Consent to Treat

I voluntarily consent to the examination, diagnosis, and treatment by the licensed nurse practitioner(s) and healthcare providers at NPConnect. I understand and agree to the following:

• Treatment will only be initiated after I have been informed of the nature of my condition, the proposed treatment plan, and any reasonable alternatives.
• I have the right to ask questions about my diagnosis, treatment plan, medications, potential side effects, and alternatives at any time during or after the visit.
• I have the right to refuse any specific treatment, medication, or procedure. I understand that refusal may carry medical risks, and those risks have been or will be explained to me.
• My provider may refer me to another healthcare provider, specialist, or emergency facility if my condition exceeds the scope of telehealth services or requires a higher level of care.
• The provider-patient relationship formed through NPConnect is subject to the same standards of care as an in-person clinical encounter.

I understand and consent to the delivery of healthcare services via telehealth technology, including audio-video conferencing. I specifically acknowledge the following limitations of telehealth:

• No Physical Examination: A hands-on physical exam cannot be performed through telehealth. This may affect the completeness of my evaluation.
• Diagnostic Limitations: Certain conditions require in-person assessment, laboratory testing, or imaging that cannot be performed remotely.
• Scope of Practice: Not all medical conditions are appropriate for telehealth. Emergent or complex conditions may require referral to in-person care.
• Technology Dependence: The quality of care may be affected by my internet connection, device, camera, or microphone.
• Right to Withdraw: I may withdraw my consent for telehealth services at any time without affecting my right to future care.

By acknowledging this section, I agree that:

• Prescriptions issued are for my personal use only, are subject to provider clinical judgment, and must be filled through a licensed pharmacy.
• Controlled substances cannot be prescribed via telehealth under federal law.

Risks I acknowledge include:

• Diagnosis via telehealth may be based solely on reported symptoms and visual observation, which may be less comprehensive than an in-person evaluation.
• Delays in evaluation or treatment may occur due to technical failures or connectivity issues.
• A misdiagnosis or delayed diagnosis could occur due to the inherent limitations of remote assessment.

Alternatives to telehealth that have been made known to me:

• In-person visit with a primary care provider or specialist
• Urgent care clinic for acute or time-sensitive conditions
• Emergency department for serious or life-threatening conditions