Telehealth Informed Consent

Revive MD is committed to providing safe, convenient, and high-quality medical care through secure telehealth technology. This Telehealth Consent explains how telehealth services are delivered and outlines your rights and responsibilities as a patient.

By scheduling or participating in a telehealth appointment, you acknowledge that you have read, understood, and agree to the terms below.

What Is Telehealth?

Telehealth allows you to receive healthcare services remotely using secure audio, video, telephone, and electronic communication technologies.

Telehealth services offered through Revive MD may include:

• Medical consultations
• Review of laboratory results
• Treatment planning
• Prescription management
• Follow-up appointments
• Patient education

Not every medical condition can be appropriately evaluated through telehealth.

Benefits of Telehealth

Telehealth offers several advantages, including:

• Convenient access to licensed healthcare providers
• Reduced travel and waiting time
• Increased privacy and comfort
• Improved continuity of care
• Faster communication regarding treatment and follow-up
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Limitations of Telehealth

While telehealth is highly effective for many patients, it has limitations.

These include:

• The provider cannot perform a traditional hands-on physical examination.
• Technical issues may interrupt or delay your appointment.
• Certain medical conditions require in-person evaluation.
• Laboratory testing or additional diagnostic studies may be necessary before treatment can be recommended.

Your healthcare provider will determine whether telehealth is appropriate for your individual situation.

Risks

Although secure technology is used whenever possible, telehealth involves certain risks, including:

• Technical failures or interruptions
• Unauthorized access despite reasonable security safeguards
• Delays in evaluation due to technology issues
• Incomplete information if video, audio, or internet quality is poor

Revive MD takes reasonable precautions to protect your personal health information in accordance with applicable privacy laws.

Provider Responsibilities

Your healthcare provider agrees to:

• Review your medical history and available records.
• Evaluate whether telehealth is appropriate for your care.
• Explain treatment recommendations.
• Answer your questions regarding diagnosis, treatment options, medications, and follow-up care.
• Recommend in-person evaluation when medically necessary.
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Patient Responsibilities

As a patient, you agree to:

• Provide complete and accurate medical information.
• Participate in appointments from a private location whenever possible.
• Use a secure internet connection when available.
• Inform your provider of any changes in your health or medications.
• Follow treatment recommendations and prescribed follow-up care.
• Seek emergency medical attention by calling 911 or visiting the nearest emergency department if you believe you are experiencing a medical emergency.

Prescriptions

Prescriptions are issued only when a licensed healthcare provider determines they are medically appropriate.

Receiving a telehealth consultation does not guarantee that medication will be prescribed.

Prescription availability may depend on:

• Medical necessity
• State laws and regulations
• Clinical guidelines
• Pharmacy availability

Laboratory Testing

Many treatment plans require laboratory testing before medication can be prescribed or continued.

You understand that:

• Laboratory testing may be required before treatment begins.
• Follow-up laboratory testing may be necessary to monitor safety and effectiveness.
• Failure to complete required laboratory testing may result in delayed or discontinued treatment.

Privacy

Telehealth appointments are conducted using secure technology designed to protect your personal health information.

Your medical information will be handled in accordance with applicable federal and state privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA).

Consent

By using Revive MD’s telehealth services, you acknowledge that:

• You understand the nature of telehealth services.
• You have had the opportunity to ask questions.
• Your questions have been answered to your satisfaction.
• You understand the potential benefits and limitations of telehealth.
• You voluntarily consent to receive healthcare services through telehealth.
• You understand that you may withdraw your consent at any time before or during a telehealth appointment, although doing so may affect your ability to receive treatment.

Contact Us

If you have questions regarding this Telehealth Consent, please contact Revive MD before your appointment.