Telehealth Informed Consent

This Telehealth Informed Consent (“Consent”) describes telehealth care provided through Erosyn Rx. By using the Services for care, you acknowledge that you have read and agree to this Consent.

1. What telehealth is

Telehealth is the delivery of healthcare using electronic communications — such as secure messaging, questionnaires, phone, or video — between you and a licensed provider who may be in a different location. It allows evaluation, diagnosis, treatment, and follow-up without an in-person visit.

2. Nature of the care

• Your care is provided by an independent provider licensed in your state, using the information you supply during intake and follow-up.
• A telehealth encounter may not include a physical examination. Care is based on the information you provide, so it is important that your information is accurate and complete.
• The provider will determine whether telehealth is appropriate for your needs and may determine that in-person care, additional testing, or a referral is necessary.

3. Benefits

• Access to licensed care without travel or waiting rooms.
• Convenient follow-up and secure communication with your care team.
• Coordination of prescriptions, pharmacy dispensing, and lab testing where appropriate.

4. Risks and limitations

• Because a telehealth visit may not include a physical exam, there is a possibility that a condition could go undetected or that a provider could reach a different conclusion than they would in person.
• Technical problems could interrupt or affect the quality of a visit.
• Despite reasonable safeguards, electronic communications carry some risk to privacy and security.
• Telehealth is not appropriate for emergencies. If you have a medical emergency, call 911 or go to the nearest emergency room.

5. Prescriptions

Any prescription is issued at the independent clinical judgment of your provider and only when appropriate. Completing an intake does not guarantee a prescription. Some treatments may be compounded medications, which are not FDA-approved; your provider will discuss risks and benefits with you.

6. Privacy of your health information

Your health information is handled in accordance with our Privacy Policy and HIPAA Notice of Privacy Practices. Telehealth encounters are documented in your medical record.

7. Your rights

• You may withhold or withdraw your consent to telehealth at any time without affecting your right to future care or treatment.
• You may request an in-person referral instead of telehealth.
• You have the right to have your questions answered before agreeing to care.

8. Consent to treat

By proceeding, you consent to receive care via telehealth as described here, you confirm the information you provide is accurate, and you understand that the provider-patient relationship is between you and the independent provider. If you do not agree, do not proceed with a telehealth visit.

9. Contact

Questions about telehealth care can be sent to [email protected].