Definition of Telehealth
Telehealth involves the use of electronic communications to enable Midlands Orthopaedics & Neurosurgery’s (MON) providers to connect with individuals using interactive video and audio communications.
Telehealth includes the practice of health care delivery, diagnosis, consultation, treatment, referral to resources, education, and the transfer of medical and clinical data.
Informed Consent for Telehealth Services
I understand the following information with respect to telehealth:
1. The state and federal laws that protect the confidentiality of my personal information also apply to telehealth. I also understand that the dissemination of any personally identifiable images or information from the telehealth interaction to other entities shall not occur without my written consent unless specifically allowed or required by law.
2. I understand that I have the right to withhold or withdraw my consent to the use of telehealth in the course of my care at any time, without affecting my right to future care or treatment.
3. I understand that the telehealth transmission of my personal information may be disrupted or distorted by technical failures that are beyond the control of my health care provider. MON utilizes secure, encrypted audio/video transmission software to deliver telehealth, but we cannot guarantee that a third-party will not be able to illegally intercept the telehealth transmission.
4. I understand that all orthopaedic and neurosurgical evaluation cannot be completed remotely. If my provider believes I would be better served by in-person evaluation and treatment, I will be asked to come to a practice location to receive care.
5. I understand the alternatives to telehealth as they have been explained to me. In choosing to participate in telehealth, I am agreeing to participate using video conferencing technology. I also understand that at my request or at the direction of my provider, I may schedule a “face-to-face” evaluation.
6. I understand that anticipated benefits of telehealth include improved access to care as well as more efficient evaluation and management of my care, but that no results can be guaranteed or assured.
Payment for Telehealth Services
MON will bill insurance for telehealth services when these services have been determined to be covered by an individual’s insurance plan. Most insurance plans apply the same co-pay or co-insurance for telehealth visits as in-person office visits.
Patient Consent to the Use of Telehealth
I have read and understand the information provided above regarding telehealth; I have discussed it with my provider’s clinical team; and all my questions have been answered to my satisfaction.
I hereby give my informed consent to participate in telehealth services for treatment as described above.