Telehealth Consent Form
Defining Telehealth: Telehealth is the delivery of health care services using interactive audio and/or video technology, where the patient and Provider are not in the same physical location. During your telehealth consultation with a provider details of your medical or health history and personal health information may be discussed through the use of interactive audio, video, and/or other telecommunications technology, and the provider may perform a physical exam through these technologies. Depending on your medical or health history and/or specific complaint, you may be asked to provide information through other electronic means, and verify your identity with a driver's license or other legal document.
Disclaimer: The telehealth services you receive from providers are not intended to replace a primary care physician relationship or be your permanent medical home. You should seek emergency help or follow-up care when recommended by a Provider or when otherwise needed, and continue to consult with your primary care physician and other health care professionals as recommended. We may make arrangements for follow-up care either through the provider, a health systems partner, or other health care providers.
Failure of Technology Protocol: If the transmission fails during your telehealth consultation with a registered dietitian, then your provider will contact you to help you get reconnected. Attempt to reconnect will be made till the end of the scheduled session.
Benefits & Risks of Telehealth: Among the benefits of staying on track with your nutrition healthcare plan with your registered dietitian, telehealth services provide improved access to health care professionals and convenience. However, there are potentials risks associated with the use of telehealth. These risks include, but may not be limited to:
-In some instances the information transmitted may be of insufficient quality to allow for appropriate medical or health care decision making by the provider (i.e., poor resolution images, etc.);
-Delays in evaluation or treatment could occur due to failure of the electronic equipment;
-In some instances a lack of access to all of your medical records may result in delayed care or incomplete course of treatment
-Although the electronic systems we use will incorporate networks and software security protocols to protect the privacy and security of health information, in some instances, security protocols may fail and cause a breach of privacy and/or personal health information.