Consent to Treat by Telehealth

I understand that telehealth involves the use of electronic communications, including video, audio, and other technologies, to provide healthcare services when the patient and healthcare provider are not in the same physical location.

I acknowledge and understand the following limitations of telehealth services:

• Telehealth may not be equivalent to an in-person examination because the healthcare provider cannot physically examine the patient.

• Certain medical conditions may require an in-person evaluation, diagnostic testing, laboratory studies, imaging, or emergency treatment that cannot be provided through telehealth.

• The quality of telehealth services may be affected by technical issues such as poor internet connectivity, equipment malfunctions, interruptions, or loss of communication.

• There may be limitations in the provider's ability to observe symptoms or assess the patient's condition remotely.

• In some circumstances, telehealth may result in delays in diagnosis, treatment, or follow-up care.

• If the provider determines that telehealth is not appropriate for the patient's condition, the provider may recommend or require an in-person visit or referral to another healthcare professional.

• Telehealth services are not intended to replace emergency medical care. If the patient experiences a medical emergency, I understand that I should call 911 or seek immediate emergency medical attention.

Consent

In choosing to see Dr. Dorothy Thomas over telemedicine, I certify that:

1. I am the parent or legal guardian of the minor patient, or I otherwise have legal authority to consent to treatment on the patient's behalf.

2. I have had the opportunity to ask questions regarding telehealth services and have received satisfactory answers.

3. I understand the potential benefits, risks, and limitations of telehealth.

4. I voluntarily consent to the provision of healthcare services to the minor patient through telehealth technologies.