I understand that my provider will be providing my care through an interactive telehealth video connection. Native American Community Clinic staff has explained to me the process for communicating with my medical provider via telehealth technology.
This telehealth technology will be utilized to complete my appointment with a provider at the Native American Community Clinic in Minneapolis, MN.
I have been reassured that my visit will be kept completely confidential and in compliance with all aspects of HIPAA. I further understand that the technology involved in providing my visit does not create a recording or any type of accessible information during or at the completion of my visit. My provider is providing my visit services in a confidential room with a closed door. There will be restricted access to this room during the visit time. My visit will be documented in my confidential electronic health record at the Native American Community Clinic.
I understand this statement and consent to treatment utilizing telehealth technology between myself and the Native American Community Clinic.
I consent to telehealth services.