Telehealth Informed Consent

[DRAFT — requires review by healthcare counsel and must satisfy each state’s telehealth consent requirements before launch.]

What telehealth is

Telehealth uses electronic communication to enable a clinician to evaluate and treat you without being in the same room. It has real benefits and real limitations.

Limitations and risks

A remote visit does not include a hands-on physical examination. Information transmitted may be insufficient for a clinician to make a decision, in which case you may be asked to seek in-person care. Technology can fail. Rarely, electronic security measures could be breached.

Your rights

You may withhold or withdraw consent at any time without affecting your right to future care. You are entitled to know who is participating in the visit and to have your information handled under applicable privacy law.

Emergencies

Telehealth is not appropriate for emergencies. If you are experiencing a medical emergency, call 911. If you are in crisis, call or text 988.

State-specific provisions

[Placeholder — counsel to complete per state of operation.]