THIS IS A LEGALLY BINDING agreement between Altibbi Ltd, a company established under the laws of British Virgin Islands under number 1823894 its address being P.O. Box 3715 (“Altibbi”, “we” or “us“), and you.

BY CLICKING “I AGREE,” OR BY OTHERWISE SIGNING UP OR FOR AN ACCOUNT, OR SIGNING THIS agreement OR BY PROVIDING THE SERVICES (AS DEFINED BELOW), YOU ARE ENTERING INTO THIS Call Doctor PREMIUM SERVICES agreement (THIS “AGREEMENT“) AND YOU AGREE TO BE BOUND BY ITS TERMS AND CONDITIONS.

Please read this agreement carefully, and do not sign up for an account or sign this agreement if you are unwilling or unable to be bound by this agreement. You and we are collectively referred to as the “Parties”.

Overview

Altibbi Call Doctor is a paid service that allows users to start an immediate, private and unique (one doctor- one patient) conversation with a doctor via video/audio and/or chat, along with the option to upload images and reports as well as completing a patient health record.

Altibbi Call Doctor is generally about more specific issues of the user and is addressed in detail.

Altibbi Call Doctor is a private service; the user’s information will be visible only to the doctor selected in the given conversation.

There are no fees, financial obligations, or rights to payment triggered solely by signing this agreement. Approval and training are required to use Altibbi Call Doctor service, and fees and rights to payment are based on your commencing and using these services, as described in this agreement.

Access to Altibbi Call Doctor

Altibbi hereby grants you, upon the terms and conditions contained herein, a non-transferable, non-exclusive license to use Call Doctor service.

Modification

Altibbi reserves the right to modify Altibbi Call Doctor service and its respective features and functionality at any time, without notice or warning and without liability.

Reservation of Right

Altibbi reserves the right to display the Altibbi brand, and any image, name, brand or label which Altibbi has rights to, on any and all of the Licensed Services. Altibbi reserves all rights not expressly granted to you in this agreement.

Warranties, Representations and Undertakings

You warrant that as at the date of this agreement: (A) you have the requisite power and authority to enter into and perform the obligations under this agreement; (B) you have all the necessary regulatory licenses and approvals ne to operate as a provider of the services.

You warrant that all of the information filled out whether in the physical registration form or online is fully correct, accurate, up-to-date and complete and you will notify us promptly of any changes which would render the provided quality assessment information incorrect during the course of this agreement.

You shall solely bear the responsibility for any invalidity or inaccuracy of any of the information that you enter during the registration process and we shall be free from any legal liability or regulatory or otherwise resulting from the false or inaccurate information entered by you during the registration process.

You undertake that you will for the duration of this agreement maintain a valid, unlimited, and unrestricted license to practice medicine in the country where you are licensed to practice medicine.

You shall make sure you are not in violation of any licensure or accreditation requirement applicable under any law and agree that he/she will act in compliance with all applicable laws. You will warrant that you are in good standing with applicable national medical boards, and that you have not been convicted of any non-misdemeanor crime

You shall act in compliance with all applicable Altibbi guidelines, rules, and regulations, and will comply with all applicable continuing medical education requirements applicable.

You warrant that you will provide immediate notice to Altibbi if there were any investigations, malpractice related actions, any problem with your license or any other regulatory issues.

Service Usage

You shall:

• Use the service for care or informational purposes only as permitted by local law, rules and regulations.
• Carry all medical liability of all recommendations or interactions he makes under Altibbi.
• Determine at all times when to use, and when not to use, the service.

Technical Details

You shall:

• Maintain high-speed internet access.
• Upgrade your technical capabilities and connectivity to function to Altibbi-acceptable standards with Altibbi’s software.

Shall not:

• Permit any third party to Copy our service or resell the Licensed Services to any unrelated third party.
• Use this service (or any other service) for commercial purposes or any other purposes not related to our intended purpose
• Allow any third party to view, use or access the service or disclose, or publish any info related to this service (specially patient’s medical info)

Each Party hereby undertakes to the other Party that, for the duration of this agreement, it will neither do nor omit to do anything which it intends will damage the reputation or good name of the other Party.

Altibbi retains the rights to:

• modify the service and its features without prior notice or liability
• display its brandings anywhere on the service

Intellectual properties

Altibbi shall own all rights, title, interest and intellectual property rights in this service and all materials and technologies used in and/or in connection with this service or any other service related to Altibbi.

