Welcome! We are glad to have the opportunity to meet you! Below you will find a lot of detailed information regarding your rights and responsibilities and established policies of 4Life Living Dietitians. Please read carefully and sign at the bottom by pressing on the “I agree” button.
CONSENT TO DIET THERAPY USING TELE-MEDICINE
I, the undersigned, give consent to receive diet therapy and counselling from one of the 4Life Living Dietitians allocated to my case, via a virtual consultation platform using telephonic calls, Whatsapp video call, Skype or Zoom. 4Life Living Dietitians practices under one practice number (0209031) and the team includes Nicola Mostert RD (owner), Sumarié Pieterse RD, Androulla Philippou RD, PhD, and Danine Lamprecht RD. I acknowledge that I am here voluntarily and that I may terminate treatment at any time. My dietitian will communicate clearly to me whether my condition is treatable through telemedicine. I realize that there is no guarantee of improvement in my condition. I acknowledge that any treatment will be a cooperative effort between my 4Life Living Dietitian and I. I agree to actively participate in our diet therapy and counselling sessions. I further acknowledge that the diet therapy and counselling session is only one part in the process of change.
MY BASIC RIGHTS AS A PATIENT PARTICIPATING IN COUNSELLING/TREATMENT AT 4LIFE LIVING DIETITIANS:
- The right to be informed of the various steps and activities involved in receiving services.
- The right to confidentiality under national laws.
- The right to humane care and protection from harm, abuse and neglect.
- The right to make an informed decision regarding whether to accept or reject treatment.
- The right to contact, consult with and select practitioners of my choice and at my expense.
All the information that I share with 4Life Living Dietitians will be protected against improper disclosure at all times according to the provisions of the Constitution, The National Health Act No 61 2003, the Promotion of Access to Information Act No 2 of 2000, the Protection of Personal Information Act No 4 of 2013, the Common law and the HPCSA guidelines on patient confidentiality. All my records will be kept strictly confidential using technologies like password protection of documents, screensavers, encrypting data and the use of authentication techniques. All documentation will be conducted thoroughly for medical records purposes. All information collected will be to determine the best outcomes possible for the purposes of diet therapy and care and will be treated with the utmost confidentiality.
VIRTUAL CONSULTATIONS AND COSTS INVOLVED
The purpose of a virtual consultation is to be able to continue with diet therapy without the ability of a face to face consultation. The first consultation will be R750.00 and will last up to 60 minutes and this where we will conduct a full nutritional assessment to determine which form of diet therapy will be best suited for you. The second consultation will last up to 30 minutes and will cost R350.00 and will include a meal plan as well as specific dietary outcomes related to your individual requirements. All follow-ups after that will be R120.00.
I will receive a reminder of all my appointments 24 hours before the allocated appointment. I agree to make every effort to keep all scheduled appointments and be on time. If I cannot attend a scheduled appointment virtually, I will call to cancel or reschedule at least 24 hours before the scheduled appointment.
I HAVE READ ALL THE INFORMATION AS SET OUT BY 4 LIFE LIVING DIETITIANS AND HEREBY AGREE TO ALL THE INFORMATION ABOVE.