Prime Direct Care

PRACTICE POLICIES

APPOINTMENTS AND CANCELLATIONS

The standard meeting time for the initial visit is 30-45 minutes and follow up visits are 15-20 minutes.

Payment is due within 24 hours of your appointment. You may lose your appointment if payment is not received within 24 hours of your scheduled time.

Cancellations and re-scheduled visits will be subject to a full charge if NOT RECEIVED AT LEAST 48 HOURS IN ADVANCE. This is necessary because a time commitment is made to you and is held exclusively for you. If you are late for an appointment, you may lose some of the allotted time for that appointment. Your card will automatically be billed 24 hours prior to your appointment if payment is not received.

TELEPHONE ACCESSIBILITY

If you need to contact PRIME DIRECT CARE between sessions, please call our main number or send us amessage through the website. We are often not immediately available: however, we will attempt to return your call or message within 24 hours. Please note that Face-to-face video visits are highly preferable to phone visits. However, in the event that you are out of town, sick or need additional support. phone sessions are available. If a true emergency situation arises, please call 911 or go to your local emergency room.

ELECTRONIC COMMUNICATION

We cannot ensure the confidentiality of any form of communication through electronic media, including, but not limited to, text messages, telephone communication, the Internet, facsimile machines, and e-mail. Telemedicine is broadly defined as the use of information technology to deliver medical services and information between two parties that are at different locations. The above electronic means of communication are considered telemedicine. Utilizing telemedicine services through PRIME DIRECT CARE is voluntary in nature and you need to understand:

1. You have the right withhold or withdraw your consent for telemedicine services at any time. If this occurs, we can provide care for you in person in the office, if you so choose.

2. We will protect your protected health information in the same fashion as a brick and mortar practice. You need to understand though that data breaches can happen. and we cannot assure your information is 100% protected.

3. We will not use your protected health information for research purposes unless you give us consent to do so,

4. There are potential benefits, risks and subsequent consequences of telemedicine. Potential benefits include. but are not limited to improved access to care. reducing costs. improving the quality of visits, and reduction of travel time associated with medical visits. The medical provider will make assessments, diagnoses, and treatment plans based off all the visual and auditory information provided during the video conference. You must understand that this is limited and posts potential risks including, but not limited to the provider's inability to make complete diagnostic assessments that might require a physical exam and to see the patient in person. During an in-person encounter, a medical provider has the ability to see the entire patient including but not limited to their gait, smell, general appearance, and demeanor. Potential consequences thus include the provider not being aware of clinically significant information that you may not recognize as significant to present verbally to the provider.

MINORS

We require parental consent for all visits done through telemedicine. We require your parents to be present during a portion of the visit to ensure that they are consenting to treatment.

If you are a minor, your parents may be legally entitled to some information about your treatment. We will discuss with you and your parents what information is appropriate for them to receive and which issues are more appropriately kept confidential.

 

TERMINATION

We can terminate treatment with you at any time. We will not terminate the medical relationship with you without first discussing and exploring the reasons and purpose of terminating. If treatment is terminated for any reason, we will provide you with a list of qualified providers to continue your care. You mayalso choose someone on your own or from another referral source. Should you fail to not show up for your follow up appointments, not obtain lab work in a timely fashion or are non-compliant with treatment. unless other arrangements have been made in advance, for legal and ethical reasons, we must consider the professional relationship discontinued.

 

BY TYPING MY NAME BELOW, I AM SIGNING THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ITEMS CONTAINED IN THIS DOCUMENT.

CONSENT FOR TELEHEALTH CONSULTATION

1. I understand that I am voluntarily engaging in a telemedicine consultation with PRIME

2. I understand that the video conferencing technology and/or phone consultations will not be the same as a direct patient/health care provider visit due to the fact that I will not be in the same room as my health care provider.

3. I understand that a telehealth consultation has potential benefits including easier access to care, decreasing costs, and allowing visits to be performed from the comfort of my home.

4. I understand there are potential risks to this technology, including interruptions, unauthorized access, and technical difficulties. I understand that my health care provider or I can discontinue the telehealth consult/visit if it is felt that the videoconferencing connections are not adequate for the situation.

5. I understand that my healthcare information may be shared with other individuals for scheduling and billing purposes. I understand that if there is another individual present during the telehealth consultation that I will be informed of their presence and I will also disclose if there is another individual with myself. It is agreed that these individuals will maintain confidentiality of the information obtained. I further understand that I will be informed of their presence in the consultation and thus will have the right to request the following: (1) omit specific details of my medical history/physical examination that are personally sensitive to me; (2) ask non-medical personnel to leave the telemedicine examination room: and or (3) terminate the consultation at any time.

6. I understand that the alternative to a telemedicine consultation is to forgo evaluation and treatment with BRIDGET RANDOLPH NP-C AND/OR PRIME DIRECT CARE and to seek out an in-person evaluation elsewhere. Thus, I am freely choosing to participate in a telemedicine consultation

7. I understand that telemedicine has limitations in regard to the physical examination I understand that the physical exam portion of the care provided through PRIME DIRECT CARE will be limited to inspection via video conferencing and some parts of the exam such as physical tests, examination of certain body parts, and vital signs may be conducted by individuals at my location at the direction of the consulting health care provider or not done at all.

8. Telemedicine services offered through PRIME DIRECT CARE are not an Emergency Service and in the event of an emergency or urgent medical issue, I will use a phone to call 911, go to the emergency department, or go to an urgent care.

9. To maintain my privacy, I will not share telemedicine login information or video conferencing links with anyone unauthorized to attend the appointment

 

By signing this form, I certify:

- That I have read or had this form explained/read to me and I understand its contents including the risks and benefits of telemedicine.

- That I have had the opportunity to ask questions and have had them answered to my satisfaction.

BY TYPING MY NAME BELOW, I AM SIGNING THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ITEMS CONTAINED IN THIS DOCUMENT.