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HIPPA Consent For Telehealth

Leader Health LLC is committed to providing high-quality healthcare services through telehealth, which includes Hormone Replacement Therapy (HRT), Sexual Health Therapy, and Fat Loss Therapy. Telehealth allows patients to receive medical care remotely through electronic communication platforms, ensuring continuity of care without the need for in-person visits.

Purpose:
The purpose of this Consent form (Consent) is to provide you with detailed information about telehealth and to obtain your informed consent to the use of telehealth in the delivery of healthcare services by physicians, physician assistants, and nurse practitioners ("Providers") using the online platforms owned and operated by Leader Health LLC (the Company).

Consent to Telehealth Services:
By clicking the I agree checkbox, submitting your information to Leader Health LLC, using any other acceptance protocol presented through the service, or otherwise affirmatively accepting this Consent, you acknowledge that you have read, understood, and agreed to be bound by the terms outlined in this Consent. If you do not agree to this Consent, you should not create an account or use the telehealth services provided by Leader Health LLC. Furthermore, by agreeing, you grant authority to any party who clicks on the I agree button or otherwise indicates acceptance of this Consent on your behalf.

1. Nature of Telehealth:
Telehealth involves the use of electronic communications to facilitate healthcare services between you and your Providers who may be in different locations. This may include:
  • Accessing patient medical records.
  • Sharing medical images.
  • Real-time two-way audio and video communication.
  • Transmission of data from medical devices and sound/video files.

The electronic systems used by Leader Health LLC incorporate network and software security protocols to protect the confidentiality of patient identification and medical data, ensuring that the data remains secure and unaltered.

2. Expected Benefits of Telehealth:
The potential benefits of utilizing telehealth through Leader Health LLC include:
  • Enhanced access to medical care and treatment for the conditions addressed by your Providers.
  • Convenience in scheduling and receiving care at times that suit you, without the need for travel.
  • The ability to consult with your Providers from the comfort of your own home, reducing the necessity for in-office visits.
  • Access to the expertise of distant specialists who may not be locally available.

3. Potential Risks of Telehealth:
As with any medical procedure, telehealth carries certain risks, which may include, but are not limited to:
  • The quality, accuracy, or effectiveness of the healthcare services provided could be limited due to technology issues. These issues may include bugs or errors in the technology, which could affect functionality, produce incorrect results, render parts of the service unavailable or inoperable, or cause data to be corrupted or lost.
  • Technology failures may impair your Providers' ability to correctly diagnose or treat your condition.
  • The inability of your Providers to conduct certain in-person tests or assessments may prevent a full diagnosis or the identification of a need for emergency care.
  • Your Providers may determine that telehealth is not suitable for your condition, requiring you to seek alternative healthcare services.
  • Delays in medical evaluation and treatment could occur due to unavailability of your Providers or failures in the technology or equipment used.
  • In rare instances, the electronic systems or security protocols used could fail, leading to a breach of your medical or personal information.
  • Regulatory limitations in certain jurisdictions may restrict your Providers' ability to prescribe certain medications or offer specific treatments.
  • In rare cases, a lack of access to your full medical history may result in adverse drug interactions, allergic reactions, or other medical errors.

4. Follow-up Care and Emergency Situations:
If you are experiencing a medical emergency, call 911 immediately. Telehealth is not suitable for emergency situations. For non-emergency follow-up care, you may communicate with your Providers through the secure messaging service in the Patient Portal. If technical issues prevent you from contacting your Providers through the Portal, you can reach us at (256) 473- 2464.

5. Data Privacy and Protection:
Leader Health LLC is committed to protecting your privacy. The electronic systems used will incorporate network and software security protocols to safeguard your information. Personal information that identifies you or contains protected health information will not be disclosed to third parties without your consent, except as required by law for consultation, treatment, billing, and administrative purposes, or as outlined in our Privacy Policy.

6. Acknowledgments and Acceptance:
By clicking I agree, checking a related box, submitting your information, or otherwise affirmatively accepting this Consent, you acknowledge and agree to the following:
  • Healthcare services provided to you by Providers via Leader Health LLC will be delivered through telehealth.
  • The technology used to deliver these services, including that provided by Leader Health LLC, may still be in development or testing phases and may contain bugs or errors that could affect the quality, accuracy, or effectiveness of the care provided.
  • Telehealth is an evolving field, and the technology used in your care may involve new or different methods not specifically described in this Consent.
  • No guarantees can be made about the potential benefits or specific outcomes of telehealth services.
  • Your condition may not be cured or improved, and in some cases, it may worsen.
  • There are limitations to the medical care and treatment provided via telehealth, and it may not be suitable for every condition.
  • You have had the opportunity to discuss the use of telehealth with your Providers, including the risks, benefits, and alternatives.
  • You understand that you may withdraw your consent to telehealth at any time without affecting your right to future care or treatment.
  • Any withdrawal of your consent will be effective upon written notice to your Providers and will not impact any actions taken by Leader Health LLC or your Providers before receiving your notice.
  • The use of telehealth involves electronic communication of your personal medical information, and it is your responsibility to provide truthful, accurate, and complete information to Leader Health LLC and your Providers.
  • Your Providers may determine that your condition is not suitable for telehealth and may advise you to seek alternative care.
  • You are free to seek medical care or prescriptions from providers not associated with Leader Health LLC.
  • Leader Health LLC may use partner pharmacies and labs for prescriptions and diagnostic tests, but you are free to choose alternative providers by contacting our support team.
  • You are solely responsible for the financial costs associated with the use of Leader Health LLC’s services, including telehealth consultations, prescriptions, and lab tests.
  • You have had a direct conversation with your healthcare provider, during which you were able to ask questions and discuss the risks, benefits, and alternatives to telehealth.
  • You have read, understood, and agreed to the terms outlined in this Consent, and you provide your informed consent for the use of telehealth in your medical care. You hereby authorize Leader Health LLC and its Providers to use telehealth during your diagnosis and treatment.

Apr 24, 2025