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Telehealth Services Agreement

By agreeing to participate in telemedicine services, I understand and acknowledge the following:

1. Nature of Telemedicine

• Telemedicine involves the use of electronic communications to enable healthcare providers to diagnose, consult, treat, and educate patients using telecommunications technology.
• I understand that the same standard of care applies to telemedicine as to in-person consultations.

2. Benefits and Risks

Benefits:

• Improved access to medical care by enabling consultation remotely
• More efficient medical evaluation and management
• Reduced travel time and costs

Risks:

• Technology may fail during consultation
• Delays in medical evaluation and treatment could occur due to technical deficiencies
• Security protocols could fail, causing a breach of privacy of personal medical information
• Some physical examinations cannot be performed remotely

3. Privacy and Security

• All telemedicine sessions are conducted through HIPAA-compliant, encrypted platforms
• Your medical information will be kept confidential in accordance with federal and state privacy laws
• Electronic medical records will be maintained with the same security as traditional medical records

4. Patient Responsibilities

• Provide accurate medical history and current medications
• Be in a private, quiet location during the consultation
• Have reliable internet connection and functioning camera/microphone
• Understand that the provider may determine that an in-person visit is necessary

5. Emergency Situations

I understand that telemedicine is not appropriate for emergency situations. In case of emergency, I will call 911 or go to the nearest emergency room.

6. Payment and Insurance

• I understand that I am responsible for any co-pays, deductibles, or fees not covered by my insurance
• Payment is due at the time of service unless other arrangements have been made

7. Provider Discretion

I understand that my healthcare provider has the right to determine whether telemedicine is appropriate for my medical needs and may require an in-person visit if necessary.