2 STEP PROCESS
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Dr. Lieberman provides
patients located in
the Commonwealth of Massachusetts only.
using this web site.
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© 2013 VIRTUAL MEDICAL CONSULTATIONS • ALL RIGHTS RESERVED • BOSTON MA
MEDICAL ACKNOWLEDGEMENT FORM
By signing this consent and release below, you acknowledge and agree as follows:
1. You are over the age of 18 and located in the Commonwealth of Massachusetts.
2. The Virtual Medical Consultations (“VMC”)
web site is not an attempt to practice medicine
or provide specific medical advice, nor does use of the VMC web site create a doctor-patient relationship. Should you request a virtual
medical consultation, we will use the information you submit to arrange a consultation with
Dr. Lieberman as appropriate. Dr. Lieberman does not provide in-person or real time medical consultations through this web site. This web site is for virtual medical consultations only.
3. You understand that we endeavor to check messages 6 times during normal business hours. VMC is not responsible for delays in online communication, transmittal or accuracy of information. You are not using the VMC web site or online communications or our services for emergencies, trauma, surgical advice,
or escalating conditions like chest pain or fevers or to report an emergency or for urgent requests. In a virtual medical consultation the physician might miss an opportunity to pick up subtle medical indicators that would be apparent during an in-person consultation. Whether or not you
use the VMC web site and our services,
you will consult with a primary physician who
can monitor your health in real time (if this is not Dr. Lieberman).
4. In providing supplemental information about your condition and options for further steps in the health care process, neither VMC nor Dr. Lieberman takes the place of or plays the role of your primary physician or other health care providers. We do not perform physical
examinations, make diagnoses, provide physician referrals, or prescribe medications or other treatments. Our recommendations are in no way to be considered a critique of your health care provider(s) and are intended neither to support nor to defend any malpractice claim.
5. By agreeing to use the VMC web site and our services, you assume the risk of not having a real time in-person consultation.
6. Only our specifically designated physicians and staff will have access to your personal information. You understand that any virtual medical consultation or telemedicine encounter in which
you participate may result in your Protected Health Information (“PHI”) being retained and used, that the privacy of this PHI is protected by law, including the Health Insurance Portability and Accountability Act (“HIPAA”) and the HIPAA regulations, and HIPAA and the HIPAA regulations pertaining to your PHI may become applicable. All communication
of information including PHI on this web site is encrypted to ensure patient confidentiality and privacy. All storage of information is accessible
only to the patient and the designated physicians and staff, not to vendors or system operators.
All information is password protected, and encrypted at the database level. You should understand, however, that electronic transmissions on the Internet are not necessarily secure from interception, and we cannot guarantee the
security or confidentiality of such transmissions. By agreeing to use the VMC web site and our services you assume the security risks in using
the VMC web site and our services. You will use
the VMC web site responsibly, lawfully and appropriately, including safeguarding and not sharing passwords. Please do not use the
Internet to email photos or files to us. Only send information through our password protected web site and encrypted web portal.
By submitting this form,
you are agreeing to the Consent and Release
Upon your submission, you will be directed to PayPal to pay for your confidential second opinion.