Clinic Privacy, Terms & Telehealth Informed Consent

What is the purpose of this form?

The purpose of this form is to provide information to you about and to obtain your consent to participate in a telehealth consultation with your practitioner.

What is Telehealth?

Telehealth is the use of telecommunication to provide services to clients. The practitioner typically uses videoconferencing to administer client sessions in real-time but may utilise other formats, such as email, for related communication. Telehealth is sometimes referred to as telepractice.

What does a Telehealth consultation involve?

• A telehealth consultation usually involves some or all of the following:
• Your practitioner will discuss your health and your health history with you and, where appropriate, will offer information and advice.
• You may bring a support person with you, as you might in a face to face consultation.
• If you attend a health service to participate in a telehealth consultation, other health professionals may be present and may need to examine you according to your practitioner's instructions.
• A technical support person might be present for part of the consultation to assist with technical issues.
• You are not permitted to video or audio record the consultation unless your practitioner gives you permission to do so.

Terms and Conditions

I understand that:

• Happy Healthy You offers private consultancy and fees are payable prior to the consultation.
• The fees charged may be higher than your private health insurance rebate. Should payment of fees present a problem, please discuss this with your practitioner.
• Failure to attend a scheduled appointment will result in a cancellation fee being charged.
• Cancellations of an appointment must be made within 24 hours prior to your scheduled appointment time. Cancellations under this time will result in a 50% cancellation fee being charged.
• Patients under 18 years of age are required to have a parent/guardian in the room for the duration of the online consultation.

Privacy & Medical Consent

The Health Privacy Act states that we require your consent to collect information about you. Please read this information carefully, and sign where indicated below. 

Naturopaths and health practitioners collect information from you for the primary purpose of providing quality health care. We require you to provide us with your personal details and full medical history, so that we may properly assess, treat and be proactive in your health care needs. This means we will use the information you provide in the following ways:

• Administrative purposes in running our online clinic.
• Billing purposes, including compliance with Health Insurance Commission requirements. 
• Relating your information to others involved in your care, including treating doctors and specialists outside this clinic. This may occur through referral to other doctors, or for medical tests and in the reports or results returned to us following referrals.
• Sharing of information to other practitioners in this practice is for the purpose of patient care. Please let us know if you do not want your records accessed for these purposes and we will note this in your records accordingly.
  
  

I have read the information above and understand the reasons why my information must be collected. I am also aware that this practice has a strict privacy policy on handling patient information.

I understand that I am not obliged to provide any information requested of me, but that my failure to do so might compromise the quality of health care treatment given to me. 

I am aware of my right to access the information collected about me except in some circumstances where access might legitimately be withheld. I understand I will be given an explanation in these circumstances. 

I understand that if my information is to be used for any other purposes than that set out above my further consent will be obtained. 

I consent to the handling of my information by Happy Healthy You Clinic for the purposes set out above, subject to any limitations on access or revelations that I may bring to the attention of the practice.

I do not expect the practitioners to be able to anticipate and explain all possible risks and complications of treatment, and I wish to rely on the practitioner to exercise judgment during the course of treatment which the practitioner thinks at the time, based upon the facts then known, is in my best interest. 

I understand that results are not guaranteed. By voluntarily signing below I show that I have read, or have had read to me, this consent to treatment form and have been told about the risks and benefits of Naturopathy and other procedures, and have had an opportunity to ask questions. 

I intend this consent form to cover the entire course of treatment for my present condition and for any future condition(s) for which I seek treatment. 

☑  I have read the terms & conditions and I agree to receive services via telehealth.

☑ I understand that I may agree or refuse any service or part of a service at any time. I can agree or refuse in writing or verbally.