Support and Updates

• Altibbi will provide technical support during its working hours.
• Altibbi may, from time to time, in its sole discretion provide updates (corrections, changes and improvements to the service) to doctors.

Term and Termination

This agreement shall commence as of the Effective Date of this agreement. This agreement shall continue to be in force for a period of 1 year (the “Term”) renewed automatically each year unless a written communication was provided either by letter or email 30 days before end of year from the start of this agreement.

Either party may terminate this agreement at any time for any reason upon thirty (30) days prior written notice to the other party.

Altibbi reserves the right to terminate the doctor’s access to the account in the event of any alleged or actual breach of any terms of this agreement, the terms of the Website or the Doctor Clinical Guidelines.

Consequences of Termination

• Any termination of this agreement shall be without prejudice to any rights accrued in favor of either party in respect of any breach committed prior to the date of (or giving rise to) such termination and to those provisions of this agreement which are by their construction intended to survive such termination.
• Altibbi shall remove and/or cause to be removed any reference to you from the Website and applications for the provision of Altibbi Call Doctor.

Additional Terms

Notification of call receipt

You will receive multiple notifications when you receive a call from Altibbi Call Doctor:

• A mobile notification on your mobile device if you are logged in your Doctor App.
• A notification will appear on your dashboard on the Call Doctor icon.

Response time and acceptance time

You will receive a notification to let you know about an incoming call. You can accept the call. The first doctor to accept the call will have the conversation with the user, on a first come first serve basis. The number of calls you accept determines your “Acceptance Rate” which directly affects your payment.

Rating

After each consultation, users will be promoted to rate you in addition to call quality. You acknowledge that Altibbi desires that Users have access to high-quality services; in order to continue to receive access to the Doctor App and Call Doctor Service, you must maintain an average rating by Users that exceeds the minimum average acceptable rating established by Altibbi for your Territory, as may be updated from time to time by Altibbi in its sole discretion (“Minimum Average Rating”).

If your average rating falls below the Minimum Average Rating, Altibbi will notify you and may provide you, in some cases, a limited period of time to raise your average rating above the Minimum Average Rating. If you do not increase your average rating above the Minimum Average Rating within the time period allowed (if any), Altibbi reserves the right to reduce your payment or deactivate your access to the Call Doctor Service.

Doctor recommendation

You will undertake to complete a brief report summarizing the conversation between you and the user. This report will be saved in User’s archive and in yours as well. It will be used for quality control and for medical history purposes for the next conversation of the user.

You agree to submit the report in a timely manner; Altibbi might count Calls left without recommendation and/or recommendations submitted more than 1 hour late as unfulfilled calls which might affect Doctor’s acceptance and fulfillment rates and final payment. If the quality of your recommendations fall below our standerds, Altibbi will notify you and may provide you, in some cases, a limited period of time to improve their quality. Altibbi reserves the right to deactivate your access to Call Doctor Service if the quality of your recommendations is not improving.

Account Information and Confidentiality

You are responsible for maintaining the confidentiality of the account information and the login data, including the password for the account, and all activities that take place within the account.

You undertake to inform the management of Altibbi Call Doctor immediately of any unauthorized use of the account or use of the password, or any other breach of security and protection of the account. Therefore, it is your duty to take all reasonable security measures to prevent account from being lost or compromised, and to prevent unauthorized disclosure or access of it. Also, you are responsible for any losses that may be incurred and be caused by the unauthorized use of the password by any person.

Altibbi may at its own discretion and without any prior notice, cease and prevent your account or access to the Website, or services, for any reason what so ever, including, but not limited to: any actual or suspected breach of conditions set forth in this agreement or the conditions of use, unexpected operational difficulties, orders to comply with the law or any other governmental request, or any fraudulent activity.

Doctors' Image information

Collection: Our app collects doctors' image information in the form of profile pictures. This information is collected when doctors sign up for our app. 

Usage: We use doctors' image information to personalize their experience with our app. This includes displaying profile pictures and allowing users to recognize doctors easily. 

Sharing: We don't share doctors' image information with third-party services and partners for the purpose of providing our app's functionality.

Confidential Information

You agree to maintain the security and privacy of patient-related information and Altibbi confidential information, and agree that all patient information shall be held in strict confidence and shall only be used in accordance with healthcare practitioners’ legislations, data protection and privacy laws and the regulations there under.

You shall ensure that patient information will be used solely for purposes relating to treatment, and other healthcare operations.

You agree to inform the management of Altibbi Call Doctor of any violation of this provision.

