Medical Consent

Consent to Telehealth

I consent to engaging in telehealth consultations with licensed healthcare providers through the CareQuo platform. I understand that telehealth involves the delivery of healthcare services using electronic communications, information technology, and other means between a healthcare practitioner and a patient who are not in the same physical location.

Nature of Services

I understand that: (1) CareQuo connects patients with independent licensed providers; (2) the provider will review my health information and determine if I qualify for treatment; (3) prescriptions are issued solely at the provider's discretion; (4) compounded medications are not FDA-approved.

Risks and Benefits

• Telehealth may involve limitations compared to in-person care
• Technical difficulties may interrupt the consultation
• Information transmitted may be insufficient for a complete medical evaluation
• Failure to disclose accurate health information may affect the quality of care

Confidentiality

I understand that my health information shared during telehealth consultations is protected by HIPAA and will be kept confidential except as permitted or required by law.

Right to Withdraw

I understand that I may withdraw my consent to telehealth services at any time without affecting my right to future care or treatment.

Emergency Services

I understand that in the event of a medical emergency, I should call 911 or go to the nearest emergency room immediately. CareQuo telehealth services are not intended for emergency situations.

Acknowledgment

By using CareQuo services, I acknowledge that I have read and understood this consent form and agree to its terms.