Telehealth Notice

This notice provides general information about telehealth services offered by [PRACTICE LEGAL NAME / DBA]. It is not a substitute for the informed-consent discussion or consent documentation required for a particular patient, service, clinician, or state.

What Telehealth Is

Telehealth uses electronic communications—such as secure video, audio, messaging, remote monitoring, or other technology—to provide health care when the patient and clinician are in different locations.

Potential Benefits

• Improved access and convenience.
• Reduced travel and time away from work, school, or caregiving responsibilities.
• Continuity and coordination of care when an in-person visit is not necessary.

Potential Risks and Limitations

• Technology, internet, audio, or video failure may interrupt the visit.
• Electronic communications may create privacy or security risks despite safeguards.
• A remote examination may be limited, and an in-person examination, testing, emergency evaluation, or referral may be necessary.
• Delays may occur if information is incomplete, systems are unavailable, or the clinician cannot verify patient location or identity.

Where You Must Be Located

Telehealth may be provided only when the clinician is legally authorized to treat a patient in the state or jurisdiction where the patient is physically located at the time of the visit. The practice may ask you to confirm your identity, current physical location, telephone number, and an emergency contact at each visit.

States currently identified for service: [STATES SERVED]

Privacy and the Visit Environment

The practice uses technology selected to support privacy and security requirements. You should participate from a private location when possible, use a trusted network and device, prevent others from overhearing, and tell the clinician if another person is present. Do not record a visit unless everyone involved has given permission and recording is lawful.

Emergency and Crisis Limitations

Technology Failure

If the connection fails, the clinician or staff may attempt to reconnect or contact you using the telephone number on file. The visit may be converted to another permitted format, rescheduled, or redirected to in-person care depending on clinical and legal requirements.

Prescribing, Testing, and Referrals

Prescribing, including controlled-substance prescribing, is subject to professional judgment and applicable federal and state law. A clinician may require an in-person evaluation, laboratory work, vital signs, records, or consultation before prescribing or continuing treatment.

Fees and Insurance

Coverage and patient responsibility vary by health plan, service, location, and applicable law. Contact the practice or health plan with billing questions. Standard financial and cancellation policies may apply.

Consent and Patient Choice

You may ask questions about telehealth and available alternatives. Where required, informed consent will be obtained and documented before or at the beginning of telehealth services. You may decline telehealth or request in-person care, although an in-person option may not always be available through the practice.

Contact and Support