You are being asked to participate in a telehealth consultation at MedPaid LLC. This form provides important information to help you understand what is involved. Please read this document carefully, and feel free to ask any questions before you agree to participate.

Telehealth involves the use of electronic communications to enable healthcare providers at different locations to share individual patient medical information for the purpose of improving patient care. Providers may include primary care practitioners, specialists, and/or subspecialists. The information may be used for diagnosis, therapy, follow-up, recommendations, and/or education.

The purpose of telehealth consultations is to provide medical care and consultation remotely, allowing you to receive care without the need to travel to a healthcare facility.

There are potential risks associated with the use of telehealth services, which may include:

• Information transmission risks: Although efforts are made to protect your information, there is a small risk that the transmission of your medical information could be disrupted or intercepted.
• Technical difficulties: There may be issues with technology, such as poor video quality, connectivity problems, or software malfunctions, which could affect the consultation.
• Incomplete assessment: Remote consultations may lack certain physical exams that can only be performed in person, potentially leading to an incomplete assessment.

The potential benefits of telehealth consultations include:

• Convenience: You can receive medical care without the need to travel.
• Access: Telehealth can provide access to specialists and care that might not be available locally.
• Continuity: Telehealth can facilitate ongoing monitoring and follow-up care.

All information disclosed during the telehealth consultation is confidential and protected by applicable privacy laws. Telehealth consultations are conducted using secure communication methods to ensure your privacy.

Your participation in telehealth services is voluntary. You have the right to withdraw your consent at any time without affecting your relationship with MedPaid LLC or your right to receive other medical care.

You will be responsible for any costs associated with the telehealth consultation. Please review our billing policies and contact us if you have any questions about your financial obligations.

By signing this form, you acknowledge that you have read and understand the information provided, and you voluntarily agree to participate in telehealth consultations.