Patient consent
Telehealth Informed Consent
This consent explains how remote care works, its potential benefits and limitations, your choices, and the information you should understand before receiving care through Caliber.
01
Consent and care team
I consent to receive healthcare services through telehealth from the licensed clinician or medical practice identified to me in connection with my care. Telehealth may be used for evaluation, consultation, diagnosis, treatment, follow-up, care coordination, health education, and monitoring.
Caliber provides non-clinical technology and administrative support. Clinical services are furnished by MDI Medical Group PC, its affiliated professional entities, and their licensed healthcare professionals. Clinical decisions are made independently by those professionals acting within the scope of their licenses and applicable law. A clinician may determine that telehealth is not appropriate for me or that an in-person examination is required.
02
How telehealth may be delivered
My care may involve one or more of the following:
- Live or recorded audio and video communications;
- Secure messages, questionnaires, photographs, documents, and other asynchronous exchanges;
- Electronic transmission of medical records, laboratory information, and health data;
- Remote monitoring, decision-support, or other digital tools used under clinician oversight; and
- Coordination with pharmacies, laboratories, or other healthcare service providers.
I will provide my current physical location when requested, use a reasonably private setting, and give complete and accurate information about my identity, health history, medications, symptoms, and current condition.
03
Potential benefits
Telehealth can make care easier to access, reduce travel and waiting time, support timely follow-up, and allow members of my care team to review information remotely. These benefits are not guaranteed, and my individual results may differ.
04
Risks and limitations
I understand that telehealth may involve risks or limitations, including:
- Information that is incomplete, inaccurate, delayed, or not sufficient for clinical decisions;
- Technology failures, poor image or sound quality, interrupted connections, or delayed care;
- The inability to perform a hands-on physical examination or certain diagnostic procedures;
- Security or privacy incidents despite reasonable safeguards;
- Errors in electronic records or communications; and
- A need for in-person care, laboratory testing, imaging, specialist care, or emergency services.
No outcome, diagnosis, treatment, medication, or prescription is promised. I will seek additional care if my symptoms worsen, persist, or require services that cannot safely be provided through telehealth.
05
Privacy and electronic communications
My health information may be created, used, stored, and disclosed for treatment, payment, healthcare operations, and other purposes permitted by applicable law. Caliber, MDI, and the care team will use reasonable safeguards based on their respective roles, but no electronic system can be guaranteed to be completely secure.
Email, text messaging, and other electronic communications may carry privacy risks. I will avoid unsecured public networks where practical and will not record a telehealth interaction without the permission of all participants. The Caliber Privacy Policy, state-specific privacy notices, and the medical practice’s Notice of Privacy Practices may also apply.
06
Prescriptions and additional care
Completing an intake or telehealth visit does not guarantee a prescription. A licensed clinician must determine that a medication is clinically appropriate and legally permitted after reviewing the available information. The clinician may request identity verification, an examination, laboratory testing, medical records, or an in-person visit before making a treatment decision.
If medication is prescribed, fulfillment may involve an independent pharmacy whose services, disclosures, pricing, and delivery terms may apply separately. I remain responsible for following prescribing instructions and reporting side effects or changes in my health.
07
Your rights and choices
- I may ask questions and request the identity and credentials of the treating clinician.
- I may decline or stop a telehealth interaction and seek in-person care instead.
- I may request access to my medical records as provided by applicable law.
- I may withdraw this consent for future care by contacting Caliber or my care team.
- Withdrawing consent will not affect the legality of care already provided or records already created.
Some services may no longer be available if I withdraw consent. Additional state-specific consent or notice requirements may be presented based on my location and treating clinician.
08
Your acknowledgment
By checking the telehealth consent box in the Caliber intake, I acknowledge that:
- I have read and understand this Telehealth Informed Consent;
- I have had or will have an opportunity to ask questions before treatment begins;
- I understand the potential benefits, risks, limitations, and alternatives to telehealth;
- I consent to telehealth care and the electronic exchange of information needed to provide that care; and
- I am the patient or a person legally authorized to consent for the patient.