Telehealth Consent

Telehealth Consent for The Virtual NP

Effective Date: 05/02/2025

By proceeding with care at The Virtual NP, I voluntarily agree to participate in telehealth services. I understand that telehealth refers to the remote delivery of medical care, which may include consultations, diagnosis, treatment planning, follow-up care, and health education, all conducted through secure two-way audio, video, or electronic communication.

Scope of Telehealth Care

I acknowledge that telehealth visits may involve the secure transmission of medical data and communication of personal health information with licensed practitioners, including nurse practitioners, physicians, and other virtual care providers. These visits are intended to offer a safe, accessible alternative to face-to-face medical services when in-person appointments are not required.

My Rights and Protections

I understand the following:

• I have the right to withdraw my consent for telehealth services at any time. Doing so will not affect my access to future care, either online or in-person.

• I consent to access my pharmacy records and to information sharing with the pharmacist and affiliated staff for obtaining medications.

• I consent to receiving care through a combination of telehealth technologies, which may include two-way audio, videoconferencing, and asynchronous or store-and-forward methods, as appropriate to support my treatment. I understand that these methods are used together in accordance with applicable state laws and clinical standards.

• All information shared during a virtual visit is protected by state privacy laws and HIPAA standards. This includes any verbal, written, or visual information disclosed.

• While our platform uses encrypted technology to protect my data, there are inherent risks in virtual care, such as technical difficulties or delays in assessment due to the lack of physical examination.

• Telehealth is not a replacement for all medical services. If a provider believes that face-to-face evaluation or treatment is more appropriate, I may be referred to a local doctor, physician, or healthcare facility for in-person assessment.

• The Virtual NP does not offer psychotherapeutic services. Mental health conditions requiring therapy, psychiatric care, or crisis intervention may be referred to specialized providers or clinics.

• Although many patients benefit from telehealth care, individual results may vary. No specific outcome is guaranteed.

• I understand I may go to another in-person facility if telemedicine does not work for me.

Security, Payments, and Consent Duration

• My telehealth sessions will be conducted using HIPAA-compliant software to ensure the confidentiality and integrity of my personal health data.

• I agree to submit full payment at the time of booking. All services are self-pay and non-refundable unless required by law or unless instructed to issue a refund by relevant regulatory authorities or payment processors during a dispute resolution process.

• This consent remains valid for one year from the date of signature unless I provide written notice of withdrawal.

Transparent Billing:

• We are an out-of-network service. We do not process any insurance, workman's compensation, employee assistance program, Medicare, or Medicaid

• Not all insurances or companies will reimburse you for seeing out-of-network providers

Emergency Disclaimer

• I understand that telehealth services are not appropriate for emergencies. In the event of a medical emergency, I will call 911 or go to the nearest emergency room.