You shall not access, attempt to access, or use any patient information or Altibbi Confidential Information for which you do not have authorization. In addition, you shall not cause or permit the patient information or Altibbi confidential information to be accessed or used by any third party.

You understand that you may disclose the Confidential Information to your employees on a need-to-know basis pursuant to the terms of this agreement.

You agree that the patient information or other confidential Information shall not be used by you or your employees in any way detrimental to Altibbi and that all patient information and other Confidential Information shall be kept confidential. You shall inform your employees to treat such information confidentially, and shall add a provision in any contract to keep such information confidential.

Intellectual Property

All Intellectual Property Rights (including but not limited to all copyright, database rights, trademarks, text, graphics, lists, photographs, illustrations, logos, icons, the look and feel of the Website) and any upgrades or modifications belong and shall belong to Altibbi, and/or Altibbi’s third party licensors, copyright and trademark owners.

You agree not to use or disclose any of Altibbi’s business information regarding Altibbi’s Website (including without limitation its functionality, options, “look and feel”) without prior written permission. You understand that no part of this Website, including but not limited to materials retrieved there from, information that Altibbi publishes on the Website and the underlying code, may be reproduced, republished, copied, transmitted, or distributed in any form or by any means. You understand that you may link to this Website’s homepage only and will not link to other content within the Website without Altibbi’s express written permission. Additionally, Altibbi reserves the right to temporarily or permanently discontinue this Website or any functionality on this Website at any time and without notice.

Publicity and Use of Name

You shall not use the name, logo, likeness or trademarks of Altibbi for any advertising, marketing or endorsement purposes without the prior written consent of Altibbi for each such use.

Medical Disclaimers

Altibbi makes no representation or warranty as to the content of any treatment response from you or any participating physician. Participating physicians are not employees of Altibbi; they are independent contractors. You are solely responsible for all information and/or communication sent during a telephone medical consultation, secure email consultation or other communication. Altibbi does not guarantee that a telephone medical consultation or secure email consultation is the appropriate course of treatment for any particular health care problem.

You are directly responsible for the quality and appropriateness of the care you render directly to users. Altibbi is by no means responsible to any health issue accrued by the user and not to be held liable to any legal action by any user regarding any answer received by a doctor through Altibbi Call Doctor.

Indemnification

YOU AGREE TO DEFEND, INDEMNIFY AND HOLD HARMLESS ALTIBBI AND ITS AFFILIATES FROM AND AGAINST ANY AND ALL RIGHTS, DEMANDS, LOSSES, LIABILITIES, DAMAGES, CLAIMS, CAUSES OF ACTION, ACTIONS AND SUITS (NO MATTER WHETHER AT LAW OR EQUITY), FEES, COSTS AND ATTORNEYS' FEES (INCLUDING APPELLATE LEVEL) OF ANY KIND WHATSOEVER ARISING, DIRECTLY OR INDIRECTLY, OUT OF OR IN CONNECTION WITH (I) YOUR SUBSCRIPTION, (II) YOUR BREACH OF THE TERMS OF USE OR THE PRIVACY NOTIC, (III) YOUR RELATIONSHIP WITH ANY PARTICIPATING USER, (IV) THE CONTENT OR SUBJECT MATTER OF OR ANY INFORMATION YOU PROVIDE TO THE USERS, AND/OR ALTIBBI ANY OF ITS AFFILIATES, ANY PARTICIPATING PHYSICIAN (V) ANY NEGLIGENT OR WRONGFUL ACTION OR OMISSION BY YOU IN THE USE OR MISUSE OF THE SITE OR THE SERVICES OR ANY INFORMATION POSTED ON THE SITE, INCLUDING, WITHOUT LIMITATION, INFRINGEMENT OF THIRD PARTY INTELLECTUAL PROPERTY RIGHTS, PRIVACY RIGHTS, OR NEGLIGENT OR WRONGFUL CONDUCT.

Governing Law and Dispute Resolution

This agreement shall be governed by and construed in accordance with the laws of United Kingdom.

Any dispute, controversy or claim arising out of or in connection with this agreement, including any question regarding its existence, validity or termination, shall be resolved exclusively by reverting to the courts of the United Kingdom, and each of the parties hereby irrevocably submits to the exclusive jurisdiction of such court.

If you are willing to take part of Altibbi Call Doctor, you acknowledge you have read and accepted all Altibbi Terms and Conditions.

