The following should be read in its entirety and the form at the bottom should be completed & submitted prior to the First Zoom appointment.

If the patient has any issues or concerns at any time with using Zoom or other Audio / Visual (AV) applications on their computer or smartphone, then the “backup plan” is a Phone Consultation, where the patient rings for the appointment instead.

WRITTEN CONSENT IS REQUIRED FOR AV CONSULTATIONS

A requirement of the Sydney Psoriasis Skin Clinics (for brevity, herein known as “SPSC”) Trade Association & Insurers is that SPSC MUST have a consent form signed one time in any 12 month period by every Patient (for brevity, herein known as “PT”) who wishes to have an appointment via AV web conferencing.

It is not a sufficient indicator of consent to just send photos beforehand & then just connect to the AV conference.

It is a condition of SPSC providing this service that the PT completes & submits the form below, prior to the first appointment, in order to provide their written informed consent that they permit SPSC to consult & obtain, use, disclose, recommend & transmit information through an AV mechanism over the internet.

PRIVACY & CONFIDENTIALITY

The PT understands that the SPSC intends to provide audio-visual consultation(s) which are designed to be private meetings between the practitioner host & PT, & that no part of the consultation will be recorded by any parties (including the patient or others associated with the patient).

The PT consents to the sharing of photos & other documents between them & the practitioner, including, but not limited to, any exchanges made before, during or after the consultation of photos, screen prints, professional reports or results or similar. The patient further understands that it may be necessary for the practitioners’ confidential staff to have access to those documents in order to facilitate meeting(s) or other activities related to file-keeping, financial transactions, despatch of medicines and other products, and for other reasonable purposes associated with the ongoing treatment of the patient.

Additionally, the PT understands that, unless further agreed at the time of the web meeting regarding any technical assistance etc required, the only persons authorized to be present in the online room for any meeting will be the PT personally, anyone that the PT has in the room in which their device is currently active, & the practitioner hosting the meeting.

No other person will be approved to be present for the duration of the consultation without the PT’s explicit consent. Should a technical person or another staff member need to enter the physical room to deal with any technical or other issue, the PT will be informed of their entry, departure & when the consultation room is again securely closed and private.

The PT is aware that the Zoom program is designed to restrict online entry only to those who have authority to be in the online room. However, the PT further understands that, as with any electronic communication in this digital age, this cannot be guaranteed due to the potential of malice and stealth issues from outside parties, regardless of the extent to which we, the AV provider and the patient go to protect the devices and meeting room security.

The practitioner host has information on the program dashboard regarding any others currently registered in the online room.

The PT understands that SPSC has appropriate technology to conduct online audio-visual consultations such as antivirus and security software, encrypted router and a technical support person onsite, to assist in maintaining confidentiality.

TECHNICAL ISSUES – PHONE CONSULTATION INSTEAD

The PT understands that it is in their interests to utilize the AV conferencing system as it will greatly assist in clearer appraisal & understanding of the current state of the skin condition, but in the event that there is a technical issue (internet connectivity, bandwidth etc that is insufficient to support audio & video quality etc) which cannot be remedied prior to or at the time of the consultation, or if the PT decides at any time to not consult via this audio-visual means, the consultation(s) may be converted to a Phone Consultation(s) instead.

Should there be a technical issue with the PT’s device, or the AV program, that can’t be remedied during the consultation, even with the remote assistance of the SPSC technical person on-site, the PT holds the practitioner & SPSC blameless & agrees to call back as soon as possible to continue as a Phone Consultation instead.

CONSULTATION, PRODUCT & POST COSTS

All consultations require a consultation fee to be paid & Phone/Web consultation fees are the same cost as personal visits. The PT agrees to pay this fee along with the cost of prescribed medicines, topical products agreed upon, & the cost of postage to the PT’s address, & agrees to pay these amounts either before or at the time of the consultation(s) as we do not hold receivable accounts.

The PT accepts that this AV consultation is in lieu of a personal visit & occupies a specific time period that is specifically reserved for the PT, & a fee is payable should they not present or reschedule in a timely manner. The PT is also aware that the practitioner continues with appointment-related activities, calculations of dosages etc & writing of prescriptions even after the face-to-face side of the consultation has ceased, and then the order will be posted by eParcel or other postage service.

The PT further understands that the costs of medicines, topical products & post will, where uncomplicated, normally be determined & communicated during the consultation.

The PT is aware that a consultation fee normally applies for any booked meetings, unless there are at least 8 clear business hours (between 9.00am & 5.30pm) provided by the PT requesting to cancel or reschedule that appointment.

NORTH SYDNEY CLINIC IS CURRENTLY CLOSED

The PT understands that all calls & emails for both clinics come only to the Sylvania Main clinic, & all files for both clinics are securely stored at Sylvania.

Additionally, the PT is aware that all orders of medicines & topical products, regardless of which clinic the PT has been associated with in the past, will be sent from the Sylvania clinic via courier, which at this time are being distributed by AUSPost secure eParcel means.

The PT is aware that the North Sydney room is currently closed & that no pickups of any products are possible from that clinic until further notice.

AUTHORITY

The form is a declaration signed by the patient, (or by the parent/legal guardian of the patient, who declares as though they are the patient) and consents to taking part in online AV consultation(s) with Moree Coburn of SPSC, or other practitioner as agreed, in order for that practitioner to provide advice, as well as treatment medicines & topical products for the skin condition, as discussed in any consultations.

If the patient is under 18 years, then the parent/guardian, additionally on their own part, provide consent both on behalf of the minor patient, & as the parent / guardian, & also agrees that one of the parents / guardians responsible for the minor patient will be present during the entire consultation(s).

The PT understands that the signing of this document does not preclude them from at any time discussing the consent authority or its’ contents with their legal professional, and we recommend doing so if the PT has any concerns whatsoever. However, any advice should be sought and acted upon prior to attending the first consultation as this document with be considered to be ratified upon attendance at the first consultation

AUTHORITY EFFECTIVE FOR 12 MONTHS

This authority will be effective for 12 months from the date of consent, and will renew automatically for another 12 months if the PT returns at a future time for another treatment period. The PT may withdraw consent at any time by simply advising in writing, & the authority, for future consultations, will then cease from the time of receipt of such consent withdrawal.

The comfort of Patients with the use of AV equipment & computers, will be variable, & so their experiences may impact on their likelihood to embrace the concept of using online audio-visual technology.

Therefore, If I have any issues at any time with using AV technology, then I will not feel compelled to provide or continue my consent, & I understand that my consultation(s) may just remain as Phone-based without penalty. 

Unfortunately, Phone Consultations are not possible for New Patients.

I agree to provide my consent, if I am comfortable in doing so, at least FOUR (4) BUSINESS HOURS  prior to attending a video consultation with SPSC. (i.e. for a 9.00am appointment, we require the form to be completed before 1.00 pm the previous business day to 1) receive the form through the internet, 2) check the form, 3) ensure that there is sufficient time to enable us to enter the appointment into the ZOOM system as well, 4) to then provide the link to you from the ZOOM program itself, and 5) for you to then receive the link via email, considering always that in times of peak workload our staff may not be able to quickly attend to any request. )

[Date of update 20 July 2022 12.43pm]