AXIS ARTHRITIS AND RHEUMATOLOGY CARE
Informed Consent and Agreement for Telehealth Services
I, the patient (or parent/legal guardian), understand and agree that by continuing the use of this website, I am confirming that I have read, understood, and agreed to the terms outlined in this document. I understand that I have the option of requesting a copy of this document and executing it with a handwritten signature upon request.
Definition of Telehealth
For the purposes of this document, telehealth is defined as the electronic communications technologies used by the physicians and staff at Axis Arthritis and Rheumatology Care, PLLC (together, the Practice), to enable them to obtain information and communicate remotely while providing me with patient care.
I understand that the same standard of care applies to medical treatment obtained through telehealth communications as applies to an in-person visit.
The information obtained through telehealth communications may be used for diagnosis, treatment, follow-up, and/or education and may include any of the following:
- Patient medical records
- Medical images
- Live two-way audio and video and data communications
- Output data from medical devices and sound and video files
- Questionnaires, email, and text messaging
The electronic systems used will incorporate network and software security protocols to protect the confidentiality of patient identification and imaging data and will include measures to safeguard the data and ensure its integrity against intentional or unintentional corruption.
Understandings
I understand that:
- Telehealth involves the communication of my health information in an electronic or technology-assisted format;
- All electronic medical communications carry some level of risk;
- Despite reasonable security efforts, electronic communication could be forwarded, intercepted, or altered without my knowledge;
- Electronic systems accessed by employers, friends, or others are not secure and should be avoided;
- It is important for me to use a secure network;
- Despite reasonable efforts by my provider, the transmission of medical information could be disrupted or distorted by technical failures;
- I may opt out of the telehealth visit at any time;
- The Practice will maintain information exchanged during my telehealth visit as part of my medical record;
- The Practice is not responsible for breaches of confidentiality caused by an independent third party or myself;
- I must verify my identity and current physical location, specifically that I am located in Connecticut, Massachusetts, New Hampshire, or Florida, to my physician. Any violation or failure to meet this requirement shall terminate the telehealth visit;
- I must not use electronic communication in emergencies or time-sensitive matters;
- Electronic communication may involve highly sensitive medical information, including information related to HIV/AIDS, sexually transmitted diseases, or addiction treatment;
- A medical evaluation via telehealth may limit my physician’s ability to fully diagnose a condition. I agree to follow my physician’s recommendations, including further diagnostic testing such as lab testing, biopsy, or in-office evaluation if advised;
- There is never a warranty or guarantee regarding a particular medical result or outcome when care is provided;
- By continuing the use of this website, I acknowledge that I understand the inherent risks of errors or deficiencies in the electronic transmission of health information and images during a telehealth visit.
Possible Benefits of Telehealth
- Easier access to medical care
- Convenience
- More time-efficient medical evaluation and management
Possible Risks of Telehealth
As with any technology used in medical care, there are potential risks associated with telehealth, including but not limited to:
- Information transmitted may not be sufficient to allow appropriate medical decision-making by my provider;
- My physician may not be able to provide certain treatments remotely;
- Regulatory and other requirements may limit available treatment options, including prescriptions;
- Delays in medical evaluation and treatment could occur due to technical deficiencies or equipment failure;
- Security protocols could fail, resulting in privacy breaches of personal medical information.
By continuing the use of this website, I confirm that I have read and understood this document in its entirety. I acknowledge that I have had the opportunity to seek clarification if needed. I consent to participation in telehealth services under the terms outlined above. I understand that I may request a hard copy of this Informed Consent at any time.