Telehealth Visits

Telehealth Consent Form

GI Medicine Associates is now using Telemedicine as a safe and effective way to provide care at a distance to our patients. Physicians and patients use a camera and a microphone-equipped device such as a laptop, computer or smartphone in order to see and interact with each other. If you do not have a computer with a camera or smartphone, you may use a regular phone.

Before your scheduled Telehealth appointment time please do the following:

  • Ensure equipment is turned on and functioning.
  • Be sure to use Google Chrome or Mozilla Firefox browsers.
  • Have a list of current medications ready, questions for your physician and a list of refills needed.
  • Make sure you are in a quiet, distraction-free environment with good internet or cellular signal to ensure the best communication with your physician.
  • Review the Telehealth Consent Form below.

When your appointment is scheduled, the receptionist will discuss with you if the appointment will be through Doxy.me or a regular telephone call. If you are scheduled through Doxy.me, please click on the corresponding provider link 10 minutes prior to your appointment time.

Doxy.me for Kerri Bewick, DO: Click here

Doxy.me for Sudhanshu Patel, MD: Click here

Doxy.me for Leonid Shamban, DO: Click here

Doxy.me for Molly Gallaway, DO: Click here

Doxy.me for Kianna Lyons, NP: Click here

You will enter into the Provider’s waiting room and your physician will arrive you as soon as possible. Please allow extra time for the provider to join as they may be running longer with the patient ahead of you.


GI Medicine Associates, PC Telehealth Consent Form

1. I understand that my health care provider wishes me to engage in a telemedicine consultation.

2. My health care provider has explained to me how the video conferencing technology will be used to affect such a consultation will not be the same as a direct patient/health care provider visit due to the fact that I will not be in the same room as my health care provider.

3. I understand there are potential risks to this technology, including interruptions, unauthorized access and technical difficulties. I understand that my health care provider or I can discontinue the telemedicine consult/visit if it is felt that the videoconferencing connections are not adequate for the situation.

4. I understand that my healthcare information may be shared with other individuals for scheduling and billing purposes. Others may also be present during the consultation other than my health care provider and consulting health care provider in order to operate the video equipment. The above-mentioned people will all maintain confidentiality of the information obtained. I further understand that I will be informed of their presence in the consultation and thus will have the right to request the following: (1) omit specific details of my medical history/physical examination that are personally sensitive to me; (2) ask non‐medical personnel to leave the telemedicine examination room: and or (3) terminate the consultation at any time.

5. I have had the alternatives to a telemedicine consultation explained to me, and in choosing to participate in a telemedicine consultation. I understand that some parts of the exam involving physical tests may be conducted by individuals at my location at the direction of the consulting health care provider.

6. In an emergent consultation, I understand that the responsibility of the telemedicine consulting specialist is to advise my local practitioner and that the specialist’s responsibility will conclude upon the termination of the video conference connection.

7. I understand that billing will occur from both my practitioner and as a facility fee from the site from which I am presented.

8. I have had a direct conversation with my doctor, during which I had the opportunity to ask questions in regard to this procedure. My questions have been answered and the risks, benefits and any practical alternatives have been discussed with me in a language in which I understand. By signing this form, I certify:

· That I have read or had this form read and/or had this form explained to me

· That I fully understand its contents including the risks and benefits of the procedure(s).

· That I have been given ample opportunity to ask questions and that any questions have been answered to my satisfaction.