Telehealth Consent Terms:

Navigate Meds Telehealth Consent Form

Purpose: This Telehealth Consent outlines the rights and responsibilities of patients receiving healthcare services via telehealth. Telehealth allows healthcare providers to deliver medical care through electronic communications, including video calls, phone calls, and secure messaging.

Nature of Telehealth Services: Telehealth involves the use of technology to facilitate healthcare services remotely. These services may include, but are not limited to:

  • Medical consultation and diagnosis

  • Treatment planning and follow-ups

  • Prescription management

  • Patient education and counseling

Patient Rights and Responsibilities: By consenting to telehealth services, you acknowledge and understand the following:

  1. Voluntary Participation: Participation in telehealth is voluntary, and you may withdraw consent at any time without affecting your access to in-person medical care. You understand acknowledge that such withdrawal may prevent us from providing requested services.

  2. Privacy & Confidentiality: Telehealth services follow HIPAA and applicable privacy laws to protect your health information. However, there is a risk of data breaches despite security measures in place.

  3. Potential Risks: Telehealth involves certain risks, including but not limited to interruptions due to technical failures, unauthorized access, or limitations in the provider’s ability to fully assess the patient’s condition remotely.

  4. Technology Requirements: You are responsible for using a secure internet connection and appropriate technology for telehealth appointments.

  5. Limitations of Telehealth: Telehealth does not replace all in-person visits. Some conditions may require an in-person examination or referral to another healthcare provider. We will make the decision based on the facts at our sole discretion and determination.

  6. Emergency Situations: Telehealth is not suitable for medical emergencies. If you experience a medical emergency, call 911 or go to the nearest emergency room.

  7. Billing & Insurance: You are responsible for understanding how telehealth services are covered by your insurance plan and for any applicable out-of-pocket costs. We do not bill insurance, Medicare or other third-party payer services for the services provided by us. You may be able to submit a claim to your insurer for reimbursement of services we provide. We make no warranty, implied or expressed, of such coverage. It is the patient’s responsibility to verify coverage with their insurer.

  8. Consent to Treatment: By proceeding with your order, you consent to receive medical care via telehealth and understand that we may determine that services we provide via telehealth are not appropriate at any time. You understand that we are not able to prescribe any controlled substances as outlined in applicable federal and state laws and/or regulations.

  9. HIPAA & Security Measures: Your telehealth sessions will be conducted using secure, HIPAA-compliant technology to maintain confidentiality. However, as with any electronic communication, there is a risk of unauthorized access.

  10. US Department of Health and Human Services Compliance: This consent follows the US Department of Health and Human Services guidelines for informed consent in telehealth, including ensuring patients understand their rights, risks, and responsibilities.

Acknowledgment & Agreement: I have read and understood the information provided above regarding telehealth services. I consent to receiving medical care through telehealth and acknowledge that I may ask questions at any time.

Updated: January 2025