Telemedicine 101

Policies and Forms

• Consent to Participate in a Telemedicine Consultation
  From the Marquette General Hospital Health System.
• Informed Consent for Telemedicine Services
  From the Ophthalmic Mutual Insurance Company.
• Missouri Telemedicine Network Evaluation Forms
  Author/editor: none
  Date: n/a
  The following forms are available for download as pdf files: Adult and Minor Consent Form; Adult Consent Form Only; Minor Consent Form Only; Patient Questionnaire; Office Staff Form (patient demographics collected by the office staff); Telemedicine Continuing Education Registration & Evaluation Form. Adobe PDF
• MTN Telemedicine Forms
  From the Missouri Telehealth Network, forms for adult and minor consent, patient questionnaire, and videoconference request, as well as others.
• Telemedicine Forms
  From the Arizona TeleBehavioral Health Network, client consent and evaluation forms.
• Telemedicine Forms from the ATA
  Sample forms provided by the American Telemedicine Association for informed consent, confidentiality, evaluation,continuing education, etc.
• UTHSCSA Telemedicine Forms
  From the University of Texas Health Science Center at San Antonio, forms for consultation, patient consent, and patient survey.

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Links updated on 5/21/2008 7:26:24 AM