TELEHEALTH VERBAL INFORMED CONSENT
Before we can do a telemedicine visit, we need to obtain verbal consent from you. Here is what you need to know:
Telehealth involves the communication of medical/mental health information in an electronic or technology-assisted format.
You may opt out of the telehealth visit at any time.
Telehealth billing information is collected in the same manner as a regular office visit, and you are subject the requirements of your insurance plan.
All electronic medical communications carry some level of risk. While the likelihood of risks associated with the use of telehealth in a secure environment is reduced, the risks are rare, but do exist. These risks include but are not limited to:
• It is easier for electronic communication to be forwarded, intercepted, or even changed without your knowledge and despite taking reasonable measures.
• Electronic systems that are accessed by employers, friends, or others are not secure and should be avoided. It is important to use a secure network.
• Despite reasonable efforts on the part of the healthcare provider, the transmission of medical information could be disrupted or distorted by technical failures.
The information exchanged during the telehealth visit will be maintained by the healthcare providers. You must take reasonable steps to protect you and your child from unauthorized use of electronic communications by others.
The healthcare provider is not responsible for breaches of confidentiality caused by an independent third party or by you.
You agree to verify to the healthcare provider your identity and current location in connection with the telehealth services, and failure to comply with these procedures may terminate the telehealth visit.
You have a responsibility to verify the identity and credentials of the healthcare provider rendering care via telehealth and to confirm that he or she is your healthcare provider.
Please understand that a medical evaluation via telehealth may limit the healthcare provider’s ability to fully diagnose a condition or disease. You agree to accept responsibility for following the healthcare provider’s recommendations—including further diagnostic testing, such as lab testing, a biopsy, or an in-office visit.
One of our office staff will review this with you prior to the appointment and make certain any questions you have are answered.