Please read through this Consent to Telehealth Care form before you request any of the services provided by Her Choice Women’s Clinic and our website at www.herchoiceclinic.com (under “Abortion Services,” “STD Treatment,” and “Family Planning/Gynecology Care”). At the beginning of each of our questionnaires, you will be asked if you accept the information in this form.
Health care through telehealth involves your health care professional using various forms of electronic communication, including audio, video, and questionnaires to interact or consult with you, or with other health care professionals working on your care. This may include discussing your medical information to educate, diagnose, follow-up a previous appointment, or use in therapy. Your medical history and health information may be discussed over video, audio, or another telecommunications method with you or another medical professional during telehealth care. Should a physical examination be necessary during telehealth care, then there may be photographs, audio, or video recordings taken to be used in your treatment in that session or the treatment in sessions that follow.
Your privacy and your health information will be protected during telehealth sessions by using both network and software security protocols. These protocols include protecting your data against corruption and exposure, whether intentional or unintentional.
There are possible risks with any method of health care treatment, and there are possible risks to be aware of when using our telehealth care, including:
Failures in electronic equipment that can postpone medical evaluation and treatment;
The rare possibility of a failure in security, which would result in breaching the privacy or your medical information;
The rare possibility of your medical records not being fully accessed by your health care provider, which could cause errors in their judgment that lead to allergic reactions, adverse drug interactions, and other health issues.
I understand that if I’m experiencing a medical emergency, I should dial 911 or go to the emergency room of the nearest hospital. In a medical emergency, I should never use the telehealth services of Her Choice Women’s Clinic.