1.Nature of Telemedicine

I understand that Firm Hill Cardiometabolic Center provides certain medical services through telemedicine, which may involve secure audio, video, electronic health records, and other approved communication technologies.

Telemedicine allows a healthcare professional to evaluate and manage appropriate medical concerns without requiring the patient and physician to be physically present in the same location.

2.Benefits and Limitations

Potential benefits include improved convenience, reduced travel, and access to appropriate physician-led care.

I understand that telemedicine has limitations, including:

• Inability to perform a complete hands-on physical examination.
• Possible technical interruptions.
• Limitations in evaluating certain symptoms or conditions remotely.
• Potential need for in-person examination, diagnostic testing, or referral.
• Privacy and security risks inherent in electronic communication.

3.Clinical Judgment

I understand that the physician will determine whether telemedicine is appropriate for my condition.

The physician may recommend in-person evaluation, emergency care, additional testing, referral, or discontinuation of a telemedicine encounter when clinically appropriate.

I understand that specific treatment outcomes are not guaranteed.

4.Patient Location and Eligibility

I understand that Firm Hill currently limits telemedicine consultations to eligible patients physically located in Texas at the time of service.

I agree to provide accurate information about my physical location during each consultation.

I understand that services may be unavailable if I am outside the authorized service area.

5.Local Primary Care

I understand that Firm Hill's telemedicine model requires patients to maintain access to an in-person local primary care physician for routine physical examinations, preventive screenings, vaccinations, and medical concerns requiring in-person evaluation.

6.Emergencies

I understand that Firm Hill does not provide emergency medical services.

For a medical emergency, I must call 911 or seek emergency medical attention.

Same-day virtual consultations, when available, are not substitutes for emergency services.

7.Medication Management

I understand that prescribing decisions are based on clinical judgment, applicable law, and medical appropriateness.

Firm Hill does not prescribe controlled substances under its stated practice policy.

No specific medication or treatment is guaranteed.

8.Privacy and Security

I acknowledge that I have been provided access to Firm Hill's Notice of Privacy Practices.

I understand that telemedicine may involve electronic transmission of protected health information through authorized systems.

I agree to use a reasonably private location and appropriate device security during consultations.

9.Communication and Follow-Up

I understand that routine clinical management is conducted through scheduled consultations and other expressly approved clinical communication pathways.

The Practice will explain how to contact it for administrative matters, time-sensitive clinical concerns, and after-hours needs.

I understand that general website forms and ordinary email are not emergency communication channels.

10.Financial Responsibility

I understand that fees, insurance arrangements, membership charges, and cancellation terms will be disclosed through the applicable financial agreement.

This consent does not itself authorize recurring charges or substitute for a separate membership agreement.

11.Questions and Consent

I have had an opportunity to ask questions about telemedicine and understand the nature, benefits, risks, and limitations of receiving care remotely.

I voluntarily consent to receive clinically appropriate telemedicine services from Firm Hill Cardiometabolic Center.

I understand that I may withdraw consent as permitted by law, subject to applicable consequences for continued telemedicine treatment and existing lawful financial obligations.