Telehealth Informed Consent

This Telehealth Informed Consent informs you about the use of telehealth services in your medical consultation. By agreeing to this document, you acknowledge the risks and benefits of telehealth and consent to receive care from our network of licensed physicians via remote electronic communication.

1. What is Telehealth?

Telehealth involves the use of electronic communications to enable healthcare 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.

2. Benefits & Risks

Benefits: Improved access to medical care by enabling a patient to remain in their home or office while the provider obtains test results and consults from distant/other sites. More efficient medical evaluation and management.

Possible Risks: As with any medical procedure, there are potential risks associated with the use of telehealth. 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.
• 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.
• A lack of access to complete medical records may result in interactions or allergic reactions or other judgment errors.

3. Expectations

Your physician will determine, in their sole discretion, whether the information provided by you is sufficient to make a diagnosis and recommend a treatment plan. If the physician determines that your condition is not suitable for telehealth consultation, they will recommend that you seek in-person medical care.

4. Privacy & Security

Electronic systems used will corporate 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.

5. Patient Acknowledgement

By checking the consent box at checkout, I understand and agree to the following:

• I understand that the laws that protect privacy and the confidentiality of medical information also apply to telehealth.
• I understand that I have the right to withhold or withdraw my consent to the use of telehealth in the course of my care at any time.
• I understand that my healthcare provider will communicate with me using secure electronic methods, and I am responsible for maintaining the privacy of my own devices.
• I understand that I am responsible for providing accurate and complete medical information to my physician during the assessment.