Telehealth Consent
This Telehealth Informed Consent describes the telehealth services provided through the Forever Health Rx platform by licensed providers of . By checking the consent box during your online visit you confirm that you have read and understood it and that you consent to receive care by telehealth.
What telehealth is
Telehealth is the delivery of health care services using electronic communications, including asynchronous questionnaires, secure messaging, telephone and video, when the provider and patient are not in the same location. Your provider will determine whether telehealth is appropriate for your condition and may require a synchronous (video or phone) encounter, laboratory tests or an in-person examination before or during treatment when required by the standard of care or state law.
Expected benefits
- Access to licensed providers without travel.
- Continuity of care through secure messaging and follow-up visits.
- Efficient review of your health history and treatment progress.
Possible risks and limitations
- Information transmitted may be insufficient for the provider to make a decision, and additional information, tests or an in-person visit may be required.
- Technology failures or delays may interrupt or prevent communication.
- Despite safeguards, security protocols could fail, causing a breach of privacy.
- Telehealth is not appropriate for emergencies. Call 911 or go to the nearest emergency department if you experience a medical emergency.
Your provider and your rights
- The identity, credentials and state of licensure of the treating provider are shown to you before or during your visit.
- You may withhold or withdraw consent at any time without affecting your right to future care, by notifying your provider through the patient portal.
- You have the right to ask questions about your treatment, including its risks, benefits and alternatives, and to receive a copy of your records as described in the Notice of Privacy Practices.
- You may request a referral to in-person care at any time.
Your responsibilities
- Provide truthful, complete and current health information, including all medications, allergies and conditions.
- Confirm your physical location at the time of each visit; services are available only when you are located in .
- Follow the instructions of your provider and the dispensing pharmacy and report side effects promptly.
Medications
Any medication is prescribed only if the provider determines it is medically appropriate. Medications prescribed through the platform are compounded preparations prepared by a state-licensed 503A pharmacy under a patient-specific prescription; they are not FDA-approved, the FDA does not review them for safety, effectiveness or quality, and they are not generic versions of, or equivalent to, any branded medication. Risks, benefits, alternatives and formulation details are presented to you before you decide to proceed.
Consent
I have read this Telehealth Consent, my questions have been answered, and I consent to receive telehealth services from licensed providers of through the Forever Health Rx platform. I understand that this consent is recorded with the date and time of my acceptance and is available in my patient portal.