I understand that due to the declared public health emergency my health care provider will be utilizing telemedicine in the place of the usual and customary face-to-face visits.
I understand the purpose of this form is to provide my consent to participate in a telemedicine consultation with NewSouth NeuroSpine, LLC, providers.
I understand that details of my medical history, examinations, imaging, and tests will be discussed utilizing video, audio, and telecommunication technology. Video and audio recordings may be kept as documentation of this visit.
I understand that my provider will take every precaution to follow the existing laws regarding HIPAA Compliance.
I understand that this visit is a billable service and will present all applicable information to NewSouth NeuroSpine in order to submit a valid claim and receive appropriate reimbursement.
I understand that at any time I may terminate this consent and that this termination should be submitted to NewSouth NeuroSpine in writing.