Telehealth Consent Agreement

1) Definitions & Scope

“Telehealth” refers to the delivery of healthcare services using electronic communications between a clinician and a patient located in different places (e.g., secure messaging, audio, or video). Telehealth may limit the ability to perform a physical examination.

2) Consent to Telehealth Services

By checking the consent box on our forms or otherwise proceeding, you authorize Precision RX Telemed and its licensed clinicians to provide services via telehealth when appropriate. You understand that participation is voluntary and that you may withdraw consent at any time (see “Withdrawal of Consent”).

3) Potential Benefits & Risks

• Potential benefits: increased access to care, convenience, timely evaluation, reduced travel, and continuity of care.
• Potential risks: technical issues, data transmission failures, incomplete assessment due to the limits of remote exams, or delays that may affect decision-making.

4) Patient Responsibilities

• Provide accurate and complete medical history, medications, allergies, and health conditions.
• Ensure a private, secure location for telehealth sessions; do not record sessions unless permitted by law and clinic policy.
• Verify that your device, camera, microphone, and connection are working properly.
• Follow the treatment plan and instructions provided by your clinician, and ask questions if anything is unclear.
• Seek in-person or emergency care when advised or when your condition warrants it.

5) Clinician Responsibilities

Clinicians will use reasonable professional judgment to evaluate, counsel, and manage care via telehealth; provide guidance on follow-up; and recommend in-person evaluation or referrals when needed.

6) Confidentiality & Privacy

We protect your information consistent with applicable privacy laws (e.g., HIPAA). No system is entirely risk-free; unauthorized access or disclosure may occur in rare cases. If legally required, you will be notified of a known breach. Do not use public or shared devices for your sessions whenever possible.

7) Limitations & Alternatives

Telehealth is not appropriate for all complaints or situations. An in-person evaluation may be recommended or required. You may decline telehealth and seek care elsewhere at any time.

8) Prescriptions & Treatment

A prescription may be issued only if a licensed clinician determines it is clinically appropriate after establishing a valid clinician-patient relationship under applicable laws. Prescriptions are not guaranteed. When used, compounded medications are prepared by licensed compounding pharmacies and are not FDA-approved.

9) Service Area, Licensure & Pharmacy

• We currently service the continental USA. Availability may vary by state due to licensure, telemedicine rules, and shipping limits.
• Care is provided by clinicians licensed in the state where you are physically located at the time of service.
• When a prescription is issued, dispensing is performed by a state-licensed U.S. pharmacy. Pharmacy details can be disclosed upon request and where required.

10) Technology, Costs & Communications

• You are responsible for your device, data plan, and any telecommunication charges.
• Electronic communications (e.g., secure messaging, email notices) may be used for clinical or administrative purposes consistent with our policies.
• Some states may require a live audio-video visit before prescribing; if so, you’ll be notified.

11) Records, Access & Corrections

You may request access to your records or ask for corrections consistent with applicable law and our policies. Contact us for instructions on submitting a records request.

12) Withdrawal of Consent & Termination

• You may withdraw consent to telehealth at any time by notifying us; this will not affect care already provided.
• Either you or Precision RX Telemed may discontinue telehealth services at any time. We will offer appropriate transition to in-person care when necessary.

13) Acknowledgment & Agreement

By checking the consent box on our forms (or otherwise indicating consent), you confirm that you have read and understand this Telehealth Consent, your questions have been answered, and you voluntarily agree to receive telehealth services under these conditions.