Telehealth Informed Consent

Introduction

This Telehealth Informed Consent describes the terms under which Dripping IV Solutions ("Dripping IV Solutions," "we," "us," or "our") provides telehealth services. Please read this document carefully. By scheduling and participating in a telehealth visit, you acknowledge that you have read, understand, and agree to the terms described below.

What Is Telehealth?

Telehealth (also called telemedicine) is the delivery of healthcare services using electronic communications, information technology, or other means between a healthcare provider and a patient who are not in the same physical location. Telehealth may include:

• Consultations and evaluations via live video conferencing
• Review of medical history and intake forms submitted electronically
• Follow-up visits and treatment plan adjustments
• Prescription management and medication adjustments
• Secure messaging between you and your provider

What Telehealth Is Not

Telehealth is not a replacement for emergency medical care. If you are experiencing a medical emergency, call 911 or go to your nearest emergency room immediately.

Telehealth services may not be appropriate for all medical conditions. Your provider will determine whether telehealth is suitable for your specific needs and may recommend an in-person visit if necessary. Some services, including IV therapy, NAD+ infusions, injections, and certain physical examinations, require in-person visits and cannot be provided via telehealth.

Texas Telehealth Provisions

In accordance with the Texas Occupations Code and Texas Medical Board rules regarding telemedicine:

• Geographic limitation: Our telehealth services are available only to patients who are physically located in the state of Texas at the time of their telehealth visit. By participating in a telehealth visit, you confirm that you are physically present in Texas.
• Provider licensing: All Dripping IV Solutions healthcare providers are licensed to practice in the state of Texas. Our providers include licensed physicians, nurse practitioners, and/or physician assistants practicing under applicable Texas regulations.
• Standard of care: The standard of care for telehealth services is the same as for in-person services. Your provider will use their professional judgment to determine the appropriateness of telehealth for your condition.
• Prescribing: Texas law permits providers to prescribe medications via telehealth when clinically appropriate and when a proper provider-patient relationship has been established. Certain controlled substances may have additional requirements.

Benefits and Risks of Telehealth

Potential Benefits

• Convenient access to healthcare from your home or other private location
• Reduced travel time and associated costs
• Timely access to medical consultations and follow-up care
• Continuity of care when in-person visits are not feasible

Potential Risks and Limitations

• Technology failures may interrupt or prevent your visit (e.g., poor internet connection, software issues)
• Limitations in the provider's ability to perform a physical examination
• Potential for misdiagnosis or incomplete assessment due to the inability to perform hands-on evaluation
• Although we use secure, encrypted platforms, there is a small risk that electronic communications could be intercepted
• Delays in treatment if technology issues prevent the completion of a visit

Your Rights

As a telehealth patient, you have the right to:

• Withhold or withdraw your consent to telehealth services at any time without affecting your right to future care
• Request an in-person visit instead of telehealth at any time
• Be informed of the identity and qualifications of your healthcare provider
• Receive the same quality of care via telehealth as you would in person
• Have your medical information kept private and confidential in accordance with HIPAA and Texas law
• Access your medical records in accordance with applicable law
• Know who else may be present during your telehealth visit
• File a complaint with the Texas Medical Board if you believe your rights have been violated

Your Responsibilities

By participating in telehealth services, you agree to:

• Provide accurate and complete information about your medical history, current conditions, medications, and allergies
• Be physically located in the state of Texas at the time of your telehealth visit
• Participate in your telehealth visit from a private, quiet location
• Ensure you have a stable internet connection and compatible device
• Notify your provider if you experience any technical difficulties during your visit
• Follow your provider's instructions and treatment plan
• Seek emergency care when needed rather than relying on telehealth

Technology Requirements

To participate in a telehealth visit, you will need:

• A device with a camera and microphone (smartphone, tablet, or computer)
• A reliable internet connection (broadband or cellular data)
• A supported web browser (current version of Chrome, Safari, Firefox, or Edge)
• A private, well-lit location with minimal background noise

Telehealth visits are conducted through Jane App's integrated video platform or other HIPAA-compliant video conferencing tools as designated by Dripping IV Solutions.

Privacy and Confidentiality

Your telehealth visit is subject to the same privacy protections as an in-person visit. All telehealth communications are conducted over secure, encrypted connections. Your health information is stored in our HIPAA-compliant electronic health records system (Jane App). For full details on how we protect your information, please review our Privacy Policy and HIPAA Notice of Privacy Practices.

Recording Policy

Telehealth visits are not recorded by Dripping IV Solutions unless you are informed and provide consent in advance. You may not record your telehealth visit without the prior written consent of your provider.

Your Consent

By scheduling and participating in a telehealth visit with Dripping IV Solutions, you acknowledge that:

• You have read and understand this Telehealth Informed Consent
• You understand the benefits, risks, and limitations of telehealth
• You consent to receiving healthcare services via telehealth
• You understand you may withdraw consent at any time
• You are physically located in the state of Texas
• You have had the opportunity to ask questions about telehealth

Contact Us

If you have questions about telehealth services or this consent form, please contact us: