TelemedicinE Consent

I understand that:

• telemedicine is the use of electronic technology for communication for the purpose of providing healthcare services wherever the consultant and the patient are located;

• the healthcare institution TRT Baltic (hereinafter – the Institution) is based in Latvia and likewise uses telemedicine to conduct a consultations with their patients;

• with the use of telemedicine, the interactions shall be done through real-time audio-video communication;

• the laws that protect privacy and confidentiality, as well as the confidentiality of medical information also apply to telemedicine;

• I will be responsible for any payments that apply to my telemedicine visits and treatment;

• I have the right to withhold or withdraw my consent to the use of telemedicine in the course of my care at any time, without affecting my right to future care or treatment;

• I have the right to access my information and to inspect my medical information that was transmitted through telemedicine;

• I have the right to privacy where it shall be necessary to seek my consent in order to disclose my information unless those that are permitted by law to disclose without the need of my consent;

• any lawsuit arising from this agreement or service shall be brought before the courts of the Republic of Latvia.

With the pronouncements above I authorise the Institution:

• to provide me their diagnosis, observations, recommendations regarding my condition through telemedicine;

• whenever necessary, to consult with other physicians or specialists whom they believe to have full knowledge and skills that can address my case.

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