Patient
Applicant Information
Description
Alert

The EMO case No. you entered is incorrect or does not exist.

Ok
Set
Upload files (optional)

Upload a single file in JPG, PDF, JPEG ,PNG, DOC or ZIP. Please put multiple files in a Zip file. Maximum 10M.

the service terms.
Back
Second Medical Opinion Serivce Consent

Second Medical Opinion Serivce Consent:

1、

All the personal and medical data, referred to as "CONFIDENTIAL INFORMATION" contained in this enrollment, or provided to ADVANCE MEDICAL in any manner, including telephonically, in relation to your case, will be used by ADVANCE MEDICAL with the only purpose of delivering an Second Medical Opinion Serivce. However, there might be instances when your personal data will be communicated to medical experts and hospitals in order for them to provide the Second Medical Opinion Serivce.

2、

The confidential information will be registered in a secure and proper manner. Your data will be anonymized in order to protect your privacy.

3、

You hereby accept that ADVANCE MEDICAL and its employees get in touch with you in order to obtain the necessary information to provide you with the service.

4、

You agree that the information that you provide to us will be accurate and complete to the best of your knowledge. It is your responsibility to ensure that all relevant information has been provided to ADVANCE MEDICAL.

5、

The physician rendering the Second Medical Opinion Serivce Report will not have the benefit of examining you in person, the ability to order additional tests, or have any information beyond what you provide. Since the medical experts will not personally examine you or order additional tests, it is not a medical diagnosis. The Report is intended to provide you with information to supplement the information you have already received from your treating physicians. The information contained in the Second Medical Opinion Serivce Report shall not be used to substitute for your physician’s recommendations.

6、

You should discuss the Report with your own doctors, who are responsible for your care. ADVANCE MEDICAL will not make any preferential recommendations, and shall be held harmless from any liability arising out of preparation or delivery of the Report and your use of the Report.

7、

You allow ADVANCE MEDICAL to share the Report with Allianz Care in order to provide better medical service.

8、

The Second Medical Opinion Serivce is not applicable to cases of first aid, accidents and ICU related critical illness. No prescription will be provided.

Telehealth Consent

Prior to start with the service you must read, understand and agree the following terms and conditions:

1、

You agree that the information that you provide to ADVANCE MEDICAL will be accurate and complete to the best of your knowledge. It is your responsibility to ensure that all relevant information has been provided to ADVANCE MEDICAL.

2、

This Call Back Service does not and cannot take responsibility for your care based only on the information you provide. Medical decisions should be made only after an in-person medical examination and diagnostic tests, as indicated by the examination and your medical history. This Call Back service is intended to provide you with medical information which shall not be used to substitute for your physician’s recommendations.

3、

You hereby accept that ADVANCE MEDICAL and its employees gets in touch with you in order to obtain the necessary information to provide you with the service.

4、

All the personal and medical data, referred to as "CONFIDENTIAL INFORMATION" contained in this enrollment, or provided to ADVANCE MEDICAL in any manner, including telephonically, in relation to your case, will be used by ADVANCE MEDICAL with the only purpose of delivering an Second Medical Opinion Serivce. The confidential information will be registered in a secure and proper manner in order to protect your privacy.

Overseas Treatment Recommendation Consent

I hereby confirm that the above information is correct and to the best of my knowledge. I understand the service of Overseas Treatment Recommendation and agree to the following terms:

1、

All the personal and medical data, referred to as "CONFIDENTIAL INFORMATION" contained in this enrollment, or provided to ADVANCE MEDICAL in any manner, including telephonically, in relation to your case, will be used by ADVANCE MEDICAL with the only purpose of delivering Overseas Treatment Recommendation. However, there might be instances when your personal data will be communicated to medical experts and hospitals in order for them to provide the service.

2、

The confidential information will be registered in a secure and proper manner. Your data will be anonymized in order to protect your privacy.

3、

You hereby accept that ADVANCE MEDICAL and its employees get in touch with you in order to obtain the necessary information to provide you with the service.

4、

You agree that the information that you provide to us will be accurate and complete to the best of your knowledge. It is your responsibility to ensure that all relevant information has been provided to ADVANCE MEDICAL.

5、

Overseas Treatment Recommendation requires completion of Second Medical Opinion Serivce. You shall provide your case No. of the Second Medical Opinion Serivce when applying for Overseas Treatment Recommendation. The physician rendering the Second Medical Opinion Serivce Report will not have the benefit of examining you in person, the ability to order additional tests, or have any information beyond what you provide. Since the medical experts will not personally examine you or order additional tests, it is not a medical diagnosis. The Report is intended to provide you with information to supplement the information you have already received from your treating physicians. The information contained in the Second Medical Opinion Serivce Report shall not be used to substitute for your physician’s recommendations.

6、

You should discuss the Report with your own doctors, who are responsible for your care. ADVANCE MEDICAL will not make any preferential recommendations, and shall be held harmless from any liability arising out of preparation or delivery of the Report and your use of the Report.

7、

You allow ADVANCE MEDICAL to share the Report with Allianz Care in order to provide better medical service.

8、

ADVANCE MEDICAL may assist you in obtaining required visa for Overseas Treatment Recommendation. Successful granting of such visa is subject to the embassy policy.

9、

Coverage of traveling and treatment expenses related to the Overseas Treatment Recommendation shall be subject to your insurance policy.