Telehealth Consent

Consent for Telemedicine/Telehealth Services; Security and Privacy of Health Information

"Telehealth Services" means the evaluation, diagnosis, or interpretation of electronically transmitted patient-specific data between a remote location and a licensed health care professional (physicians, physician assistants, nurse practitioners) that generates interaction or treatment recommendations. Telehealth services include telemedicine and the delivery of health care services, including services to a patient, regardless of patient location, provided by way of an interactive telecommunications system, asynchronous store and forward system, remote patient monitoring technologies, e-visits, or virtual check-ins. Telehealth Services may include the electronic transmission of your health information, photos, medical records, health data collected from devices or other information between you and a licensed health care professional.

By checking the consent box, you consent to the provision of Telehealth Services. You understand that Telehealth Services enable a person to receive health care services at locations separate from a health care providers and result in more convenient services for patients and more efficient medical management with access to health care providers with specific expertise. It is important that you provide wholesome health care information, accurate personal health histories, complete lists of medications taken and allergies to us in order to prevent serious adverse events, adverse drug or allergic reactions. Delays resulting from equipment failures or deficiencies in communication devices could result from the provision of Telehealth Services. The quality or accuracy of the Telehealth Services could be impacted or limited due to technology failures or shortcomings, transmission errors or bugs, unavailable service or losses or the inability of a certain professional to delivery the health care services you need. The electronic systems or security safeguards could be inadequate and fail, subjecting you to a loss or unauthorized access to your health information. You understand the inherent risks associated with Telehealth Services and consent to the receipt of services in this manner.

You understand that the Health Insurance Portability and Accountability Act of 1996 Public Law 104-191 (“HIPAA”) may not apply to the security and privacy of the information you provide to us, in addition to the applicability of state laws governing the security and privacy of health information. We will comply with all such laws to the extent they apply. Should we provide services as a ‘business associate’ or in providing telehealth services, your individually identifiably health information will be protected as required by those laws. However, any information that is not subject to those laws or regulations, we may use such information as permitted by the Privacy Policy. You consent to all such permitted uses as set forth in the Privacy Policy.

You may ask to discontinue the receipt of Telehealth Services at any time. You may withdraw your consent for any future collection or sharing of your health information. You may have the right to access your health information, the right to correct inaccuracies or to delete your health information. Any such requests will be handled by contacting us as set forth in the Privacy Policy.

By checking the consent box, you authorize us to share your personal health information with other health care providers, pharmacies, labs, or as otherwise permitted in the Privacy Policy and to the extent permitted under applicable law. State or federal laws regarding patient access to health records may apply to the Telehealth Services and questions regarding access should also be handled as set forth in the Privacy Policy. You may also contact the state medical or licensing boards in the state in which you are located if you have any concerns regarding your health care professionals.