Informed Consent for Telemedicine Visit

I hereby provide my informed consent to participate in a telemedicine visit with LivWell Clinic through electronic communication technologies. I understand and acknowledge the following:

1. Nature of Telemedicine: Telemedicine involves the use of electronic communication technologies, such as video conferencing or telephone, to facilitate medical consultations remotely. It allows for the evaluation, diagnosis, treatment, and management of medical conditions without the need for an in-person visit.

2. Benefits of Telemedicine: Telemedicine offers several potential benefits, including increased accessibility to healthcare services, convenience, reduced travel time and costs, and the ability to receive medical care from the comfort of my own location.

3. Limitations of Telemedicine: I understand that telemedicine has its limitations and may not be appropriate for all medical conditions or situations. It may not provide the same level of physical examination or diagnostic accuracy as an in-person visit. There may be technical limitations, such as interruptions or connectivity issues, that could affect the quality of the consultation.

4. Privacy and Security: I acknowledge that my healthcare provider will take reasonable measures to ensure the privacy and security of my personal health information during the telemedicine visit. However, I understand that there are inherent risks associated with electronic communication, including the potential for unauthorized access or interception of information.

5. Alternative Options: I understand that I have the right to choose whether to participate in a telemedicine visit or opt for an in-person consultation. I have been informed of alternative options for medical care and have had the opportunity to discuss these alternatives with my healthcare provider.

6. Risks and Benefits: I have been provided with information regarding the risks and benefits of telemedicine, including the potential benefits of receiving medical care remotely and the potential risks associated with limited physical examination or technical issues.

7. Confidentiality: I understand that my healthcare provider will maintain the confidentiality of my personal health information in accordance with applicable laws and regulations. However, I acknowledge that there are inherent risks to privacy and confidentiality in electronic communication and that my healthcare provider cannot guarantee absolute security.

8. Emergency Situations: I understand that telemedicine may not be appropriate for medical emergencies or life-threatening conditions. In such cases, I will seek immediate medical attention through emergency services or visit the nearest emergency room.

9. Costs and Insurance: I acknowledge that telemedicine services may be subject to fees, which may vary depending on my insurance coverage or payment arrangements. I understand that it is my responsibility to verify coverage and any associated costs with my insurance provider.

I confirm that I have read and understood the information provided in this informed consent for telemedicine visit.

I have had the opportunity to ask questions and have received satisfactory answers.

I voluntarily consent to participate in a telemedicine visit with LivWell Clinic healthcare providers and agree to the terms and conditions outlined above.