TELEHEALTH INFO Telehealth Info/Consent - Union Mill Pediatrics | Centreville, VA Pediatrician

Telehealth Info/Consent

Please click this link below by time and date of appointment to enter the virtual waiting room for one of the providers at Union Mill Pediatrics in Centreville Virginia. When prompted please enter PATIENT name AND DATE OF BIRTH in the name field. By clicking on this link you are CONSENTING TO THE USE OF TELEMEDICINE SERVICES WITH UNION MILL PEDIATRICS as outlined below.

What is Telemedicine?

Telemedicine involves the use of electronic communications to enable health care providers at different locations to share individual patient medical information for the purpose of improving patient care. Providers may include primary care practitioners, specialists, and/or subspecialists.

The information may be used for diagnosis, therapy, follow-up and/or education, and may include any of the following:

· Patient medical records

· Medical images

· Live two-way audio and video

Electronic systems used will incorporate network and software security protocols to protect the confidentiality of patient identification and imaging data and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption.

Expected Benefits:

· Improved access to medical care by enabling a patient to remain in his/her home while the physician gathers history and limited physical to determine the best medical plan for the patient

· More efficient medical evaluation and management.

Possible Risks:

As with any medical procedure, there are potential risks associated with the use of telemedicine.

These risks include, but may not be limited to:

· In rare cases, information transmitted may not be sufficient (e.g. poor resolution of images) to allow for appropriate medical decision making by the physician and consultant(s);

· Delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment;

· In very rare instances, security protocols could fail, causing a breach of privacy of personal medical information;

· The physician will only be able to perform a limited physical exam and may not be able to prescribe certain medications such as antibiotics unless clinically appropriate. The physician may also determine that telemedicine is not appropriate care and require an in person visit.

By clicking the link below, I am acknowledging that I understand the following:

1. I understand that the laws that protect privacy and the confidentiality of medical information also apply to telemedicine, and that no information obtained in the use of telemedicine which identifies me will be disclosed to researchers or other entities without my consent.

2. I understand that I have the right to withhold or withdraw my consent to the use of telemedicine in the course of my care at any time, without affecting my right to future care or treatment.

3. I understand that my normal copayments and insurance payments may apply. 

4. I understand that a variety of alternative methods of medical care may be available to me, and that I may choose one or more of these at any time. Union Mill Pediatrics has explained the alternatives to my satisfaction.

Union Mill Pediatrics


Contact Us

Our Location

13880 Braddock Road Suite 201 Centreville, VA 20121

Hours of Operation

Our phones are only open 8AM to 5PM M-F and Saturday 8:30-10. Below are the times that patients are scheduled. We close for lunch 1:00 PM to 1:30 PM.

Union Mill Pediatrics


8:00 am-7:00 pm


8:00 am-7:00 pm


8:00 am-7:00 pm


8:00 am-7:00 pm


8:00 am-6:00 pm


Call For Saturday Triage Service: 8:30-10:00