TCHC Telehealth Informed Consent
Last Modified: January 09, 2023
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By clicking “I accept”, you hereby consent to receive health care services from licensed health care providers contracted with or employed by TCHC Provider Group (“TCHC Providers”) who are located at sites remote from you to provide consultative services to you. The receipt of health care services from a TCHC Provider (the “Services”) is a type of telemedicine or telehealth service.
TCHC Health, Inc. does not provide the Services; it performs administrative, payment, and other supportive activities for TCHC Provider Group and TCHC Providers.
What is Telehealth?
Telehealth involves the delivery of health and wellness services using electronic communications, information technology, or other means between a licensed, certified, or registered health care professional at one location and a patient in another location about a clinical matter with or without the support of an intermediary extender. Telehealth may be used for diagnosis, treatment, follow-up, and/or health and wellness education. These telehealth services may involve various modalities, including asynchronous interactions, real-time video and audio encounters and interactive audio with store and forward. This “Telehealth Informed Consent” informs the patient or guardian (“patient,” “you,” or “your”) concerning the treatment methods, risks, and limitations of utilizing telehealth to meet your health and wellness needs.
Description of Services
TCHC Providers may include behavioral health or primary care practitioners, nurse practitioners, physician’s assistants, specialists, and/or subspecialists. The name, credentials, and specialty or subspeciality of your TCHC Provider will be disclosed to you before, during, or after the Services are provided. In some cases, telemedicine visits may not be the most appropriate way for you to seek medical care and treatment. For example, certain medical conditions may require an in-person procedure, more urgent attention, or a health care provider other than your health care provider using the Services.
We may ask you a series of initial questions to help you determine whether a telemedicine visit is appropriate for you. Based on your responses to these questions, we may determine that a telemedicine visit may not be appropriate for the particular issue for which you are seeking a telemedicine visit or for other reasons related to your health status. In such a case: (i) you will receive an alert notifying you that you will be unable to use the Services for the particular issue you submitted; (ii) your request for a telemedicine visit will not be submitted to your TCHC Provider; (iii) your TCHC Provider will not receive any of the information that you submitted; and (iv) you will need to seek any needed care in another way.
Your TCHC Provider may, following submission of a telemedicine visit request, determine that your diagnosis or treatment requires an in-person office visit or is otherwise not appropriately addressed through use of the Services. In such a case, your TCHC Provider may notify you that you will be unable to use the Services for the particular issue you submitted and provide additional information regarding next steps. Your TCHC Provider is solely responsible for providing you any such notification, whether through the Services or by some other means.
We will use store-and-forward technology, audio-only consultations, and/or audio-video consultations to provide the Services. To ensure privacy and confidentiality of the Services, we use industry standard security measures. The Services may, but not necessarily will, result in a new prescription, refilling an existing prescription, patient education, non-prescriptive recommendations, or a recommendation to seek follow-up care in-person or through a different provider.
A TCHC Provider may also perform oversight for laboratory tests provided by third-party healthcare providers. This oversight involves ordering tests when appropriate, providing Patient Outreach when appropriate (defined below), and reviewing and releasing test results. TCHC does not provide laboratory tests and is not responsible for the provision of laboratory tests or other services provided by third parties or through third-party websites. If you receive a laboratory test result with a value that is outside the normal range to a degree that may constitute an immediate health risk to you or require immediate action on the part of the ordering TCHC Provider (“Critical Result”) or below the established norms for a particular test, but not as urgent as a Critical Result (“Abnormal Result”), a TCHC Provider will reach out to you directly (“Patient Outreach”). The TCHC Provider will review for symptoms, educate you on the test results, and make recommendations for follow-up treatment.
TCHC Provider Group will have no responsibility or liability for your TCHC Provider’s delay or failure to respond to a telemedicine visit request, to notify you that your telemedicine visit cannot be completed, or to provide you with next steps or follow-up information, or for any care, medical advice or treatment provided by your Provider.
Treatment-Specific Consent
Benefits and Risks
Your use of the Services may have the following possible benefits:
As with any medical procedure, there are potential risks associated with the use of telemedicine or telehealth services, which may include, without limitation, the following:
By clicking “I accept”, you also represent and warrant the following:
Acknowledgement
By clicking “I accept”, you (a) further certify that you are the patient, or that you are duly authorized by the patient as the patient’s representative or legal guardian, (b) acknowledge and accept the risks identified above and the terms associated with the receipt of clinical services via the Services, and (c) give your informed consent to receive clinical services under the terms described herein.
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