MDHIT Consent Form

Please review the following. Once you have carefully read it, if you wish to proceed, please click on START SURVEY below and complete the MDHIT Consent Form

MDHIT Permission for Telehealth/Telemedicine Visits


What is telehealth, also called telemedicine?

Telehealth is a way to visit with healthcare providers, such as your doctor or nurse practitioner. You can talk to your provider from any place, including your home. You don’t go to a clinic or hospital.

How do I use telehealth?

  • You talk to your provider by phone, computer, or tablet.
  • Sometimes, you use video so you and your provider can see each other.

How does telehealth help me?

  • You don’t have to go to a clinic or hospital to see your provider.
  • You won’t risk getting sick from other people.

Can telehealth be bad for me?

  • You and your provider won’t be in the same room, so it may feel different than an office visit.
  • Your provider may make a mistake because they cannot examine you as closely as at an office visit. (We don’t know if mistakes are more common with telehealth visits.)
  • Your provider may decide you still need an office visit.
  • Technical problems may interrupt or stop your visit before you are done.

Will my telehealth visit be private?

  • We will not record visits with your provider.
  • If people are close to you, they may hear something you did not want them to know. You should be in a private place, so other people cannot hear you.
  • Your provider will tell you if someone else from their office can hear or see you.
  • We use telehealth technology that is designed to protect your privacy.
  • If you use the Internet for telehealth, use a network that is private and secure.
  • There is a very small chance that someone could use technology to hear or see your telehealth visit.

What if I want an office visit, not a telehealth visit? Please schedule an office visit with your physician.

What if I try telehealth and don’t like it?

  • You can stop using telehealth any time, even during a telehealth visit.
  • You can still get an office visit if you no longer want a telehealth visit. But until the office opens for all appointments, you will get an office visit only for one of the reasons listed above.
  • If you decide you do not want to use telehealth again, please inform your routine provider.

How much does a telehealth visit cost? The MDHIT does not charge for care.

Do I have to sign this document? No. Only sign this document if you want to use telehealth.


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