To provide more accessible healthcare services, we now offer medical consultations through video, audio, or electronic information transmission, collectively referred to as "telehealth." Telehealth allows healthcare providers to evaluate, diagnose, manage, and treat various health issues from a remote location. It is crucial that you understand and provide informed consent for the use of telehealth in your care, including any AI-assisted features or subscription-based concierge services.
DISCLAIMER: Telehealth is not suitable for medical or mental/behavioral health emergencies. In case of a medical emergency, dial 911. For a mental/behavioral health emergency, you can: (1) call 911; (2) go to the nearest emergency room; or (3) contact your local crisis center.
Telehealth and Concierge Services Telehealth involves using electronic communications to enable healthcare providers, including physicians, psychiatrists, nurse practitioners, physician assistants, licensed professional counselors, and social workers, to evaluate, diagnose, manage, and treat various health issues, including mental/behavioral health. This includes services offered through ViClinic’s subscription-based concierge service, which allows for more personalized care, priority access, and on-demand consultations.
AI-Driven Pre-Visit Symptom Deep Dive As part of ViClinic's telehealth service, we offer an AI-driven Pre-Visit Symptom Deep Dive feature. This feature automates the collection of structured symptom data before your appointment. By consenting to telehealth services, you agree to the collection, analysis, and summarization of your health data through AI systems, which will be securely transmitted to your healthcare provider's electronic medical record (EMR) for evaluation and treatment planning.
Information Collection Directly:We may collect personal information, including names, symptoms, medical history, and other relevant health details necessary to provide telehealth or concierge services. If using the AI-driven Pre-Visit Symptom Deep Dive, you will provide structured symptom details prior to your consultation.
Automatically:We may collect information such as device details, domain names, and browser types, as well as other usage data via cookies or similar technologies, including for children under 13, where necessary and with parental consent.
How We Use Information
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To provide healthcare services, including via telehealth, concierge, and AI-assisted features.
- To respond to customer service and support requests.
- To de-identify and/or aggregate information for research and analysis to improve the telehealth experience.
Possible Risks
Quality of transmitted information: Information transmitted electronically may be of inadequate quality, requiring a face-to-face meeting.
Delays: Evaluation and treatment could be delayed due to issues with telehealth equipment or data transmission.
Security breaches: While we follow strict security protocols, technical failures could result in privacy breaches.
Incomplete medical records: There may be a lack of access to your full medical records, leading to potential errors or misdiagnosis.
By agreeing to this HIPAA Authorization Form, you acknowledge:
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Privacy laws apply to telehealth, concierge, and AI-driven services.
- Your information will not be disclosed without your consent, except in emergencies, abuse cases, court orders, billing claims, evaluations, or when otherwise legally required.
- You can withdraw consent at any time by contacting ViClinic.
- You understand the available alternatives to telehealth and AI-assisted services.Information, including health data, may be shared with out-of-state practitioners to facilitate your care.
- The AI-driven Pre-Visit Symptom Deep Dive is designed to enhance efficiency, but results are not guaranteed.
Important Notices
Medication side effects: Call 911 for immediate assistance if you experience serious side effects from medications prescribed via telehealth.
Health Information Sharing: Health data may be shared for scheduling, billing, or treatment purposes, with confidentiality maintained in compliance with HIPAA and applicable regulations.
Electronic Signature
By electronically signing this document, you confirm that you have read and understood this HIPAA Authorization Form, including the associated risks and benefits of telehealth, concierge, and AI-driven services. You understand that ViClinic's healthcare providers rely on this informed consent to provide services to you.
My ability to access ViClinic's services is conditional upon this informed consent. I understand and acknowledge that ViClinic’s healthcare providers are relying upon this informed consent to interact with and facilitate healthcare services to me.
Contact Us If you have any questions or require assistance, please contact us at
support@viclinic.com.
