I understand that telemedicine is the use of electronic information and communication technology by health care provider/s to deliver services to an individual when the patient location is on a different site than the provider.
I understand that the laws that protect privacy and the confidentiality of medical information also apply to telemedicine. HIPPA applies to telehealth consults, however we cannot control a patient’s environment or company they may have while within the visit. This is at the patient’s discretion. As always, your insurance carrier will have access to your medical records for quality review/audit.
I give consent to THE ENLYV CLINICS in New Jersey to provide health care services to me via telemedicine.
I give consent to THE ENLYV CLINCS to release information requested by insurance companies and/or its representatives. I understand that I have the right to withhold or withdraw my consent to the use of telemedicine in the course of my care at any time, without affecting my right for future care or treatment.
I may revoke my consent in writing at any time by contacting THE ENLYV CLINICS at info@enlyv.com.
As long as this consent is in effect, THE ENLYV CLINICS may provide health care services to me via telemedicine without the need to sign another consent form.
I understand that I am directly responsible for all charges incurred for medical services for myself regardless of insurance coverage. I understand that my current insurance may not cover the additional fees of the telehealth practices and I may be responsible for any fee that my insurance company does not cover. I understand telemedicine consultation is deemed appropriate for the needs of the patient's care and my provider may recommend an “In Person” medical visit that may require more advanced care that telemedicine may or may not be able to afford for proper patient care.
I understand that technical difficulties may occur before or during the telehealth sessions and my appointment cannot be started or ended as intended on time.
I accept that the professionals can contact interactive sessions with video call; however, I am informed that the sessions can be conducted via regular voice communication if the technical requirements such as internet speed cannot be met.
I agree that my medical records on telehealth can be kept for further evaluation, analysis and documentation, and in all of these, my information will be kept private