This Telehealth / Virtual Care Consent explains how Harmony Medical PLLC may provide care to you using telehealth technologies in connection with Asthma Allergy Care & Treatment. Please read it carefully.

What Telehealth Means

Telehealth includes healthcare services delivered when you and your clinician are not in the same physical location. Telehealth may occur by secure video, audio-only communication where appropriate and legally permitted, secure messaging, remote patient monitoring, or related technologies used to support your care.

Telehealth Technologies We May Use

Harmony Medical does not currently use a dedicated telehealth platform. When telehealth services are activated, they may include one or more of the following categories of vendors:

• a HIPAA-eligible video visit platform (vendor to be disclosed before any visit);
• the Zocdoc patient messaging system for secure messaging;
• remote patient monitoring tools, if clinically indicated and offered.

These services may be operated by third-party vendors acting on our behalf under appropriate business associate agreements.

Nature of the Consent

By signing or otherwise affirmatively agreeing to this Consent, you authorize Harmony Medical to provide telehealth services when your clinician determines telehealth is appropriate and lawful for your situation.

Benefits of Telehealth

Possible benefits include easier access to care, reduced travel time, improved continuity of care, more convenient follow-up, and faster communication for appropriate issues.

Possible Risks and Limitations

Telehealth also has risks and limitations, including:

• technical failures, interruptions, poor audio or video quality, or platform outages;
• privacy or security risks if you or others use unsecured networks, devices, or locations;
• the possibility that a remote visit may not allow the same level of examination as an in-person visit;
• the possibility that your clinician may determine an in-person visit, emergency evaluation, testing, or referral is needed; and
• delays caused by inaccurate location, identity, or contact information.

Alternatives

You may choose not to use telehealth and may request in-person care when available and appropriate. You will not be denied services solely because you do not consent to telehealth, except where a particular service cannot reasonably be delivered in another form or where the practice is unable to accommodate an immediate alternative.

Identity and Location

To receive telehealth services, you agree to provide accurate identifying information and your current physical location at the time of the encounter. You understand that licensure, emergency-response planning, and care decisions may depend on your location. If your location changes during a telehealth session, you agree to inform us promptly.

Privacy and Security

Harmony Medical will use reasonable safeguards to protect your privacy and security during telehealth visits. You understand that no technology is entirely risk-free. To help protect your privacy, you agree to participate from a private location when possible, use a secure device, protect usernames and passwords, and limit others from overhearing or viewing the session unless you want them present.

Patient Responsibilities During Telehealth

You agree to:

• use a device and connection that reasonably support the visit;
• safeguard your device and account credentials;
• tell us if someone else is in the room or listening;
• provide accurate contact, medication, allergy, symptom, and health-history information; and
• follow instructions about follow-up care, emergency escalation, or in-person evaluation.

Recording

Telehealth sessions will not be recorded by Harmony Medical without your consent, unless otherwise permitted by law. You agree not to record a telehealth session without first notifying the clinician and obtaining permission where required by law.

Emergency Situations

Telehealth is not a substitute for emergency care. If you are experiencing a medical emergency, such as severe shortness of breath, signs of anaphylaxis, chest pain, or any life-threatening condition, call 911 immediately or go to the nearest emergency room. You consent to Harmony Medical using the location and emergency contact information you provide to help coordinate emergency response if clinically appropriate.

Clinical Judgment

You understand that your clinician may stop a telehealth visit and recommend in-person evaluation, emergency care, specialist referral, diagnostic testing, or another level of care if telehealth is not clinically appropriate.

Fees, Billing, and Insurance

You are responsible for any applicable co-payments, deductibles, coinsurance, self-pay charges, cancellation or no-show fees, or other charges not paid by insurance, subject to applicable law and your financial agreement with Harmony Medical. Telehealth coverage may vary by payer and plan. Estimated patient responsibility will be confirmed with you in advance of any telehealth visit when applicable.

Consent to Related Electronic Communications

You consent to receive scheduling links, telehealth instructions, and related practice communications by the communication methods you authorize, including email, text, or portal notification, subject to our communication policies.

Minors and Personal Representatives

If the patient is a minor or lacks legal capacity, this Consent must be signed or accepted by a parent, guardian, or other legally authorized personal representative, except where law permits the patient to consent on their own behalf.

Right to Withdraw

You may withdraw your consent to telehealth at any time for future care by notifying Harmony Medical, but withdrawal will not affect care previously provided in reliance on this Consent. Even after withdrawal, you may continue to receive in-person care if accepted and available.