Telehealth Consent

Telehealth Authorization

Telehealth is the use of electronic information and communication technologies to enable a healthcare provider and a patient at different locations to share medical information for evaluation, consultation, screening, treatment, follow-up, and related healthcare services. Your telehealth encounter may include asynchronous technology, secure messaging, questionnaires, photographs, video, audio, or other electronic communications.

By accepting this Telehealth Consent, you consent to the use of telehealth technologies by the applicable medical group and provider to deliver healthcare services to you.

Benefits and Risks

Telehealth can improve access to healthcare services and may allow you to receive care without traveling to an in-person appointment. Telehealth also has potential risks, including interruptions or delays in connection, incomplete or unclear information, technology failures, unauthorized access, privacy or security breaches, and limitations on a provider's ability to perform a physical examination.

Telehealth is not appropriate for every medical condition or concern. A provider may determine that telehealth is not sufficient for your circumstances and may recommend in-person care, follow-up with another healthcare professional, urgent care, or emergency care.

Alternatives

Alternative methods of care, including in-person medical services, may be available to you. You may choose an alternative at any time. You understand that choosing not to use telehealth may limit your ability to access certain services through Barefaced RX.

Privacy and Medical Information

The applicable medical group and provider use security protocols designed to protect the confidentiality of your health information. Personal information that identifies you or contains protected health information will not be disclosed to third parties without your consent except as permitted or required by law for treatment, payment, healthcare operations, or as described in the Barefaced RX Privacy Policy and applicable medical group privacy practices.

You understand that electronic communications may involve risks to privacy and security, and you agree to provide complete and accurate information so your provider can make appropriate clinical decisions.

Follow-Up Care and Emergencies

Barefaced RX is not a primary care provider and does not provide emergency care. If you experience an urgent health issue or believe telehealth will not provide sufficient safety or quality, you should seek in-person care from an appropriate healthcare facility or provider.

If the situation is an emergency, call 911 immediately.

Patient Acknowledgements

• I understand that telehealth involves the use of electronic information and communication technologies by a healthcare provider to deliver services when I am located at a different site than the provider.
• I understand that my telehealth visit may not be the same as an in-person visit and that results cannot be guaranteed.
• I understand that I am responsible for providing truthful, accurate, and complete medical information and for following up with my primary care provider or another specialist regarding any concerns, abnormal results, or instructions from my provider.
• I understand that I have the right to withhold or withdraw my consent to telehealth at any time, without affecting my right to future care, subject to applicable law and service availability.
• I understand that the provider may have a financial relationship with Barefaced RX and that I am free to obtain consultation or treatment elsewhere.
• I understand that I will be responsible for payments that apply to my telehealth visit and that services may not be reimbursable by any government or commercial health insurance plan.
• I have read and understand this Telehealth Consent, and all of my questions have been answered to my satisfaction.

For purposes of this informed consent, I understand and agree that checking the applicable box, clicking an acceptance button, creating an account, submitting an intake, purchasing a product, or otherwise indicating acceptance electronically constitutes my electronic signature.

Related Policies

You should also review the Barefaced RX Terms and Conditions, Privacy Policy, and Consumer Health Data Privacy Policy, which describe additional terms, privacy practices, and rights that may apply to your use of the Service.