• Telehealth Consent Form Colorado

    Telehealth Consent Form Colorado

  • Technology allows services to be made online. Telehealth allows remote communication in providing health care services to patients. This includes health care services and can be made in real-time two-way audio and video communication via electronic communication or the internet in order to evaluate, diagnose, and treat medical conditions.

    Colorado law requires health care service providers to get the consent of patients prior to engagement through telehealth. With this form, we intend to get your consent before you can use the service by helping you being informed of the benefits and limitations of this method of treatment.

  • What is Telehealth?

    Telehealth a term where involves audio and video communication, as well as the exchange of digital files or images, including medical records, x-rays, etc. This mode of communication and exchange is made through a secure channel that is private between the doctor and the patient.

    With Telehealth, the doctor or health care service provider is on a different location than the patient. The patient may be at home, or in a facility where the service provider other than the physician may be able to assist in the treatment. In any case, the patient shall be informed whenever it is necessary for additional personnel is needed to be present.

    Your Right to Telehealth

    Given that this is voluntary, you may withhold or withdraw your consent from participating in telehealth. Your withdrawal or your withholding of consent shall not be taken against you and you are afforded other means of health care services other than telehealth. You may again apply for a request for treatment through telehealth at any time.

    Your Right to Privacy

    Laws governing confidentiality to health information, including, but not limited to Health Insurance Portability and Accountability Act (HIPAA) applies in telehealth. Access to the transmission of data will be limited to the necessary people, organization, and staff of the health care service provider and shall not be transmitted to anyone outside the network unless otherwise with your prior written consent.

    Health insurance services have access to your medical information.

    Your Right to Access to Information

    You have the right to get a copy of your information, for a reasonable fee. You may also follow-up with your health care provider in case you have additional questions or concerns relating to your condition for which you have consulted/treated through telehealth.

    Emergency Cases

    In case you are in your home, you must immediately call 9-1-1 and as much as possible, stay connected with your telehealth provider until help arrives. If you are on-site such as a telehealth facility, medical personnel shall attend to you in addressing your case.

    Fees

    You are personally responsible for the fees which you may incur from telehealth. You shall process your reimbursements for telehealth with Medicaid if you have any, including telehealth for remote patient monitoring.

    Prescriptions

    The state of Colorado prevents physicians from prescribing patients dangerous and controlled substances or drugs.

  • By signing this form, I hereby declare that I agree and understand the information above and I have had the opportunity to ask my questions and which have been answered accordingly and to my satisfaction. 

    I hereby give my consent for the use of Telehealth and I do so in my own free will, free from any form of coercion or undue influence.

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