This Telemedicine Informed Consent ("Consent") is part of your care at Optivita Health ("Clinic"). Please read it carefully and ask questions before signing. "Telemedicine" or "telehealth" means the delivery of healthcare services using interactive audio, video, or other electronic communications between a provider and a patient who are not in the same physical location.

1. Nature of Telemedicine Services

Telemedicine visits at the Clinic may include: synchronous video visits, audio-only telephone visits when clinically appropriate and permitted, secure messaging through the patient portal, remote review of laboratory and imaging results, electronic prescribing, and digital transmission of health information. The provider treating you by telemedicine has the same professional obligations as during an in-person visit.

2. Geographic & Licensure Limitations

Telemedicine is regulated by the state where the patient is physically located at the time of the visit. The Clinic does NOT provide telemedicine services to patients located in New York, Pennsylvania, Massachusetts, West Virginia, and Rhode Island. Liza Maria Rodriguez Jimenez, MD must be licensed in the state where you are located at the time of each visit. You agree to disclose your physical location at the beginning of each visit. If you are not in an authorized location, the visit must be rescheduled or converted to an in-person visit.

3. Expected Benefits

Improved access to specialized functional and integrative medicine care without travel.
Reduced time away from work, family, and other obligations.
Continuity of care for chronic conditions between in-person visits.
Earlier intervention when symptoms or concerns arise.

4. Possible Risks and Limitations

Telemedicine has limitations that you should understand and accept:

The provider cannot perform a hands-on physical examination, which can limit clinical assessment in some situations.
Technology may fail, calls may drop, audio or video quality may be poor, or images and information may be inadequate. In such cases the visit may need to be rescheduled or converted to in person.
Electronic transmission of information carries some risk of interception or unauthorized access, despite security measures.
In rare cases, a delay in diagnosis or treatment could occur because of a missing in-person examination, the inability to perform on-site testing, or technology limitations.
Some conditions, symptoms, or interventions are not appropriate for telemedicine and will require an in-person visit, urgent care, or emergency evaluation.
Electronic prescribing of controlled substances is subject to federal and state rules and may not be possible in all circumstances.

5. Alternatives

You always have the right to receive in-person care from the Clinic (where geographically feasible) or from another provider of your choice. Choosing telemedicine is voluntary. You may withdraw consent for any individual telemedicine visit and request to be seen in person, although doing so may delay care.

6. Privacy and Confidentiality

Telemedicine visits are subject to the same federal and state confidentiality protections as in-person visits, including HIPAA. The Clinic uses video and messaging platforms that are designed to support HIPAA-compliant communications. Despite reasonable safeguards, electronic communications can never be made completely secure. You agree to take reasonable steps to protect your own privacy during a telemedicine visit by using a private location, securing your device, and not allowing unauthorized people to view or hear the visit. The Clinic does not record telemedicine visits without your express written authorization, except as required by law.

7. Emergencies

Telemedicine is not appropriate for emergencies. If you are experiencing a medical emergency — chest pain, signs of stroke, severe shortness of breath, suicidal thoughts, severe bleeding, signs of anaphylaxis, or any other life-threatening symptom — call 911 or go to the nearest emergency department immediately.

8. Your Rights

To withhold or withdraw consent for telemedicine at any time without affecting your right to future care or treatment.
To be informed of the names, locations, and credentials of all persons participating in a telemedicine visit.
To request that a telemedicine visit be discontinued at any time.
To have access to all medical information generated during a telemedicine visit, in accordance with HIPAA.
To be informed of the alternatives to telemedicine, including in-person care.

9. Financial Responsibility

Telemedicine visits are billed in accordance with the Financial Policy. Coverage of telemedicine varies by payer, state, and plan. You are responsible for any portion not covered by insurance.

10. Prescriptions

The provider may prescribe medications based on the telemedicine evaluation. Controlled substance prescribing by telemedicine is subject to federal and state rules and may require an in-person evaluation. The provider may decline to prescribe any medication if telemedicine evaluation is not sufficient.

11. Consent

By proceeding with a telemedicine visit, you confirm that you have read this Consent, had the opportunity to ask questions, and voluntarily consent to receive telemedicine services from the Clinic under the terms described.