Telemedicine Services Consent
Introduction
Telemedicine involves the use of electronic communications to enable healthcare providers at different locations to share individual patient medical information for the purpose of improving patient care. Providers may include primary care practitioners, specialists, and/or subspecialists. The information may be used for diagnosis, therapy, follow-up, and/or education, and may include any of the following:
- Patient medical records
- Medical images
- Live two-way audio and video
- Output data from medical devices and sound and video files
Consent to Use Telemedicine Services
By agreeing to receive telemedicine services from NATT Weightloss, Testosterone, and Wellness Clinic (“we,” “us,” or “our”), you (“you” or “your”) acknowledge and agree to the following terms and conditions:
Nature of Telemedicine
- Services Provided:
You understand that telemedicine involves the delivery of healthcare services using interactive audio, video, or other electronic media.
- Scope of Telemedicine Services:
The telemedicine services provided by our clinic may include consultation, diagnosis, treatment, and follow-up. These services may be provided by physicians, nurse practitioners, or other licensed healthcare professionals.
Benefits and Risks
- Potential Benefits:
- Access to care that may not be available in your local area.
- The convenience of not having to travel to the clinic.
- Reduced wait times for consultation and treatment.
- Potential Risks:
- Information transmitted may not be sufficient to allow for appropriate medical decision-making.
- Delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment.
- Security protocols could fail, causing a breach of privacy and the unintended dissemination of your personal information.
- In rare cases, a lack of access to complete medical records may result in adverse drug interactions or allergic reactions or other judgment errors.
Confidentiality and Privacy
- Confidentiality:
We will take all reasonable measures to ensure that your health information is kept private and secure. However, as with any electronic communication, there is a potential risk of breach.
- Privacy Practices:
Your information will be handled in accordance with our Notice of Privacy Practices, which is available on our website.
Rights and Responsibilities
- Right to Refuse:
You have the right to withhold or withdraw your consent to the use of telemedicine services at any time without affecting your right to future care or treatment.
- Responsibility to Provide Information:
You agree to provide accurate and complete information about your medical history and current condition. You understand that failure to provide such information may affect the quality and safety of the telemedicine services.
Technical Requirements
You are responsible for providing the necessary computer, telecommunications equipment, and internet access for your telemedicine sessions. You must ensure that the telemedicine platform used is secure and that your environment is private to protect your confidentiality.
Financial Responsibility
You are responsible for any fees associated with the telemedicine services provided by our clinic. These fees will be communicated to you in advance. You are responsible for understanding your insurance coverage and any out-of-pocket expenses that may apply.
Emergency Situations
Telemedicine services are not appropriate for all medical conditions, particularly emergencies. If you are experiencing a medical emergency, you should call 911 or go to the nearest emergency room immediately.
Contact Information
If you have any questions or concerns regarding this consent or the telemedicine services provided, please contact us at:
- Email: info@nattww.com
- Phone: 346-558-1815
- Mailing Address: 545 S Mason Rd, Katy TX 77450
By signing below, you acknowledge that you have read and understood this Telemedicine Services Consent and that you agree to its terms.
