimary Care and Specialty Clinics Affiliate of Lubbock Heart & Surgical Hospital PATIENT CONSENT FOR TELEMEDICINE CONSULTATION Pa ENT Name: ___ Medical Record No: ___ 1. I understand
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How to fill out telemedicine video visits at

01
Schedule an appointment with your healthcare provider for a telemedicine video visit.
02
Make sure you have the necessary equipment and internet connection for the video call.
03
Hhave your insurance information ready in case it is needed for billing purposes.
04
Be prepared to discuss your medical history, symptoms, and any concerns with your healthcare provider during the video visit.
05
Follow any instructions provided by your healthcare provider for follow-up care or prescriptions after the video visit.

Who needs telemedicine video visits at?

01
Individuals with limited mobility who may have difficulty traveling to a healthcare facility.
02
Those who live in rural areas with limited access to healthcare providers.
03
People who need routine check-ups or follow-up appointments but prefer the convenience of a video visit.
04
Patients with chronic conditions who require frequent monitoring and communication with their healthcare provider.
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Telemedicine video visits are virtual medical consultations conducted via video calls.
Healthcare providers or institutions offering telemedicine services are required to file telemedicine video visits.
Telemedicine video visits can be filled out through online platforms or electronic health record systems.
The purpose of telemedicine video visits is to provide medical consultations remotely, especially for patients who cannot visit a healthcare facility in person.
Information such as patient's details, date of visit, services provided, and healthcare provider's information must be reported on telemedicine video visits.
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