Introduction

Altibbi has embarked on an effort to establish practice guidelines for telemedicine to advance the science, to assure uniform quality of service to patients, and to promote reasonable and informed patient and provider expectations. These guidelines were developed based on the American Telemedicine Association (ATA) guidelines for telemedicine service and Telemedicine Clinical Guidelines by Province of BC Health Authorities and were reviewed by panels that include experts from the field and other strategic  stakeholders from the region. The guidelines are reviewed and updated periodically.

These guidelines are designed to serve as both an operational best practice and an educational tool to aid physicians in delivering telemedicine care for patients to the same standard as care they receive in face-to face encounters, within the limitations imposed by available (or unavailable) regulations, technology, and others.

The practice of medicine is an integration of both the science and art of preventing, diagnosing, and treating diseases. It should be recognized that these guidelines are not intended to substitute for the independent  medical judgment, training, and skill of the practitioner and that the adherence to these guidelines will not  guarantee accurate diagnoses or successful outcomes. 

The purpose of these guidelines is to assist practitioners in pursuing a sound course of action to provide effective and safe medical care that is founded on current information, available resources, and patient  needs. 

The guidelines are not meant to be unbending requirements of practice and they are not designed to, nor should they be used, to establish a legal standard of care.

The primary care or managing practitioner is responsible for the decision about the appropriateness of a specific procedure or course of action, considering all presenting circumstances. An approach that differs from these guidelines does not necessarily imply that the approach varied from the standard of care. 

If circumstances warrant, a physician may responsibly pursue a course of action different from these guidelines when, in the reasonable judgment of the practitioner, such action is indicated by the condition  of the patient, restrictions or limits on available resources, or advances in information or technology  subsequent to publication of the guidelines. 

These guidelines shall specifically describe roles, responsibilities, communication, and procedures around emergency issues. The degree of involvement and the degree of care you can provide will vary greatly and be determined by region’s regulatory restrictions and available data & resources.

Administrative Guidelines

Follow local regulations

You must provide a copy of your medical license or any other documents the team might request to prove that you are a duly licensed and duly authorized medical professional by the relevant authorities to conduct and practice the medical profession in your country.

You shall notify Altibbi if you have any updates related to your license.

You shall conduct care consistent with the jurisdictional regulatory, licensing and credentialing laws and rules for your profession in the jurisdiction/country in which you are practicing and shall ensure compliance as required by appropriate regulatory and accrediting agencies.

Privacy and confidentiality

• Telemedicine consultations should be private and confidential. Patient’s privacy and confidentiality should be always maintained.
• While using the service, you should ensure that service is conducted in a secure, private, reasonably soundproof, and have a lockable door room to prevent unexpected entry. Efforts shall be made to ensure privacy so provider discussion cannot be overheard by others outside of the  room where the service is provided.
• Do not share your account: Altibbi grants you an exclusive access to this service; you shall not:
  • Permit any third party to Copy our service or resell the Licensed Services to any unrelated third party.
  • Allow any third party to view, use, or access the service or disclose, or publish any info related to this service (especially patient’s medical info).
• Do not use Altibbi for other services other than Altibbi purpose: You shall not use Altibbi platform or any of its services to sell or promote products, services, or enterprises.
• You shall not request patients' personal contact information or any other behavior that breaches the privacy policy and standards Altibbi upholds.

Clinical Guidelines

Conducting the consultation

• The practice of medicine through telemedicine should be conducted in a similar manner to a face-to face consultation taking into considerations of the limitations of the tools and medium of communication utilized.
• Providers are expected to provide recommendations for assessment, clarification of diagnosis, and recommendations for treatment or next steps. These information and other relevant information should be  clearly  communicated as per current best practice models of care and the service guidelines.
• At the beginning of each consultation, you should provide some background information, including your credentials and experience.
• Accepting the consultations means that you’re committed to the user.

Promotion and advertisement

Using Altibbi’s services to promote the use of any pharmaceutical product, healthcare facility or healthcare professionals is prohibited. You may recommend other facilities, practitioners, products, or procedures if users explicitly ask you to.

Guidelines for the practice of telemedicine

Telemedicine and clinical practice

• Care standards for practice, such as evidence-based best practice, should be carried through to care delivered via telemedicine. 
• Whenever possible, you will use existing applicable clinical best practice guidelines when providing care via telemedicine.
• Modifications may need to be made to accommodate for the inability to physically examine a patient or the need to have physical examination performed and translated by a remote site  assistant.

Duty of care

• The duty of care for telemedicine should follow the same principles as face-to-face care. You shall give patients adequate, current, and ongoing care instructions.

