Dental-Consults Teleconsultation Consent Form

Basic Description of Services

Dental-Consults is a Web-based teledentistry consultation system developed for use by dentists. The system enables referring dentists to send a consult, including dental images and radiographs, for a specialist second opinion via the Internet.

The referring dentist logs into our secure web-server, fills in the patient's details, specific reasons for consultation, chief complaints, provisional diagnosis information, uploads (attaches) intra-oral images and dental radiographs. The specialist is notified immediately of the new referral. The specialist reviews the consult and provides the diagnosis and treatment plan. Where they are available, we will also send the dentist the scientific information (e.g. reference citations and abstracts) underlying our suggestions. The referring dentist is then informed by email to retrieve this information. Consultations are not provided to patients. Consultations are given only to dentists to increase patient access to quality dental care.

Dental-Consults does not transmit any identifying information to third parties. We will take commercially reasonable security measures to protect any information transmitted as required by applicable United Kingdom laws, regulations and rules.

Since we have not seen the patient, we cannot truly diagnose the patient. We can only provide our opinion as to what the problem is likely to be, and based on this proposed diagnosis, we provide the dentist with recommendations for the most common treatments of this problem. The advice is solely based on the information the dentist provides to us as part of the consultation. The dentist must ensure we receive all relevant information about the oral health problem being experienced and the person experiencing it, including their history both medical and non-medical. If incorrect information is provided, or pertinent information that would otherwise influence or aid in the diagnosis/treatment plan is not provided, the accuracy of the assumed diagnosis and proposed treatments will be adversely effected. While consultants may provide additional information, the ultimate medical, ethical, and legal responsibility for diagnosing and treating the patient is with the treating dentist. While Dental-Consults is willing to provide its best efforts in helping the patient, it assumes no legal liability for this consultation or any consequences resulting from it. The referring dentist remains responsible for the patient's primary diagnosis and is responsible for evaluating the report and communicating any information in the report to the patient.

By agreeing to use our services both the dentist and the patient agree to hold Dental-Consults, its officers, employees and agents harmless from and against any and all liability, loss, expense (including reasonable legal fees), or claims for injury or damages arising out of a Dental-Consults consultation.

I have read, understand and consent to the above stipulations:

Do not send us this form. This is for the referring dentist's own records.

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