Telehealth Medical Consent

Telehealth uses electronic communications to support healthcare when the patient and healthcare professional are not in the same physical location. Depending on the service and applicable law, telehealth may involve online health questionnaires, secure messages, telephone calls, audiovisual visits, electronic records, remote review of laboratory information, or other permitted technologies.

The healthcare professional will determine whether telehealth is appropriate for the requested service. An in-person examination, additional information, laboratory testing, referral, or emergency evaluation may be required before care can be provided or continued.

• Convenient access to healthcare without requiring every interaction to occur in person.
• The ability to share health history, symptoms, laboratory information, and follow-up information remotely.
• Coordination among healthcare professionals, laboratories, pharmacies, and support services when appropriate.
• Ongoing communication and monitoring when offered as part of the care plan.

Telehealth has limitations and may not provide the same information as an in-person examination. Potential risks include:

• Incomplete or inaccurate assessment when information is missing, incorrect, delayed, or cannot be verified remotely.
• Technology failure, poor connection quality, communication delays, or interruption of access to records or messages.
• Privacy or security risks associated with electronic communications, personal devices, shared accounts, or unsecured networks.
• The need to repeat information, testing, or evaluation through another method.
• Delay in diagnosis or treatment if symptoms change, worsen, or require in-person examination.
• Differences in service availability based on location, healthcare-professional licensure, pharmacy rules, and other legal requirements.

No particular diagnosis, prescription, treatment, outcome, or result is promised or guaranteed.

Telehealth through ACT 2 Health is not an emergency service. Do not use an online assessment, website message, email, text message, or patient portal for an emergency. Call 911 or go to the nearest emergency department for severe or rapidly worsening symptoms, including chest pain, difficulty breathing, loss of consciousness, signs of stroke, severe allergic reaction, suicidal thoughts, or any condition that may require immediate care.

You agree to participate honestly and safely by:

• Providing complete and accurate information about identity, current location, symptoms, health history, allergies, medications, supplements, pregnancy status when relevant, and other care you receive.
• Updating the care team when information changes or when you experience new symptoms, side effects, or a change in health status.
• Following instructions for laboratory testing, medication use, storage, monitoring, and follow-up care.
• Asking questions when information is unclear and notifying the care team if you do not understand or cannot follow a recommendation.
• Using your own secure account, protecting passwords and devices, and participating from a private location when reasonably possible.
• Seeking in-person or emergency care when advised or when symptoms require immediate attention.

Medical decisions are made by a licensed healthcare professional based on the information available, professional judgment, and applicable law. Completing an assessment does not create a guarantee that treatment or a prescription will be offered. A healthcare professional may decline, delay, modify, or discontinue a treatment when it is not clinically appropriate or when required information, monitoring, or follow-up is unavailable.

Prescription medications may be sent to a licensed pharmacy when prescribed. The pharmacy may provide separate notices, instructions, pricing, shipping terms, and patient counseling. You must use medication only as directed for you and must not share, transfer, resell, or misuse it.

A healthcare professional may discuss an FDA-approved treatment, an off-label use of an approved treatment, or a compounded medication when legally available and clinically appropriate. Off-label use means an approved medication is prescribed for a use, dose, form, or population not specifically included in its FDA-approved labeling. Compounded medications are prepared for an individual patient and are not FDA-approved; the FDA does not review compounded medications for safety, effectiveness, or quality before they are marketed.

The healthcare professional should explain material risks, expected benefits, reasonable alternatives, monitoring needs, and the regulatory status relevant to the proposed treatment. You may ask questions and may decline a proposed treatment.

Laboratory testing or other monitoring may be required before or during treatment. Results can be affected by timing, preparation, specimen quality, laboratory methods, medications, illness, and other factors. A result may need to be repeated or evaluated in person. You are responsible for completing required testing and follow-up within the timeframe recommended by the healthcare professional.

Information created or received during telehealth may become part of a medical or service record and may be shared with authorized healthcare professionals, laboratories, pharmacies, and service providers as permitted by law and described in applicable privacy notices. Electronic communication carries privacy and security risks even when reasonable safeguards are used.

Alternatives to telehealth may include seeking care from a local healthcare professional, an in-person clinic, urgent care, or an emergency department, depending on your needs. Participation in telehealth is voluntary. You may stop using telehealth or withdraw consent for future telehealth services, but withdrawal does not affect care already provided, records already created, or actions already taken in reliance on your consent. Ending telehealth participation may limit the ability to provide or continue remote care.

By requesting or receiving telehealth services, you acknowledge that you have had the opportunity to review this consent, understand the general benefits, risks, limitations, and alternatives, agree to provide accurate information, and consent to the use of telehealth for your care. Additional treatment-specific consent may be required before a particular medication, procedure, test, or service is provided.