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TELEHEALTH INFORMED CONSENT

  1. WHAT IS TELEHEALTH?
    Telehealth involves the delivery of healthcare services using interactive audio, video, or other electronic communications when you and your provider are not in the same physical location. This practice uses HIPAA-compliant telehealth platforms with end-to-end encryption and business associate agreements.

  1. TECHNOLOGY REQUIREMENTS
  • Device with camera and microphone
  • Reliable, private internet connection
  • Private location where consultation cannot be overheard

  1. BENEFITS
  • Increased access to care
  • Reduced travel time and costs
  • Continuity of care
  • Scheduling convenience

  1. RISKS AND LIMITATIONS
  • Technology may fail during consultation
  • Physical examination is limited to visual assessment
  • Some conditions require in-person evaluation
  • Electronic communications carry inherent privacy risks despite encryption
  • Emergencies cannot be managed via telehealth – call 911

  1. PRESCRIBING VIA TELEHEALTH
  • DEA telemedicine flexibilities for controlled substances are extended through December 31, 2026, allowing Schedule II-V prescribing via audio-video without a prior in-person evaluation.
  • If flexibilities expire, controlled substance prescribing may require prior in-person evaluation under the Ryan Haight Act.
  • Some states impose additional restrictions (e.g., New York, Florida). Your prescriber will comply with the laws of the state where you are physically located.
  • Non-controlled medications (GLP-1 agonists, compounded therapies) may be prescribed via telehealth where state law permits.

  1. PRIVACY
  • All sessions use HIPAA-compliant platforms. You are responsible for a private location. Sessions are documented in your record but not recorded without consent.

  1. YOUR RIGHTS
  • You may refuse telehealth and request in-person care at any time.
  • You may end a session at any time. Refusal does not affect future care.

  1. STATE-SPECIFIC REQUIREMENTS
    The provider must be licensed in the state where you are physically located. You must disclose your location at each visit.

  1. PATIENT ACKNOWLEDGMENTS
  • I understand the nature, benefits, risks, and limitations of telehealth.
  • I understand telehealth is not for emergencies.
  • I will provide accurate information about my physical location.
  • I consent to receiving healthcare services via telehealth.
  • I may withdraw consent at any time.
PATIENT SIGNATURE
PROVIDER SIGNATURE