Ethics

You shall ensure the patient-provider relationship via telemedicine:

• Maintains the integrity and value of the therapeutic and workplace relationships.
• Upholds professional standards governing health and medical professions.
• Meets the standards of quality and safety as for face-to-face services.
• Eliminate any conflict of interest to influence decisions made about, for, or with patients who receive care via telemedicine.
• You must recognize when telemedicine approaches are not appropriate for the patient’s needs and be aware of any ethical risks to patients.
• Health care professionals are required to follow the Health Authority’s process and their Professional Practice Standards when addressing ethical concerns and issues that arise due to the use of telemedicine if  the telemedicine service requires duties outside normal scope of practice.

Managing minors:

Do not provide any consultation to pediatric patients (< 14 years) without the presence of the legal guardian. This should be clearly communicated properly during the consultation (verbally during the call and in written words in chat and recommendation).

Managing teens/adolescence:

Before providing any consultation, request the consent of one of the parents or the legal guardian. While consent will be collected upon registration, you should request the presence and the confirmation from the parent(s) or legal guardian in a clear language.

Start the consultation with an overview of what to expect (education) as well as clarity on how communication with providers is different (any prescription or medical investigation requested cannot be made without the approval of the parent/guardian), including what can and cannot be shared during the consultation.

The decision to provide education or to refuse to provide the education is decided on a case-by-case basis according to physician's discretion and putting patient safety and privacy as a priority.

Patient management and evaluation

Always interact with patients in a culturally competent way, in the language familiar to that patient. If the patient cannot understand because of language barrier, telemedicine should not be used.

Patient evaluation should be based on the patient’s medical history and medical records whenever possible. Needed information to give assessment includes:

• Chief health/medical complaint
• History of present illness
• Associated signs & symptoms
• Past medical history
• Family history
• Personal and social history
• Medication review
• Allergies
• Detailed review of symptoms
• Provider-directed patient self-examination (if needed)
   

Diagnosis and final assessment

Given the limitations of telemedicine, reaching a final diagnosis, and giving patients a final clinical assessment might not be possible.

While clinical care standards for Altibbi Call Doctor service should mirror those of face-to-face visits, including all aspects of diagnosis and treatment decisions as would be reasonably expected in traditional  office-based encounters, you should practice your clinical judgment when determining the scope and  extent of telemedicine applications in reaching these decisions.

As the field of telemedicine is likely to rapidly develop, the extent in which telemedicine applications in general can be utilized will expand. Altibbi will be working with its team of medical professionals to update these guidelines in accordance with global and local standards.

Prescriptions and e-prescription

Prescribing medications through any of Altibbi services and platforms  is at the professional discretion of the practitioner. The practitioner, in accordance with current standards of practice and the local regulations, must evaluate the indications, appropriateness, and safety considerations for each prescription.

Prescriptions entail the same professional accountability as prescriptions incident to an in-person contact. Compliance with all laws and regulations pertaining to prescriptions is expected. Measures to assure informed, accurate and error-free prescribing practices are encouraged.

Prescribing the following medications is prohibited under all services and circumstances:  narcotics, controlled substances, Gabapentin, Tramadol, Nubain. Please refer to Altibbi prescription policy and the other guidelines for specific details regarding prescription at service level.

Psychiatry medications

Altibbi doctors, working on Altibbi Call doctor service which provides service at primary care level, are not authorized to prescribe psychiatric medications over telehealth service. 

Over-the-counter Medication

Prescribing OTC medications is at the professional discretion of the prescribing practitioner. The indication, appropriateness, and safety considerations for each prescription provided via telemedicine services must  be evaluated in accordance with applicable law and current standards of practice.

Where such measures are upheld, and the appropriate clinical consideration is carried out and documented, the practitioner may exercise their judgment and prescribe medications as part of telemedicine encounters  in accordance with applicable laws.

Prescribing medications for pregnant women

Altibbi doctors, working on Altibbi Call doctor service which provides service at primary care level, are not authorized to prescribe any medication rather than category A or B for pregnant or lactating users. Altibbi doctors are encouraged to refer pregnant and lactating users for their specialist for further medication prescriptions

Managing patients’ expectations

Patient education is a key factor in the success of the consultation. As Telemedicine is relatively new in the region, you might encounter patients that have never accessed virtual care before and may not understand  when it is appropriate. This can lead to understandable frustration when a visit ends up with a recommendation for further in-person care or does not result in a prescription for which the patient had  hoped.

You should explain to patients that their self-reporting is the primary source of information that will be used when formulating an assessment and recommendation.

