Termo de Consentimento Livre Esclarecido
Eu, ARLETE TURA DA SILVA inscrito no CPF sob 0 n® 194.606.688-52, dou expressa e plena
autorizagio de ser atendido por estagidrios do curso de Fisioterapia, estudantes do Centro
Universitario de Belo Horizonte ~ UniBH, sob supervisio de um fisioterapeuta (professor e, ou
preceptor. }, CREFITO, n® para realizar 0 atendimento de consulta/acompanhamento
a distancia através de servicos eletrénicos. Declaro ter ciéncia que: |. 0 atendimento a distancia é
limitado por nao permitir a realizagdo do exame fisico presencial e utilizagdo de todos os recursos
fisioterapéuticos. E essencial que todas as informagbes questionadas pelo Fisioterapeuta sejam
corretamente respondidas para que se possa indicar adequadamente e realizar os atendimentos de
teleconsulta ou telemonitoramento. Os estagidrios sob supervisio do fisioterapeuta responsavel
poderdo orienté-lo e instrui-lo a respeito da realizag3o de alguns procedimentos de avaliacio a
distancia incluindo aspectos relacionados ao exame fisico. I. Os estagidrios supervisionados irdo
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