Medical Consent

We may change these terms at any time, as required by law. This may include changing, adding, or removing terms. We may do this in response to legal, business, competitive environment or other reasons not listed here.

Telehealth Consent

Telehealth is the type of care that allows clients to access health services using audio-video interface such as videoconferencing.

Electronic systems used will incorporate network and software security protocols to protect the confidentiality of client identification and imaging data and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption.

Expected Benefits

• Improved access to foot & ankle care by enabling a client to receive services across distances and between programs.
• More efficient foot & ankle care including medical evaluation and management.
• Obtaining expertise of a distant specialist.
• Maintaining connections with established providers in other areas.

Possible Risks

As with any medical procedure, there are potential risks associated with the use of telehealth for foot & ankle care and treatment. These risks include, but may not be limited to:

• In rare cases, information transmitted may not be sufficient (e.g. poor resolution of images) to allow for appropriate medical decision making by the physician or other clinical staff.
• Delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment.
• In very rare instances, security protocols could fail, causing a breach of privacy of personal medical information.
• In rare cases, a lack of access to complete medical records may result in adverse drug interactions or allergic reactions or other judgmental errors.

By consenting to these forms, I understand the following:

I understand that the laws that protect privacy and the confidentiality of medical information also apply to telehealth, and that no information obtained in the use of telehealth which identifies me will be disclosed to researchers or other entities without my consent.

• I understand that I have the right to withhold or withdraw my consent to the use of telehealth in the course of my care at any time, without affecting my right to future care or treatment.
• I understand that I have the right to inspect all information obtained and documented in the course of a telehealth interaction and may receive copies of this information for a reasonable fee.
• I understand that a variety of alternative methods of foot & ankle care may be available to me, and that I may choose one or more of these at any time.
• I understand that it is in my best interest to inform my physician or other clinical staff of any other healthcare providers involved in my medical care.
• I understand that I may expect the anticipated benefits from the use of telehealth in my care, but that no results can be guaranteed or assured.

Client Consent to the Use of Tele-health

HIPAA Consent

The Health Insurance Portability and Accountability Act (HIPAA) provides safeguards to protect your privacy. Implementation of HIPAA requirements officially began on April 14, 2003. This form is a "friendly" version. A more complete text is available through the office.

What this is all about

Specifically, there are rules and restrictions on who may see or be notified of your Protected Health Information (PHI). These restrictions do not include the normal interchange of information necessary to provide you with office services. HIPAA provides certain rights and protections to you as the patient. We balance these needs with our goal of providing you with quality professional service and care. Additional information is available from the U.S. Department of Health and Human Services.

We have adopted the following policies

• Patient information will be kept confidential except as is necessary to provide services or to ensure that all administrative matters related to your care are handled appropriately. This specifically includes the sharing of information with other healthcare providers, laboratories, health insurance payers as is necessary and appropriate for your care.
• Patient files may be stored in open file racks and will not contain any coding which identifies a patient's condition or information on the face of the folder.
• It is the policy of this office to remind patients of their appointments. We may do this by telephone, e-mail, U.S. mail, or by any means convenient for the practice and/or as requested by you. We may send you other communications informing you of policy or procedure changes that you might find valuable or informative.
• The practice utilizes a number of vendors in the conduct of business. These vendors may have access to PHI but must agree to abide by the confidentiality rules of HIPAA.
• You understand and agree to inspections of the office and review of documents which may include PHI by government agencies or insurance payers in normal performance of their duties.
• You agree to bring any concerns or complaints regarding privacy to the attention of the office manager or the doctor.
• Your confidential information will not be used for the purposes of marketing or advertising of products, goods, or services.
• We agree to provide patients with access to their records in accordance with state and federal laws.
• We may change, add, delete, or modify any of these provisions to better serve the needs of both the practice and the patient.
• You have the right to request restrictions in the use of your protected health information and to request change in certain policies used within the office concerning your PHI. However, we are not obligated to alter internal policies to conform to your request.

Financial Consent

I understand and accept the terms in order to render services that a credit card may be kept on file and that any remaining balances for services rendered shall be paid in full. I authorize NowCare Health, LLC to submit on my behalf and the release of any medical records or other information necessary to process my consultation order. Fee schedules and receipts for all professional services are available upon request.

I authorize NowCare Health, LLC to make invoice changes and debit my account for consultation and care services rendered not fully covered by third party vouchers or credits. I understand that NowCare Health charges only for virtual consultation and care services and does not sell, ship, distribute, or collect payment for any medications.

I authorize NowCare Health, LLC to charge my credit card account upon any unpaid balances due.

Prescription Authorization

NowCare Health does not sell, ship, distribute, or collect payment for any medications. If a licensed provider determines that medication is medically appropriate, the provider writes a prescription and transmits it to a pharmacy (for Weight Loss programs, typically a preferred pharmacy offering direct shipping). Any prescription is dispensed by that pharmacy according to state and federal law, with the approval of the pharmacist in charge and in compliance with all applicable Medical Boards and State Boards of Pharmacy. I obtain and pay for any medication directly from my chosen pharmacy, and I agree to hold harmless NowCare Health, LLC for the acts, delays, or errors of that pharmacy.