Audio/Video Consent Form

• Use of Ortil Conferencing Application for Patient Consultation
  • The Physician has offered to communicate using Audio / Video Conferencing (including Ortil / Skype / Zoom). The Physician will participate in the audio/video conference in a private office with a closed door and will use a headset to prevent others from overhearing the discussion.

• By choosing this option, I understand that:
  • Conferencing is an online communication tool allowing for face-to-face video, voice, or text-based chat dialogue.
  • Ortil Healthcare Private Limited will send the conferencing link to the patient based on the information provided and agreed by the Physician and Patient.
  • Patient can click the conferencing link at least five minutes before the time, alone, in a quiet, closed room. The Physician will connect with you at the scheduled appointment time.
  • For best video and audio quality (preferred headphones for better audio quality), a hardwired connection (via LAN cable) rather than a wireless one should be used if possible.
  • Technical problems could occur. If the call is disrupted, the Physician will call back within ten minutes. If reconnection is unsuccessful, the session will be rescheduled by the Ortil Healthcare Private Limited Team based on the patient's requirements or an alternate option will be provided.
  • Audio/video conferencing technology will be used to create the teleconference, and there are inherent limitations in this type of consultation. It will not be the same as a direct patient/health care provider visit because I will not be in the same room as my health care provider. Diagnosis done by the Physician will be solely based on the data provided by the patient through documents or verbal communication.
  • Responsible for making sure that I am in a private area where disruptions (e.g., others coming into the room or hearing what I say in another room) are minimized as much as possible./li>
  • There are no guarantees with teleconferencing services, and it should not be used for emergency medical situations.

• Ortil conferencing application collects following Information:
  • Individual’s name, contact number, email, date, and time.
  • Offers audio and video recording function. As the conference “host," the Ortil Healthcare Private Limited Team will not be using the recording function and will not be saving any recordings on the cloud service.

• Ortil Conferencing Application Security and Privacy
  • Terms of service, effective March 2021, state, in part:\
    • Obligations for Content:
      • Will maintain reasonable physical and technical safeguards to prevent unauthorized disclosure of or access to content, in accordance with industry standards.
      • Will notify You, if it becomes aware of unauthorized access to content. We will not access, view, or process content except:
        • As provided in this Agreement and in Privacy Policy
        • As authorized or instructed by You
        • As required to perform its obligations under this Agreement
        • As required by Law.
  • Privacy Policy, effective March 2021, states, in part:
    • Does not monitor or use customer content [information you or others upload, provide, or create while using Ortil audio/video conferencing service] for any reason other than as part of providing our service.
  • By enabling “Submit," I certify that:
    • I have read this form
    • I fully understand its contents, including the risks and benefits of teleconsultation
    • I fully understand that Ortil Healthcare Private Limited is only a facilitator and not liable for the outcome of the audio/video conferencing with the physician.

Treatment and Travel Consent Form

• I understand that ORTIL Healthcare Private Limited is not a medical referral service and does not endorse, recommend, or approve any travel agency, healthcare provider, or any other business listed in ortil.com (website address).
• I understand that ORTIL Healthcare Private Limited facilitates contact with and provides information about health care providers, including their self-reported credentials, to assist in making informed decisions.
• I understand that ORTIL Healthcare Private Limited does not, however, recommend any preferred or specific health care providers for my desired medical treatment.
• I agree to assume all responsibility to choose the health care provider for my desired treatment or procedure.
• I understand that ORTIL Healthcare Private Limited has no responsibility or liability for any treatment or other services rendered by any hospital, physician, or other health care provider or for any malpractice claims and other claims that may arise directly or indirectly from any such advice, treatment or other services.
• I understand that ORTIL Healthcare Private Limited shall not be liable for any delays and alterations in the program or expenses incurred – directly or indirectly – due to natural hazards, flight cancellations, accidents, breakdown of machinery or equipment, breakdown of transport, weather, sickness, landslides, political closures, or any untoward incidents.
• I understand that ORTIL Healthcare Private Limited shall not be liable for any loss, injury, or damage to a person, property, or otherwise in connection with any accommodation, transportation or other services, resulting – directly or indirectly from dangers like fire, accident, breakdown in machinery or equipment, breakdown of transport, wars, civil disturbances, strikes, riots, thefts, pilferage’s, epidemics, medical or custom department regulations, defaults, or any other causes beyond our control.
• I understand that ORTIL Healthcare Private Limited is not responsible for any allergies patients may encounter by taking certain medication doctor or specialist prescribed or any weather or food allergies upon arrival and or during their stay in the preferred country of treatment.
• I understand that ORTIL Healthcare Private Limited is not responsible for repatriating the body in-case of patient or bystander’s death during their stay in the preferred country of treatment.
• I understand that ORTIL Healthcare Private Limited will be assigned on behalf of the patient to apply only for an e-visa to travel to the preferred country of choice (based on patient's request). The administration fee varies depending on the country of citizenship of the patient at the time of request. If the visa is rejected, ORTIL Healthcare Private Limited cannot be held liable, and the administration fee will not be refunded.
• I understand that ORTIL Healthcare Private Limited will collect the amount only for the Audio / Video Consultation. All other services are free of charge except for the e-visa charge and ticket fare if processed from ORTIL Healthcare Private Limited.
• I understand that the associated cost related to the services availed should be paid directly to the service provider. ORTIL Healthcare Private Limited will not be responsible for any disputes related to the payment.

By enabling “Submit," I certify that: I have read this form I fully understand that Ortil Healthcare Private Limited is only a facilitator and not liable for the outcome of the treatment and complications.