Last Updated: May 2024
EMERGENCY DISCLAIMER: WE ARE NOT A REPLACEMENT FOR EMERGENCY MEDICAL SERVICES. IF YOU HAVE A MEDICAL EMERGENCY, SEEK IMMEDIATE IN-PERSON CARE OR DIAL 911.
We reserve the right to modify these terms at any time in response to changes in legal requirements, our business practices, or the competitive environment. Changes may include modifications, additions, or deletions to these terms.

Telehealth Consent

Telehealth at Root Health & Wellness involves the delivery of health services using electronic means such as videoconferencing. Our electronic systems are designed with strong network and software security protocols to protect the confidentiality of your identification and imaging data. These measures are in place to safeguard the data and to ensure its integrity against both intentional and unintentional corruption.

Expected Benefits

• Enhanced access to care, enabling you to consult with healthcare providers across distances.
• More efficient healthcare management, including evaluations and ongoing treatment.
• Access to specialist consultations.
• Continued care with established providers, regardless of location.

Possible Risks

• While telehealth provides significant benefits, there are potential risks associated with the technology:
• Information transmitted may occasionally be insufficient for medical decision making due to technical issues like poor image resolution.
• Equipment failures could delay medical evaluations and treatment.
• In rare instances, security protocols could fail, leading to a breach of personal medical information.
• Incomplete medical records could lead to errors such as adverse drug interactions or misdiagnosis.

Consent Acknowledgement

• By consenting to this form, you acknowledge and accept:
• The same laws protecting the privacy of your medical information also apply to telehealth.
• You can withhold or withdraw consent to use telehealth at any time without affecting your future care.
• You have the right to access all telehealth transmitted information and can obtain copies at a reasonable fee.
• You have the right to access all telehealth transmitted information and can obtain copies at a reasonable fee.
• You are encouraged to inform all healthcare providers about your telehealth interactions.
• Anticipated benefits from the use of telehealth, though no results can be guaranteed. By using our services, you agree to and authorize the use of telehealth for your treatment.

HIPAA Consent

Effective from December 1, 2023, the Health Insurance Portability and Accountability Act (HIPAA) protects your privacy. HIPAA rules restrict the disclosure of your Protected Health Information (PHI) to ensure your privacy is maintained while providing you with high-quality health care.

Office Policies

• Your information will be confidential except as necessary to provide you services or manage our administrative tasks.
• We may contact you to remind you of appointments and inform you of changes to our policies.
• Our practice uses third-party vendors who are compliant with HIPAA confidentiality protocols.
• You have the right to request restrictions on the use of your PHI and may access your records as allowed by law.
• Continued use of our services indicates acceptance of these HIPAA policies and any future modifications.

Financial Consent

• For service provision, we require keeping a credit card on file. You authorize Root Health & Wellness to:
• Charge for consultations and treatments not covered by insurance.
• Automatically renew and charge for ongoing programs unless you request cancellation.
• Provide invoices and receipts upon request.
• All charges are final and non-refundable unless otherwise specified by law.

Contact Information

For questions or concerns about this Medical Consent, please contact us at: admin@roothealthandwellness.com ATTN: MEDICAL CONSENT