Telehealth Informed Consent

1Purpose and Nature of Telehealth

Telehealth is the delivery of health care when the patient and clinician are in different locations using electronic communications. Depending on the service and applicable law, telehealth may include live video, audio, secure messaging, review of questionnaires or images, remote monitoring, and review of home sleep testing information. The same professional duties that apply to in-person care apply to telehealth, but telehealth has different practical limitations because the clinician is not physically present with you.

2Potential Benefits

Potential benefits can include improved access to clinicians, reduced travel, more convenient follow-up, and the ability to exchange records and information remotely. Whether telehealth is appropriate for you is a clinical decision.

3Material Risks and Limitations

Telehealth may involve limitations or risks, including inability to perform parts of a physical examination; incomplete information or image quality; delay or interruption caused by technology; privacy or security risks inherent in electronic communication; the possibility that the clinician will determine that in-person evaluation, additional testing, emergency care, or another specialist is needed; and the possibility that information you provide is incomplete or inaccurate. No telehealth encounter guarantees a diagnosis, prescription, test result, treatment recommendation, or particular health outcome.

4Your Location and Clinician Licensure

At the time of the encounter, you must tell us where you are physically located. The clinician must be authorized to provide care in that jurisdiction. If the clinician is not authorized to treat you where you are located, the encounter may need to be rescheduled, transferred to another clinician, or converted to another appropriate arrangement.

5Prescriptions, Tests, and Devices

A clinician decides whether a prescription, test, device, referral, or other order is clinically appropriate and lawful. Payment, a product request, or participation in telehealth does not entitle you to a particular prescription or order. Some prescriptions and services are subject to additional federal or state requirements and may require in-person evaluation.

6Privacy and Security

Information created or received during telehealth is part of your health information and is protected under our Notice of Privacy Practices and applicable law. We use technologies and safeguards intended to protect the confidentiality and security of telehealth communications. You are responsible for choosing a reasonably private setting and protecting your own device and account credentials.

7Recording and Other Participants

We will not record a clinical encounter unless any notice and consent required by applicable law have been obtained. Tell your clinician if another person is present with you. If another clinician, trainee, interpreter, or support person is present on the clinician's side, you will be informed as required and may raise any concern about that person's presence.

8Technology Failure and Backup Plans

If technology fails, the clinician may attempt to reconnect, use another legally permitted communication method, or reschedule. A clinician may end or defer an encounter when the technology is not adequate to provide safe care. Billing consequences are governed by the Appointment Cancellation, No-Show and Billing Policy.

9Emergencies

Telehealth through SBA is not a substitute for emergency medical services. If you believe you are experiencing a medical emergency, call 911 or go to the nearest appropriate emergency facility. Your clinician may direct you to emergency or in-person care when clinically appropriate.

10Alternatives and Voluntary Consent

You may ask about reasonable alternatives to telehealth, including in-person care where available or referral to another provider. You may decline telehealth or withdraw this consent for future telehealth care as permitted by law. Withdrawing consent does not undo care already provided or erase the medical record.

11State-Specific Requirements

Telehealth consent, licensure, prescribing, minor-consent, and documentation requirements vary by state. SBA or your clinician may present additional state-specific disclosures or obtain additional verbal or written consent when required. Those additional requirements supplement this Consent.

12Consent

By affirmatively accepting this Telehealth Informed Consent, you acknowledge that you have had an opportunity to review the information above, ask questions, understand the material benefits, risks, and alternatives, and voluntarily consent to receive telehealth services subject to applicable law. This Consent is not an arbitration agreement and does not waive a legal claim or patient right.

13Contact

Questions about telehealth or this Consent: support@sleepbalanceacademy.com. For clinical questions about active care, use the secure patient communication method provided for your care team.