Setting up an appointment implies consent to engage with our genetic counselor. Please read below:
This consent is for the provision of telephone and video conferencing genetic counseling by GeneXsure and its genetic counselors.
You should share complete and accurate medical history and details regarding any conditions you may have or may be aware of in your family. The recommendations from your genetic consultation will depend on the accuracy of your family history. Issues of non-paternity (for example, named father is not the biological father) will affect the evaluation of your family history. We may request that you obtain genetic test results or medical records from a family member, if possible, in certain circumstances.
In the unlikely event of the telemedicine session being interrupted due to a technological problem or equipment failure, the appointment may be rescheduled.
While telehealth may improve access to care and lead to more efficient diagnosis, treatment, and care management, there are potential risks associated with telehealth, as there are with any medical treatment or procedure. The potential risks associated with telehealth include, but are not limited to: insufficient transmission of information that does not allow for appropriate decision-making and diagnosis by the health care provider; delays in diagnosis, consultation, and/or communication due to deficiencies or failures of equipment or systems; failure of security protocols, resulting in a breach of privacy of personal health information; or adverse results or reactions due to lack of access to complete medical records.
Under certain circumstances, telehealth may not be as effective or appropriate as face-to-face interaction, and your genetic counselor may refer you to another provider for follow-up or additional care. You can always choose to receive in-person care, even after consenting to receive services via telehealth.
The details of your telehealth interaction, which may include oral, written, and electronic communications between you and your health care provider, may become part of your medical records, as such details would not substitute for any other type of face-to-face interaction with a health care provider.
You hereby agree to indemnify and hold harmless GeneXsure, its affiliates, and its respective members, officers, directors, agents and employees from and against any and all claims, demands, losses, causes of action, damage, lawsuits, judgments, including without limitation attorneys’ fees and court costs, of any actual, threatened, or pending, civil, criminal, administrative cause of action, claim, inquiry, lawsuit, or other proceeding, and costs of investigation, arising out of or related to this online engagement.
You may discuss any questions regarding this consent form with the staff at Genexsure (615) 475-8350.
STATEMENT OF CONSENT
I have read and fully understand this informed consent document relating to genetic counseling and telehealth and the risks described in this consent. I wish to proceed with the genetic counseling session.