A Telehealth service means that my visit with a practitioner at the distant site will happen by using special audiovisual equipment (Zoom). This consent is valid for all follow-up Telehealth services with HorizonView Health.
I understand that:
- I can decline the Telehealth service at any time without affecting my right to future care or treatment.
- If I decline the Telehealth services, the alternative option would be in-person services.
- The same confidentiality protections that apply to my other medical care also apply to the Telehealth services.
- I will have access to all medical information resulting from the Telehealth service as provided by law.
- The information from the Telehealth service (images that can be identified as mine or other medical information from the Telehealth service) cannot be released to researchers or anyone else without my additional written consent.
- I understand that my insurance will be billed for the telehealth services, and that I will be billed for what my insurance does not cover. By signing this consent, I am giving permission to release information to my insurance company or third-party payor for billing purposes.
- I have read this document carefully, and my questions have been answered to my satisfaction. I understand this consent is valiid for all telehealth follow-ups at HorizonView Health.