Remote Patient Monitoring Services (RPM) Consent Form
Remote Patient Monitoring (“RPM”) is the use of a digital technology to collect your physiological health data outside of a clinical setting (for example, while you are at home or at work) and transmission of that data to a healthcare provider for evaluation. The type of health data collected may include weight, blood pressure, and other physiologic data that can help your physician or other healthcare provider monitor your health and make treatment recommendations. If you do not understand or agree to any or all of the information below, do not sign this agreement.
Risks and Benefits of RPM
RPM services allow your healthcare provider to monitor your health on an ongoing basis. This may help your healthcare provider identify issues that need to be addressed sooner than they would without RPM and allows you to communicate your information to your provider without having to travel to your provider’s office. RPM relies on devices and a good Bluetooth and/or internet connection to transmit data, and deficiencies in connection may result in missed readings or failure to transmit information.
By signing below, you acknowledge the following:
By signing below, you acknowledge that you have read and understand all of the above and you consent to receive RPM services from your healthcare provider.
Patient/Guardian Sign Below:
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If you have questions about the contents of this document, you can email the document owner.
Document Name: Remote Patient Monitoring Services (RPM) Consent Form
Agree & Sign