Telehealth Consent

Telehealth Consent

Last Updated: 01/01/25

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Provider Name & Address
Rebecca Martel Nurse Practitioner PLLC, doing business as “Certicare NP”
418 Broadway #4220, Albany, NY 12207, USA
Phone: (607) 301-3594 | Fax: (518) 413-8063 | Email: support@certicare.org

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1. Introduction

Welcome to Certicare NP (“we,” “us,” or “our”), an asynchronous telehealth platform. By clicking “I Agree” or otherwise indicating your acceptance of this Telehealth Consent (the “Consent”), you confirm that you have read, understand, and agree to the terms outlined below. If you do not agree, you will not be able to use our telehealth services.

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2. Description of Telehealth Services

1. Asynchronous Consultations
   • We provide asynchronous telehealth consultations, meaning you will submit information about your health condition via an online form, and our licensed healthcare provider will review and respond with documentation or guidance, usually within a specified timeframe.
   • No real-time video or phone encounters occur in this model, although email or other digital communications may be used for follow-up as needed.
2. Scope of Care
   • Our services are intended for mild, non-emergency conditions and the issuance of short-term medical notes or documentation.
   • We do not treat severe or emergency conditions. If you are experiencing an emergency or believe you require immediate care, please call 911 or go to the nearest emergency department.

3. Potential Benefits & Limitations of Telehealth

1. Benefits
   • Convenience: You can receive certain healthcare services without needing an in-person visit.
   • Accessibility: Telehealth can serve patients in remote locations or those with scheduling challenges.
2. Limitations
   • Clinical Limitations: Because telehealth is conducted asynchronously, our ability to diagnose or treat conditions may be limited by the information and documentation you provide.
   • Technical Issues: Delays or interruptions in communication may result from internet connectivity problems or technical device failures.
   • Not a Complete Substitute: Telehealth does not replace in-person, comprehensive medical care. You may need an in-person examination for certain issues, diagnoses, or procedures.

4. Patient Acknowledgments & Responsibilities

1. Accuracy of Information
   • You agree to provide true, accurate, and complete information about your health condition, medical history, and personal details.
   • You understand that incomplete or inaccurate information can affect the accuracy of the healthcare provider’s recommendations and documentation.
2. Physical Location
   • You confirm that you are physically present in the State of New York at the time of your consultation.
   • Our services are only available to individuals located in New York, where our provider is licensed.
3. Age Requirement
   • You must be at least 18 years old to use these telehealth services.
   • We do not knowingly provide services to minors or accept requests on behalf of third parties.
4. Technology & Device Requirements
   • You are responsible for obtaining a compatible device, internet connection, and any software necessary to use our asynchronous telehealth platform.
   • We are not liable for any inability to access or use the services due to issues with your equipment or internet connection.
5. Follow-Up & In-Person Care
   • You acknowledge that if your condition worsens or does not improve, or if a new issue arises, you should seek in-person medical care.
   • You understand that you may be referred to another healthcare provider if your condition requires services beyond our scope of care.

5. Privacy & Confidentiality

1. HIPAA Compliance
   • Your Protected Health Information (PHI) will be protected in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and other applicable laws.
   • For more information on how we handle your data, please review our HIPAA Authorization & Consent Agreement and Privacy Policy.
2. Secure Platforms
   • We use secure, HIPAA-compliant platforms to collect your health information and transmit our documentation back to you.
   • Despite our security safeguards, no internet-based communication is entirely free from risk. You acknowledge the potential for unauthorized access or data breaches.

6. Financial Responsibility & Insurance

1. Self-Pay Model
   • We charge a fee at the time of booking for each service. There is no subscription or insurance billing. You are solely responsible for paying the fee.
   • Our fees are disclosed upfront; you will have the opportunity to accept or decline them before proceeding.
2. No Refunds
   • No refunds are offered for services once rendered. If you believe there is an error in your documentation or if you require changes, please contact us; additional fees may apply for significant revisions or new requests.

7. Consent to Receive Telehealth Services

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By clicking “I Agree”, you confirm that:

1. You understand the nature of asynchronous telehealth services and acknowledge the potential benefits and limitations.
2. You voluntarily consent to receive telehealth services from Certicare NP.
3. You understand that telehealth might not be as comprehensive as an in-person visit, and you may need in-person care for certain conditions.
4. You acknowledge that no guarantees have been made to you regarding a specific diagnosis, outcome, or that your documentation (e.g., absence notes) will be accepted by your employer or educational institution.

8. Emergencies & Limitations of Care

1. Not for Emergencies
   • Our telehealth service is not for emergencies or life-threatening situations. If you need immediate medical attention, please seek emergency care or call 911.
2. Unsupported Documentation
   • As noted in our Terms & Conditions, we do not provide certain types of documentation (e.g., FMLA, workers’ compensation, military service, disability, court appearances, probation check-ins). If you need documentation for any of these, you must seek in-person care.

9. Termination of Services

We reserve the right to discontinue or refuse telehealth services if:

• You fail to comply with our policies or refuse to provide necessary information.
• We find that your requests fall outside our scope of practice.
• We identify misuse of our documentation or fraudulent activity.

10. Changes to This Consent

1. Policy Updates
   • We may update or modify this Telehealth Consent from time to time. A revised “Last Updated” date will appear at the top of this page.
   • Your continued use of our telehealth services after any updates means you accept the revised Consent.

11. Contact Information

For questions or concerns about this Telehealth Consent, or if you need to discuss or clarify any telehealth matters, please contact us:

• Certicare NP
• Phone: (607) 301-3594
• Fax: (518) 413-8063
• Email: support@certicare.org
• Address: 418 Broadway #4220, Albany, NY 12207, USA

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