Terms of service
This comprehensive consent form covers the terms and conditions for pediatric and adolescent telehealth services provided by Hey Nouri Medical Services, P.A., Hey Nouri Medical Services East, P.C. (collectively referred to as "the Practice"). It includes consent for telehealth/teletherapy, use of digital tools, privacy practices, and various authorizations required under U.S. law. Please read each section carefully.
1. Telehealth and Teletherapy Services Consent
Consent to Telehealth: By using our services, you consent to receive health care services via telehealth (including telemedicine and teletherapy) from the Practice's licensed providers. "Telehealth" means the delivery of medical, mental health, or therapy services using interactive audio, video, or other electronic communications between the provider and patient at different locations.
Scope of Services: Telehealth services offered may include assessment, diagnosis, treatment planning, therapy or counseling sessions, prescription of medication, coordination of care, and patient education. The Practice's providers will determine whether the services are appropriate for telehealth and may advise in-person care or referral if a condition cannot be fully addressed remotely.
Benefits & Risks: Benefits of telehealth include convenience, access to services from home, and expedited scheduling. Potential risks include technical problems, internet connectivity issues, equipment failures, or unauthorized access to electronic information. In rare cases, the information transmitted may be insufficient to allow for appropriate medical or therapeutic decision making.
Right to Refuse or Withdraw: Participation in telehealth is voluntary and you have the right to refuse telehealth services or withdraw consent at any time, without affecting your right to future care or treatment.
2. Waiver of Liability and Indemnification
Assumption of Risk: You acknowledge that you have been informed of the risks and limitations of telehealth services, including risks of technology failures, unauthorized access, or misunderstandings due to lack of in-person interaction. You voluntarily assume all such risks in proceeding with telehealth.
Release and Hold Harmless: You hereby release, discharge, and hold harmless Hey Nouri Medical Services, P.A., Hey Nouri Medical Services East, P.C., and Naeven Health Corp., and their respective owners, directors, officers, employees, contractors, and agents from any and all liability, claims, demands, or causes of action that may arise from your use of telehealth services.
3. Consent to Use AI Scribe and Electronic Note-Taking Tools
The Practice may utilize electronic tools, including an AI-powered note-taking service ("AI Scribe"), to assist in documenting clinical encounters and therapy sessions. These notes and transcripts will become part of the confidential medical record.
The Practice assures that the AI Scribe or similar tools used are HIPAA-compliant and secure, meaning they meet federal standards for encryption and protection of health information. You have the right to request that the AI Scribe be turned off for a portion or entirety of a session.
4. Confidentiality and HIPAA-Compliant Privacy Provisions
The Practice is required by law (HIPAA and applicable state laws) to maintain the privacy and security of your health information. All information disclosed during telehealth sessions or in-person visits, including medical histories, treatment notes, and communications, is confidential and protected.
Limits of Confidentiality: There are specific exceptions and legal limits to confidentiality, including danger to self or others, suspected abuse or neglect, legal proceedings requiring disclosure, and serious medical emergencies.
5. Personal Responsibility and Health Care Claims Release
You agree to provide accurate and complete health information to the best of your ability. Effective care requires your active participation. You agree to follow the treatment or care plan recommended by your provider.
You acknowledge that you are financially responsible for any services provided. You recognize that healthcare providers cannot guarantee any specific results of treatment.
6. Testimonial and Feedback Release
By providing testimonials or feedback, you authorize the Practice to use your statements for marketing, public relations, or educational purposes. Providing a testimonial is completely voluntary and separate from your treatment. You have the right to revoke this authorization at any time by sending a written notice to the Practice.
7. Cancellation and No-Show Policy
If you need to cancel or reschedule an appointment, you agree to provide at least 24 hours' notice. Late cancellations or failure to appear for a scheduled appointment ("no-show") may result in a fee. Insurance companies generally do not cover cancellation or no-show fees, so any such charge would be your personal responsibility.
8. Emergency Protocols
Telehealth is not intended for medical emergencies. If you experience a medical emergency, call 911 or go to the nearest emergency room immediately. The Practice will provide guidance on emergency protocols during your initial consultation.
9. Insurance and Billing
You authorize the Practice to submit claims to your insurance provider on your behalf. You are responsible for understanding your insurance benefits and any applicable co-pays, deductibles, or coinsurance amounts. If your insurance does not cover a service, you are responsible for the full cost.
10. Contact Us
Have questions about these terms? We're here to help. 📩 Email: info@heynouri.com