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Royal Flying Doctor Service
Online Agreement for new Flying Doctor Telehealth sites
Name of organisation
Address Line 1
State / Province / Region
Authorised Representative Details
Terms and conditions of use of the Flying Doctor Telehealth service:
The hosting of telehealth appointments with patients may be held at the practice or at a location suitable for Telehealth@Home If held at the practice, the practice agrees to provide appropriate rooms for telehealth appointments, waiting area etc. If utilising a Telehealth@Home appointment, the practice agrees to ensure the patient has appropriate technology and digital literacy to access the appointment from home, or has a support person to assist them in doing so The practice will nominate one or more ‘Appointment Facilitator’s’ that will manage the booking and attendance of telehealth appointments for patients. The practice will complete and return any forms relating to the appointment including but not limited to Medicare Db4 forms within a reasonable timeframe from the date of the appointment. The practice will participate in evaluation activities including data collection and distributing patient feedback forms. The practice will not share their allocated log in details with any other site. The practice will implement locally appropriate strategies to manage DNAs (Did Not Attend). If a valid referral is missing from a patient file and the appointment goes ahead without this in place, and cannot be added after the appointment, the full cost of the appointment will be passed on to the practice The term of this agreement is for 24 months and following this the agreement will remain active until a new agreement is completed. If either party want to cease this agreement prior to the 24 month period, confirmation of cessation must be received in writing. All Royal Flying Doctor Service (RFDS) equipment must be returned to RFDS Victoria within 1 month of the termination of this agreement.
On behalf of the organisation, I agree to the above terms and conditions.
I understand that my failure to comply with these conditions will result in my access to the Flying Doctor Telehealth platform being revoked from my organisation.
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