Telehealth Informed Consent

Telehealth technologies may include secure questionnaires, messaging, telephone calls, audio/video communications, photographs, medical records, laboratory information, and other electronic technologies.

Potential benefits may include:

• convenient access to healthcare;
• reduced travel;
• more efficient communication;
• and access to healthcare professionals when in-person care may be less convenient.

Telehealth has limitations and potential risks, which may include:

• technology failures;
• interruptions or delays;
• limitations on physical examination;
• privacy or security risks associated with electronic communications;
• incomplete or inaccurate information;
• and the possibility that an in-person evaluation may ultimately be required.

The healthcare professional responsible for your care determines whether telehealth is appropriate and whether additional evaluation, testing, telephone or video consultation, medical records, or in-person care is necessary.

Telehealth evaluation does not guarantee a prescription.

Prescribing decisions are made by appropriately licensed healthcare professionals based on independent professional judgment and applicable law.

Patients are responsible for:

• providing accurate medical information;
• accurately identifying their physical location;
• providing requested medical records or testing;
• notifying the healthcare professional of relevant changes;
• following treatment instructions;
• and seeking urgent or emergency care when appropriate.

Reasonable safeguards are used to protect information transmitted during telehealth services; however, electronic communications may involve privacy and security risks.

Telehealth services available through Noma Health are not intended for medical emergencies.

The following statement is presented for affirmative acceptance during intake:

“I understand the nature, potential benefits, limitations, and risks of telehealth. I understand that I may ask questions regarding telehealth and may withdraw consent as permitted by applicable law without affecting my right to future care.”