Virtual Care Consent Form
Virtual care (also known as “telehealth” or “telemedicine”) is the use of secure electronic communications, information technology, or another communication method between you and your Provider at different locations. Virtual care services are offered by Hartford HealthCare and its affiliated entities (“HHC”) and providers (your “Provider”), and may include patient consultation, diagnosis, treatment recommendation, prescription, or a referral to in-person care, as determined appropriate by your Provider.
Potential Benefits: You may benefit from virtual care services, but results cannot be guaranteed. Potential benefits include easier access to care and the convenience of meeting with your Provider from a location of your choosing.
Potential Risks: There are some risks of virtual care, including, but not limited to:
- Technological failures such as unclear video, loss of sound, poor internet connection or loss of internet connection. If any of these risks occur, the virtual encounter might need to be stopped.
- In rare events, security protocols could fail, causing a breach of privacy of medical information;
- Though unlikely, delays in evaluation and treatment could occur due to deficiencies, disruptions or failures of the equipment or technology.
Service Limitations: Virtual care may not be the most effective form of treatment for certain individuals or health concerns. Your Provider may determine that you would be better served by a face-to-face visit, in which case you may be asked to schedule an in-person appointment.
Privacy. The laws that protect the privacy and confidentiality of your health information also apply to virtual care services. Virtual care services are provided through a HIPAA-compliant platform. HHC does not control the devices or computers or the internet over which you may choose to provide your confidential or personal information and therefore cannot prevent interceptions or compromises to your information while in transit to HHC. Upon your request, your Provider must disclose the records from your virtual care encounter to your primary care provider.
Revocation. Your participation in virtual care services is voluntary. You may refuse to participate or decide to stop participation at any time without affecting your rights to future care or treatment. Notify your Provider if you wish to revoke consent to receive virtual care services.