Telemedicine Informed Consent

1. Nature of Telemedicine Services

Telemedicine involves the delivery of healthcare services using electronic communications, information technology, and other digital means between a healthcare practitioner and a client who are not in the same physical location. Services may be delivered via video visit, secure messaging, or asynchronous review of submitted health information, depending on the type of care needed.

Telemedicine services provided by Hillary Lin, MD may include initial clinical consultation, ongoing care management, prescription management, laboratory ordering, and health and longevity optimization, as clinically appropriate. All telemedicine services are held to the same standard of care as equivalent in-person medical services.

2. Technology and Platform

2.1 How the Platform Works

Telemedicine visits are conducted via a HIPAA-compliant video-conferencing platform. You will receive a link or login instructions by email prior to your visit. A reliable internet connection and a device with a working camera and microphone are required.

2.2 Technical Requirements

• A broadband internet connection (minimum 5 Mbps recommended)
• A smartphone, tablet, or computer with a working camera and microphone
• A current, supported web browser or the platform's app
• A private, quiet space where you can speak freely

2.3 If the Connection Fails

Technical failures may interrupt or prevent a visit. If the connection fails during a session, Dr. Lin or her team will attempt to re-connect via video first, then by phone. If the visit cannot be completed due to a technical failure on our end, you will be offered a full refund or a complimentary reschedule at your election.

2.4 Security Risks

Despite the use of HIPAA-compliant, encrypted technology, no electronic communication method is completely secure. There is a residual risk of unauthorized interception or disclosure of health information. You acknowledge this risk and consent to the use of telehealth technology for your care.

3. Limitations of Telemedicine

You understand and acknowledge the following limitations:

• Telemedicine may not be as complete as in-person care. The inability to perform a physical examination may affect diagnosis and treatment recommendations.
• Certain conditions cannot be adequately diagnosed or treated via telehealth. Dr. Lin may determine during a visit that in-person care is required.
• In-person care is always an available alternative to telehealth.
• Telehealth is not appropriate for medical emergencies.
• Dr. Lin may refer you to a local specialist or emergency provider if your clinical situation requires in-person evaluation.

4. Privacy, HIPAA, and Records

4.1 HIPAA Compliance

Hillary Lin, MD is a HIPAA-covered healthcare provider. Your Protected Health Information (PHI) generated during telemedicine visits is handled in accordance with our Notice of Privacy Practices, available at hillarylinmd.com/privacy-policy.

4.2 How Health Data Is Stored

Your health information from telemedicine visits is stored in a HIPAA-compliant electronic health record system. Access to your PHI is limited to Dr. Lin and authorized members of her care team with a legitimate need for access in connection with your care.

4.3 Session Recording

Telemedicine sessions will NOT be recorded without your separate, explicit written consent. If recording is ever proposed (for quality improvement, training, or other purposes), you will be informed in advance and have the right to decline without any impact on your care.

4.4 Sharing with Other Providers

You have the right to request that records from your telehealth visits be shared with your primary care provider or other specialists. Such sharing requires your authorization, except where required or permitted by law.

5. Emergency Protocol

Telehealth is not appropriate for medical emergencies. If you believe you are experiencing a medical emergency, stop the visit and call 911 or go to the nearest emergency room immediately.

At the start of each telehealth visit, you agree to provide your current physical address so that emergency services can be dispatched if necessary. If Dr. Lin believes a medical emergency is occurring during a visit, she will direct you to seek emergency care and may share your location information with emergency services if you appear to be in immediate danger.

For mental health crises, including active suicidal ideation or self-harm, the appropriate resource is the 988 Suicide and Crisis Lifeline (call or text 988) or your nearest emergency room.

6. Your Rights as a Client

You have the following rights in connection with telehealth services:

• You may refuse telehealth services at any time without penalty or loss of other treatment options
• You may end a telehealth visit at any time
• You have the right to access all records from your telehealth visits
• You may request that records be sent to your primary care provider or other treating physicians
• You have the right to know who else may be present during a telehealth session; no unauthorized personnel will be present without your knowledge
• You have the right to choose in-person care as an alternative to telehealth

7. State-Specific Notices

The following notices apply to clients in specific licensed states. All licensed states are also subject to the universal requirements above.

CaliforniaCalifornia

California Business and Professions Code Section 2290.5 requires both verbal and written consent for telemedicine services. Verbal consent will be obtained at the start of each visit and documented in your medical record. Written consent (this document) must be signed and placed in your medical record.

If Dr. Lin provides any nutritional advice in connection with your care, the following notice applies under California Business and Professions Code Section 2068:

State law allows any person to provide nutritional advice or give advice concerning proper nutrition, which is the giving of advice as to the role of food and food ingredients, including dietary supplements. This state law does NOT confer authority to practice medicine or to undertake the diagnosis, prevention, treatment, or cure of any disease, pain, deformity, injury, or physical or mental condition and specifically does not authorize any person other than one who is a licensed health practitioner to state that any product might cure any disease, disorder, or condition.

UtahUtah

Utah Administrative Code requires that Dr. Lin verify your physical location and identity prior to each telehealth encounter. Informed consent must be obtained prior to your first visit and renewed at least annually thereafter. You will receive a consent renewal reminder each year.

Your consent covers the following disclosures required by Utah law:

• Fees for telehealth services and how payment is made
• Who may have access to your health information and for what purpose
• Your health information rights under HIPAA and Utah law
• Appropriate uses and limitations of telehealth, including emergency situations
• Confirmation that services meet industry security and privacy standards and comply with HIPAA and HITECH
• Potential privacy risks that exist regardless of security measures
• Risk of lost information due to technical failures; by consenting you agree to hold the provider harmless for losses caused by technical failure outside our control

TexasTexas

Texas law requires verbal consent, which is documented in your medical record. The following notice is required by the Texas Medical Board:

Complaints about physicians, as well as other licensees and registrants of the Texas Medical Board, including physician assistants, acupuncturists, and surgical assistants, may be reported for investigation at the Texas Medical Board, P.O. Box 2018, MC-263, Austin, Texas 78768-2018, (800) 201-9353, www.tmb.state.tx.us.

Texas telemedicine services are held to the same standard of care as in-person visits. If the standard of care cannot be met via telehealth in your specific situation, Dr. Lin will advise you that an in-person visit is required.

New York, Illinois, Florida, Michigan, Washington

These states do not mandate a specific telehealth consent form beyond the universal requirements above. All visits comply with applicable HIPAA requirements, state medical practice standards, and general informed consent requirements for medical care.

8. Billing and Insurance

Dr. Lin's practice operates primarily on a direct-pay (cash-pay) model. Services are not billed to insurance as a standard practice. Fee schedules are provided at the time of booking and in your membership or service agreement. A financial agreement covering specific fees will be provided prior to your first visit.

You are responsible for confirming your payment method and understanding the fee structure before your visit. Superbills for potential insurance reimbursement may be available upon request, subject to applicable state requirements.