What is an Online Consultancy Service?

Online Consultancy Service is the remote delivery of healthcare services by a registered medical practitioner (“Doctor”) using information and communication technologies, that involves sharing Your health information with the Doctor via a text-based, audio-based or video-based medium, on the basis of which the Doctor will arrive at a diagnosis and treatment plan (“Online Consultancy”).

By availing the Online Consultancy Service, You understand and consent to following:

Risks of Teleconsultation

The beneficiary of the Online Consultancy Service (“I/me”) understand that, in addition to the risks associated with the treatment being administered through an Online Consultancy itself, Online Consultancy also bears certain risks. These include:

  • The inability to have direct, physical contact with the patient which may impact the quality of service and treatment being rendered.
  •  In rare cases, information transmitted may not be sufficient (e.g. poor resolution of images) to allow for appropriate medical decision making by the Doctor(s);
  • Delays in medical evaluation and treatment could occur due to deficiencies or failures of the technical infrastructure;
  • In very rare instances, security protocols could fail, causing a breach of privacy of personal medical information/ PII;
  • In rare cases, a lack of access to complete medical records or information may result in adverse drug interactions or allergic reactions or other judgment errors;

Doctor-Patient Relationship

I understand that this Online Consultancy is being facilitated by GUSTAVO but is being provided by the Doctor only. GUSTAVO does not, and is not qualified to, provide medical services. There is no doctor-patient relationship being established between GUSTAVO and me.

Outcomes of Teleconsultation

I acknowledge that the outcome of the Online Consultancy is reliant on the information that I provide, and agree to provide such information to the Doctor that is true and accurate.

I understand that the diagnosis and treatment plan determined during the Online Consultancy could change based on my condition, and that I should visit a Doctor for a an in-person consultation if my clinical condition worsens.

I understand that, by agreeing to a Online Consultancy, the Doctor is not guaranteeing the suitability of a teleconsultation for my case, and the Doctor is at liberty to, at any time, discontinue the Online Consultancy.

I understand that if my Doctor believes I would be better served by another form of services (e.g. face-to-face services), I will be referred to a Doctor who can provide such services in my area.

Neither the Doctor nor GUSTAVO make any explicit or implied guarantee that a prescription will be issued to me following the Online Consultancy.

My Rights

I understand that I have the following rights with respect to the Online Consultancy:

  • I have the right to withhold or withdraw consent at any time without affecting my right to future care or treatment.
  • The laws that protect the confidentiality of my medical information also apply to Online Consultancy.
  • As such, I understand that the information disclosed by me during the course of my treatment/ consultation is generally confidential. However, there are both mandatory and permissive exceptions to confidentiality under the law.
  • I also understand that the dissemination of any personally identifiable images or information from the Online Consultancy interaction to researchers or other entities shall not occur without my written consent except as governed by the Privacy Policy of GUSTAVO.

Acceptance of Terms

I acknowledge and agree that my Online Consultancy will be governed by the Terms and Conditions and Privacy Policy, as well as this Informed Consent Form.

I hereby clarify that I am above eighteen (18) years of age, and competent to contract. If I am agreeing to these terms for the treatment of a third-party, I represent that am authorised to consent to treatment on behalf of the patient.

I hereby agree to avail of Online Consultancy offered by the Doctor and GUSTAVO for my medical care.

BY ENGAGING IN THIS ONLINE CONSULTANCY, I AGREE AND CERTIFY THAT I HAVE READ AND UNDERSTAND THE INFORMATION PROVIDED ABOVE, AND UNDERSTAND THE RISKS AND BENEFITS OF ONLINE CONSULTANCY. FURTHER, I GIVE MY INFORMED CONSENT TO PARTICIPATE IN ONLINE CONSULTANCY AND OTHER SERVICES PROVIDED BY GUSTAVO.