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Telehealth Release Form
"I need a Telehealth Release Form for our mental health practice in Manchester that covers video consultations and messaging services, with specific provisions for recording sessions and handling sensitive mental health data under UK GDPR."
1. Patient Information: Patient's personal and contact details, including full name, date of birth, address, contact numbers, and email
2. Service Description: Detailed description of telehealth services being provided, including types of consultations and technology platforms used
3. Consent Declaration: Express patient consent for telehealth services, including acknowledgment of risks and limitations
4. Data Protection Notice: Information about how personal data will be processed, stored, and protected in compliance with UK GDPR
5. Technology Requirements: Technical requirements for accessing telehealth services, including minimum internet speeds and device specifications
6. Limitations and Risks: Disclosure of service limitations and potential risks associated with telehealth consultations
1. Insurance Details: Patient insurance information section, used when services are being billed to insurance providers
2. Emergency Protocols: Specific procedures and protocols for emergency situations during telehealth consultations
3. Recording Consent: Additional consent section for consultation recording and storage of recorded sessions
1. Technical Requirements Schedule: Detailed technical specifications for telehealth access, including supported devices and browsers
2. Privacy Policy: Comprehensive privacy policy detailing data handling practices and patient rights
3. Service Fee Schedule: Detailed breakdown of service fees and payment terms where applicable
4. Emergency Contact Form: Form for recording patient emergency contact information and preferred local emergency services
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