Informed Consent for Telehealth
Informed Consent for Telehealth Services
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MADRES connects you with licensed telehealth providers for the treatment you've requested. This document explains what you can expect from your provider and your care, and certain state laws require you to read and consent to it before treatment begins.
Who provides your care
MADRES's telehealth services are provided by Beluga Health, P.A. and its network of licensed physicians and other qualified healthcare professionals. Your provider's credentials are available to you before your visit, and any questions about those credentials should be directed to your provider.
How telehealth works
Beluga's platform supports both asynchronous and synchronous telehealth. Asynchronous ("store-and-forward") care means you and your provider communicate at different times, for example through a questionnaire, message, or photo you submit that your provider reviews and responds to. Synchronous care means real-time communication, such as a live video or phone visit.
Your care may include chart review, remote prescribing where appropriate, appointment scheduling, refill reminders, and patient education. Electronic communications used for your care are protected with network and software security protocols designed to safeguard your information.
- Telehealth is an addition to, not a replacement for, your relationship with a local primary care provider. If you don't have one, we encourage you to find one.
- Your provider will determine whether your specific clinical needs are appropriate for a telehealth encounter, and reserves the right to decline care if telehealth is not medically or ethically appropriate for your situation.
- There is no guarantee that you will be prescribed any specific medication or treatment. That determination is made by your provider's professional judgment.
- You may withdraw your consent to telehealth services at any time, without affecting your right to future care.
- You understand that federal and state law requires healthcare providers to protect the privacy and security of your health information, and that this information may be shared with other licensed practitioners involved in your care, including out of state, as needed to provide treatment.
- You understand there is a risk of technical failure during a telehealth encounter, and that delays in evaluation or treatment can occur as a result, beyond MADRES's or Beluga's control.
- You may be asked to confirm your identity and physical location before or during a telehealth visit.
- You understand that alternatives to telehealth, including in-person care, are available, and that MADRES does not operate any in-person clinic locations.
- You understand that some aspects of your care, such as lab work or bloodwork, may need to be completed in person at a testing facility, at your provider's direction.
- You may request a copy of your medical records at any time.
State-specific disclosures
All providers in the Beluga Health network are fully licensed in the specific states where they provide care.
In compliance with state regulations, including California (Cal. Bus. & Prof. Code § 680.5(e)), Massachusetts (Mass. Board of Registration in Medicine Policy 15-05), Rhode Island (R.I. Board of Medical Licensure and Discipline Telemedicine Guidelines), and Vermont (Vt. Board of Medical Practice Policy on Telemedicine), we disclose that our telehealth clinical services are managed and provided by:
- Medical Group Name: Beluga Health
- Website: www.belugahealth.com
Individual License Verification
Because Beluga Health utilizes a wide network of physicians to ensure you receive care from a doctor licensed in your specific state, the assigned provider will be matched after submission of the medical intake form.
Patients will be provided with the specific name, credentials, and state license number of their reviewing physician during the consultation process and within their secure patient portal. They may independently verify the licensure of their assigned provider through their respective state medical board's website.
Questions
If you have questions about this consent, your provider, or your care, contact your Beluga Health provider directly through your patient portal, or reach MADRES at the contact information below.