Referrals

It is important for clinicians to understand that telemedicine is not appropriate for every patient or in all situations. Telemedicine should not be a substitute for an ongoing relationship with a primary care provider, but an extension of a care continuum.

As our primary commitment must be to patient safety, not treating as many patients as possible, you must refer to all patients whose symptoms and conditions are unsuitable for virtual care to be evaluated in-person.  You must never put a patient at risk by assuming that you have enough data to make a diagnosis if that is not actually the case.

Report misuse

You should report aggressive or malicious users or other users with unacceptable behavior to the Altibbi team.

Medical liability

As a qualified medical professional, you are solely responsible for the content you communicate or submit.

Documentation and patient records 

After each call, you are requested to fill out the “recommendation” which will be stored in the patient's files. This recommendation serves as a summary and a reference for the consultation and will feed into the patient health record of that patient.

Additionally, you might be required to fill out some information about the patient. Depending on your country/state, you might be required to update the patient's public health record if applicable.  All documentation must be submitted within 24 hours from completing each consultation. 

Quality measures

We are always working on our quality assurance programs and evaluation methods, this information might be updated. As one of our practicing telemedicine physicians, you will be evaluated based on the following categories:

• Access: Including but not limited to the number of consultations accepted and completed during working hours
• Quality: Outcomes, patient satisfaction, etc. 

Outcome indicators would be determined within the clinical telemedicine program. The indicators will be used to identify successes and opportunities for improvement. Results will be shared with relevant stakeholders.

Suspension of access

Physicians and healthcare professionals who engage in misconduct (including discrimination, harassment, retaliation, or other forms of unprofessional behavior) or whose performance is unsatisfactory may be subject to corrective action, up to and including dismissal or termination of access to the platform.

Physician's access may be suspended for any of the following reasons:

• If a physician violates any of the local laws or medical regulations related, or if there’s a court order, or other governmental request regarding that physician.
• If the physician violates any of Altibbi’s policies or guidelines (Altibbi Call Doctor Service: Doctor Agreement),  related to call doctor service or any other services.
• If a physician provided any consultation or recommended any medication that can induce harm to the patient, or any action identified as an incident by Altibbi team.
• Low performance:

▪ Low Call Acceptance Rate

1. Acceptance rate is low for more than three consecutive weeks.

2. Acceptance rate is lower than the doctor's country average for three consecutive weeks.

▪ Fulfilment Rate

1. Fulfilment rate lower than doctor’s country average for three consecutive weeks. ▪Low User Rating

1. Average rating lower than 3.0 for three consecutive consultations.

2. Average rating lower than doctor’s country average for three consecutive weeks.

 3. Valid user(s) complaint related to doctor’s attitude and/or behavior.

▪ Altibbi’s medical team feedback

1. Doctor's weekly assessment generated by Altibbi medical team of expertise; flagged as “weak” and shows no improvement for three consecutive weeks.

• Physicians will be notified that they are on probation period before they are terminated.
• Physicians can request an “appeal”. Altibbi team will review cases where further considerations are required.

References

1. Pantanowitz, L., Dickinson, K., Evans, A. J., Hassell, L. A., Henricks, W. H., Lennerz, J. K., … Bernard, J. (2014). American Telemedicine Association clinical guidelines for telepathology. Journal of Pathology Informatics, 5, 39.  http://doi.org/10.4103/2153-3539.143329
2. Krupinski, E. A., & Bernard, J. (2014). Standards and Guidelines in Telemedicine and Telehealth. Healthcare, 2(1), 74– 93. http://doi.org/10.3390/healthcare2010074
3. McSwain S. David, Bernard Jordana, Burke Bryan L. Jr., Cole Stacey L., Dharmar Madan, Hall-Barrow Julie, Herendeen Neil, Herendeen Pamela, Krupinski Elizabeth A., Martin Amanda, McCafferty Dan, Mulligan Deborah Ann, North Steve, Ruschman Jennifer, Waller Morgan, Webster Kathleen, Williams Sherrie, Yamamoto Susan, and Yeager Brooke.  Telemedicine and e-Health. September 2017, 23(9): 699-706. https://doi.org/10.1089/tmj.2017.0176
4. Province of BC Health Authorities – Telehealth Clinical Guidelines 
5. http://www.phsa.ca/Documents/Telehealth/TH_Clinical_Guidelines_Sept2015.pdf
6. Telemedicine Guidelines - Virginia Department of Health Professions

https://www.dhp.virginia.gov/medicine/guidelines/85-12_Telemedicine.doc