WhatsAppTelehealth Consent Form
Last Updated: 11/10/2024
This Telehealth Consent Form outlines the terms and conditions of receiving telehealth services from LeanNest, which operates under BEEWELL PHYSICALS LLC. By signing this form, you consent to participate in telehealth services provided through LeanNest and understand the potential risks, benefits, and limitations associated with telehealth.
1. Purpose of Telehealth Services
Telehealth allows you to receive healthcare services remotely through secure electronic communication methods, including video conferencing, phone consultations, and online messaging. The purpose of telehealth is to provide convenient access to healthcare while maintaining high standards of care.
2. Nature of Telehealth Services
During a telehealth session:
- Healthcare Services: You may be evaluated, diagnosed, treated, or advised by a licensed healthcare provider using electronic communications.
- Limitations of Physical Examination: Telehealth consultations are limited by the inability to conduct a physical examination, which may affect diagnostic accuracy. In some cases, an in-person consultation may be recommended.
3. Benefits of Telehealth
- Accessibility: Telehealth provides access to healthcare from the comfort of your home.
- Convenience: Telehealth can save time and reduce travel requirements.
- Continuity of Care: Telehealth allows for regular follow-ups and care management.
4. Risks and Limitations
By using telehealth services, you acknowledge and understand that:
- Technical Issues: Telehealth services may be impacted by internet connectivity, software malfunctions, or device limitations, which could delay or disrupt your session.
- Potential Security Risks: Although we employ HIPAA-compliant, encrypted technology, there is a small risk of unauthorized access or data breaches.
- Incomplete Information: Without an in-person examination, telehealth consultations may lack certain details required for a comprehensive assessment. You may need to seek in-person care if necessary.
5. Your Rights
- Confidentiality: Telehealth services provided by LeanNest comply with HIPAA regulations to protect your privacy and health information.
- Withdrawal of Consent: You have the right to withdraw your consent to telehealth at any time, without impacting your ability to seek future care from LeanNest.
- Right to Ask Questions: You have the right to ask questions about your telehealth session, the provider’s credentials, and any recommended treatments.
6. Alternative Options
Telehealth is not the only option for healthcare. You may choose to seek in-person care at any time. Telehealth may not be suitable for all medical conditions, and your healthcare provider may advise in-person visits if deemed necessary.
7. Payment and Insurance
By consenting to telehealth, you acknowledge that:
- Payment: Telehealth services may require payment at the time of service. LeanNest’s telehealth services may not be covered by insurance, and you agree to assume responsibility for any applicable fees.
8. Telehealth Prescriptions
If your healthcare provider prescribes medication, they will issue it based on their professional judgment. LeanNest does not guarantee that you will receive a prescription and does not endorse any specific medication or pharmacy.
9. Acknowledgment and Consent
By signing below, you acknowledge that:
- You have read and understood this Telehealth Consent Form.
- You consent to receive telehealth services from LeanNest.
- You understand the benefits, risks, and limitations of telehealth and agree to participate.
- You have been provided with an opportunity to ask questions regarding telehealth and have had them answered to your satisfaction.