Telehealth Informed Consent

1. What telehealth means

Telehealth uses electronic communications and technology to allow a healthcare professional and patient in different locations to exchange information and provide care. Telehealth may include online questionnaires, secure messages, telephone or video conversations, photographs, medical records, prescription information, laboratory results, device data, and educational materials.

The exact method of care is selected by the treating clinician based on applicable law, clinical judgment, patient location, and the information needed for an appropriate evaluation.

2. Independent healthcare providers

Clinical services are delivered by independent, licensed healthcare professionals or medical groups made available through MD Integrations. Dr. Miami Clinic operates the program’s administrative and technology services unless expressly identified as your treating provider. Independent clinicians are responsible for diagnosis, treatment, prescribing, follow-up, medical records, and professional judgment.

The clinician must be licensed or otherwise authorized to treat you in the state where you are physically located at the time of care. You agree to provide your true physical location and notify the clinician if your location changes during an encounter. You may ask for the clinician’s name, credentials, professional license information, and practice location, and may verify a Florida telehealth provider through the applicable licensing board.

3. Potential benefits and alternatives

Potential benefits of telehealth include:

• more convenient access to a licensed clinician;
• reduced travel and waiting time;
• efficient review of history, photographs, progress, and medication needs; and
• ongoing electronic communication and refill coordination.

Alternatives may include an in-person visit with a local clinician, another telehealth provider, delaying care, or declining the program. You may ask the clinician whether an in-person examination or another form of care is appropriate.

4. Risks and limitations

You understand that telehealth has risks and limitations, including:

• the clinician may not be able to perform a hands-on physical examination or obtain the same observations available in person;
• incomplete, inaccurate, delayed, or poor-quality information may affect clinical judgment;
• technology, internet, audio, video, portal, or equipment failures may interrupt or delay care;
• records or messages may be delayed between providers, pharmacies, laboratories, or health systems;
• despite safeguards, unauthorized access or a privacy or security incident may occur;
• a clinician may determine that telehealth is inappropriate and require in-person evaluation, testing, emergency care, or referral; and
• no result, prescription, medication availability, side-effect profile, or amount of weight loss can be guaranteed.

5. Your information and responsibilities

You agree to:

• provide complete and accurate identity, location, contact, medication, allergy, pregnancy, medical-history, symptom, and health information;
• answer follow-up questions truthfully and submit requested photographs or records;
• tell the clinician about other providers, prescriptions, over-the-counter medications, supplements, and changes in your condition;
• follow medication directions, monitoring, testing, and follow-up instructions and not share or transfer prescribed medication;
• use a reasonably private location and protect your device, password, email, and patient portal from unauthorized access; and
• seek in-person or emergency care when instructed or when symptoms require it.

A clinician may rely on the information you provide. Withholding or misrepresenting information may create serious health risks and may result in refusal or discontinuation of treatment.

6. Prescriptions, medication, and pharmacies

A prescription is issued only if the clinician determines, in independent professional judgment, that treatment is medically appropriate and lawful. Enrollment or payment does not guarantee a prescription, a requested drug, a particular dose, continued refills, or insurance or manufacturer-program eligibility.

The clinician may require laboratory testing, outside records, an in-person examination, follow-up, or consultation with another provider. Prescriptions may be sent to an independent licensed pharmacy or manufacturer-affiliated fulfillment partner. The pharmacy controls dispensing, medication payment, inventory, substitution, and shipping.

GLP-1 and related medications may cause side effects and may not be appropriate for every patient. Your clinician and the medication’s current FDA-approved labeling will provide the controlling risk, warning, contraindication, and use information. Contact a clinician promptly about side effects and seek emergency care for severe symptoms.

7. Privacy, records, and technology

Telehealth information may become part of the medical record and may be shared among the treating clinician, medical group, MD Integrations, pharmacies, laboratories, and service providers as permitted by law and needed for care, payment, or healthcare operations. Our Privacy Policy and HIPAA Notice provide additional detail.

Sessions will not be audio- or video-recorded by us without notice and any consent required by law. Routine system logs, secure messages, submitted forms, photographs, and clinical documentation may be retained as part of program or medical records.

8. Emergencies, urgent symptoms, and follow-up

Telehealth messaging is not continuously monitored and must not be used for emergencies. Call 911 or go to the nearest emergency department for trouble breathing, chest pain, severe allergic reaction, fainting, severe abdominal pain, thoughts of self-harm, or any other emergency.

For urgent but non-emergency concerns, contact an appropriate local provider or urgent care service. Response times through email, text, or portal messaging are not guaranteed. You remain responsible for obtaining follow-up and in-person care when recommended.

9. Electronic communications and technical interruptions

You consent to receive electronic communications related to enrollment, identity verification, care, prescriptions, refills, billing, support, and safety. Standard email and text messages can carry privacy risks; use secure portal messaging for sensitive clinical information when available.

If a telehealth connection fails, the clinician or support team may attempt to reconnect, contact you using the information provided, reschedule, or direct you to in-person care. You are responsible for maintaining accurate contact information.

10. Voluntary consent and withdrawal

Telehealth participation is voluntary. You may ask questions, decline a proposed treatment, request an in-person option, or withdraw this consent for future telehealth services by notifying the treating provider or program. Withdrawal does not affect care already provided, actions already taken in reliance on your consent, or legally required record retention.

Because this program is designed for telehealth, withdrawal may prevent continued participation and may result in cancellation or transition of services. Withdrawal does not automatically refund completed program, clinical, pharmacy, or medication charges. Any non-waivable state-specific telehealth notice or consent provided by the treating clinician also applies and controls if it provides greater patient protection.

11. Patient acknowledgment

By checking the acceptance box and continuing, you confirm that:

1. you have read and understand this Telehealth Informed Consent;
2. you understand the nature, expected benefits, alternatives, risks, and limitations of telehealth;
3. you understand the respective roles of Dr. Miami Clinic and independent providers;
4. you had the opportunity to ask questions and may ask additional questions at any time;
5. you are at least 18 and are consenting voluntarily; and
6. you consent to receive medical evaluation and treatment through telehealth.