WRITTEN CONSENT TO PARTICIPATE IN SERVICES VIA TELEHEALTH 

 

1. I agree to receive health care services via telehealth with Pathways To Wellness Medication Clinics.

 

I understand that:

a. I have the right to access Medi-Cal covered services through an in-person, face-to- face visit or through telehealth.

b. The use of telehealth is voluntary, and I may withdraw my consent to, or stop, receiving services through telehealth at any time without affecting my ability to access covered services in the future.

c. Medi-Cal provides coverage for transportation services to in-person services when other resources have been reasonably exhausted.

d. There may be limitations or risks related to receiving services through telehealth as compared to an in-person visit, if applicable.

 

2. I have read this document carefully, understand the potential limitations and risks of receiving services via telehealth, and have had my questions answered to my satisfaction.