Telehealth consent

By scheduling an appointment with Comet Healthcare Inc., I acknowledge that I understand the following: 

1. Comet Healthcare Inc. wishes me to engage in a telehealth visit. 

2. A telehealth visit has potential benefits including easier access to care and the convenience of meeting from a location of my choosing. A potential risk of my telehealth visit is that because of my specific condition or due to technical problems, a face-to-face appointment may still be necessary after a telehealth appointment. 

3. While security measures, such as patient login and using HIPAA compliant software vendors, have been taken to ensure patient privacy with the use of telehealth services, potential risks to this technology still exist notwithstanding such measures including interruptions, unauthorized access, and technical difficulties. I understand that my healthcare provider or I can discontinue the telehealth consult/visit if it is felt that the videoconferencing connections are not adequate for the situation. 

4. My provider may be permitted to conduct activities such as photography, recording, or videotaping with my consent and if required in the course of clinical care.

5. I am holding Comet Healthcare Inc. and its officials, employees, and contractors harmless for any information lost due to technical failures. 

6. Comet Healthcare Inc. may forward client-identifiable information to third-party entities (e.g., practice management software provider, insurance company, claims processor). 

7. Telehealth by Comet Healthcare Inc. is NOT an Emergency Service and in the event of an emergency, I will use a phone to call 911. 

8. Though my provider and I may be in direct, virtual contact through the telehealth service, neither Comet Healthcare Inc. nor the Telehealth Service provides any medical or healthcare services or advice including, but not limited to, emergency or urgent medical services.