Young & Radiant Med Spa Telehealth Informed Consent
This “Telehealth Informed Consent” informs you, the patient, about the treatment methods, risks, and limitations of using our telehealth platform. Please read this in conjunction with our Terms of Use available on our website.
Telehealth Overview
Telehealth involves delivering healthcare services using electronic communications, information technology, or other means between a healthcare provider and a patient who are not in the same physical location. Telehealth may be used for diagnosis, treatment, follow-up, and member education, and may include, but is not limited to:
- Electronic transmission of medical records, photo images, personal health information, or other data between you and a healthcare provider.
- Interactions via audio, video, and/or data communications.
- Use of output data from medical devices, sound, and video files.
Services Provided
Telehealth services offered by Young & Radiant Med Spa may include consultations, diagnosis, treatment recommendations, prescriptions, and/or referrals to in-person care, as deemed clinically appropriate. Your provider will be licensed in the state where you are located at the time of your consultation.
Electronic Transmissions
The types of electronic transmissions that may occur using the telehealth platform include:
- Appointment scheduling
- Completion of medical intake forms
- Exchange and review of medical records, images, diagnostic and lab test results
- Two-way interactive audio or audio-video interactions
- Treatment recommendations based on data from medical devices
- Delivery of consultation reports
- Prescription refill reminders
Expected Benefits
- Improved access to care while you remain in your preferred location.
- Convenient access to follow-up care.
- More efficient evaluation and management of care.
Service Limitations
- Telehealth cannot replace direct, physical contact with a healthcare provider. Some clinical needs may not be suitable for telehealth and will be determined by your provider.
- Our providers do not address medical emergencies. For emergencies, dial 9-1-1 or go to the nearest emergency room.
- Telehealth services are an addition to, not a replacement for, your local primary care provider. We encourage you to maintain a relationship with a local provider.
Security Measures
Our electronic communication systems incorporate security protocols to protect the confidentiality of your data and comply with HIPAA requirements.
Possible Risks
- Delays in evaluation and treatment due to equipment or technology failures.
- Inadequate quality of transmitted data affecting the quality of services.
- Technical failures leading to rescheduled consults or in-person visits.
- Security protocol failures potentially causing privacy breaches.
- Lack of access to complete medical records possibly resulting in adverse reactions or errors.
Patient Acknowledgments
By starting treatment, I acknowledge and understand the following:
- I have had the opportunity to review my provider’s credentials.
- In a medical emergency, I will dial 9-1-1 immediately.
- I may seek services from a medical group with in-person clinics as an alternative.
- I can withhold or withdraw my consent for telehealth at any time without affecting future care.
- Federal and state laws protect the privacy and security of my health information.
- My health information will be kept confidential and may involve electronic communication with other health practitioners.
- Dissemination of my identifiable images or information will not occur without my consent.
- I will not hold Young & Radiant Med Spa or my provider liable for delays or information loss due to technical failures.
- Parts of the Services may require tests conducted at another location.
- I will be informed of any additional persons present during my telehealth visit.
- My provider will explain my diagnosis, treatment options, and their risks and benefits.
- I have the right to request and receive a copy of my medical records.
- I must provide complete and accurate medical history for effective treatment.
- Prescription decisions will be made by my provider, and I have the right to select my pharmacy.
- My provider reserves the right to deny care if it is not medically or ethically appropriate.
Disclaimer
The above statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.
Patient Informed Consent
By starting treatment, I acknowledge that I have carefully read, understand, and agree to these terms and consent to receive the Services. I understand and agree that I am signing this Informed Consent electronically and that I have the legal capacity to provide this consent.
For more information or if you have any questions, please contact us at [email protected]