MEDICAL CONSENT FORM
Before starting your consultation with a physician of Private Palz Home Care Center (Palz Sağlık Limited Company) via the ELRA Remote Health Service Platform (“Remote Health Information System”) and before receiving remote healthcare services, please read the following terms carefully and confirm your consent by approving this form.
In this consent form, the term “Healthcare Facility” refers to Private Palz Home Care Center.
1. The nature of the telehealth service to be provided through this consultation is limited to the scope defined by the Regulation on the Provision of Remote Healthcare Services. During this consultation, you will not be in the same physical environment as the healthcare professional, and no physical contact will occur. Remote healthcare service is not equivalent to an in-person medical service. Telehealth services differ from hands-on treatment.
2. The health information you provide during the consultation will be recorded and shared with the Ministry of Health in compliance with the Personal Data Protection Law (Law no 6698, KVKK).
3. All medical opinions and decisions regarding your health and/or questions fall within the professional discretion of the physician you consult. Our platform has no authority to intervene in these decisions.
4. If there are third persons present in your environment during the consultation, you are responsible for informing the physician about their presence.
5. To use the online consultation service, you must grant access permission to your microphone and camera. No audio or video recording can be made without your consent. Technical problems with your camera or microphone may prevent the video consultation from starting or continuing.
6. You acknowledge that any health-related decisions made after receiving this service are solely your responsibility as the user.
7. In case of any medical emergency, you must immediately apply to the nearest emergency department and/or call 112 emergency services. Healthcare Facility does not accept any responsibility otherwise. Likewise, if during the consultation the physician of the Healthcare Facility advises you to contact emergency services, it is your responsibility to call 112 or another emergency hotline.
8. If you are undergoing an ongoing treatment, you may benefit from telehealth services provided that it does not interfere with or interrupt your current treatment. In such cases, the physician of the Healthcare Facility reserves the right to refuse to modify or intervene in your ongoing treatment. Similarly, the physician may, based on the information you provide, refer you directly to a physical examination without giving any diagnosis or medical opinion.
9. You are receiving this online consultation service in return for a fee. This service is not covered by any health insurance.
10. For medical or legal reasons, the physician of the Healthcare Facility may unilaterally terminate the consultation—either before the telehealth service is provided or before the consultation time is completed—after informing the other party.
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☐ I HAVE READ, UNDERSTOOD, AND FREELY CONSENT TO THIS INFORMED CONSENT FORM.
☐ I HAVE READ, UNDERSTOOD, AND FREELY CONSENT ON BEHALF OF MY CHILD/PATIENT AS THEIR LEGAL GUARDIAN.
☐ I HAVE READ, UNDERSTOOD, AND FREELY CONSENT ON BEHALF OF MY PATIENT AS THEIR LEGAL CUSTODIAN.