TELEMEDICINE CONSENT FORM - Texas
Patient Name: DOB: Medical/TDCJ #: Provider Name: Telemedicine site: Informed Consent to Telemedicine. Consultation. I have been asked by my healthcare provider to take part in a telemedicine consultation with Texas Tech University Health Sciences Center (TTUHSC) and its physicians, associates, technical assistants, pharmacists, affiliated hospitals and others deemed necessary to … ................
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