Detailed Digital Consent

If I receive telehealth, I understand that care is delivered using electronic communication and may have technical or clinical limitations. An in-person evaluation may be recommended or required. I understand telehealth is not an emergency service and that eligibility depends on clinical appropriateness and applicable law.

I understand that prescriptions are based on individualized clinical judgment and that evaluation does not guarantee any medication, controlled substance, opioid, procedure, refill, or other requested treatment. If a controlled or high-risk medication is prescribed, clinically appropriate or legally required monitoring may include prescription-monitoring review, toxicology testing, medication reconciliation, pill counts, pharmacy verification, follow-up, or other safety measures. Lost/stolen medication and early refill requests are not guaranteed to be replaced or approved.

I authorize Nexus Health PC to submit claims and related information to my insurer/payer when applicable and authorize payment of benefits to the Practice to the extent permitted. I understand that benefit verification or an insurance listing is not a guarantee of coverage or payment. I remain responsible for applicable copayments, deductibles, coinsurance and non-covered services, subject to applicable law and payer rules, and I agree to provide accurate insurance information.

I acknowledge that the Nexus Health PC Notice of Privacy Practices has been made available to me. I understand that health information may be used and disclosed as permitted or required by HIPAA and applicable law for treatment, payment, health care operations, and other permitted or required purposes. A separate authorization will be obtained when legally required.

Review Notice of Privacy Practices

I understand that prescriptions and clinically appropriate prescription information may be transmitted electronically to or obtained from pharmacies and other permitted systems when allowed by law and appropriate for my care.

I understand that Nexus may coordinate care with other treating providers and organizations as permitted by law, including physicians, home health agencies, PT/rehabilitation, nursing, imaging, pharmacies, facilities, and other members of my care team. Separate authorization will be obtained when required. Clinical determinations, including any homebound-status documentation, remain the responsibility of the qualified clinician and are not automatically generated by the website.

Clinical photographs or digital images may be useful for documentation or treatment in some circumstances. Images will be handled as health information when applicable. This choice is for clinical use only and does not authorize marketing, advertising, social media, or other promotional use.

I understand that Nexus may use the contact information I provide for appropriate administrative communications such as appointment reminders, requests to complete forms, or notices that a secure message is available. Sensitive clinical information should be handled through approved secure channels. Communication preferences can be updated subject to operational and legal requirements.

I agree to provide information that is complete and accurate to the best of my knowledge, including medications, allergies, health history, treating providers, insurance and relevant advance-directive or health-care power-of-attorney information. I will notify the Practice of important changes and use medications only as directed.

I understand that I may ask questions before signing. I may decline optional permissions. I may withdraw consent prospectively where permitted, subject to actions already taken and circumstances in which treatment, documentation, billing, retention, or disclosure is otherwise permitted or required by law. Selecting “I Don’t Know” means I am requesting clarification before my signature is finalized.