Telehealth Informed Consent and Open Payments Notice

Grana Medical, P.A. and Affiliated Professional Practices

If you are thinking about suicide, or you are worried about your safety, call or text 988 to reach the Suicide & Crisis Lifeline, any time, free and confidential. If someone may have overdosed, is unresponsive, or is in immediate danger, call 911. Naloxone (Narcan) can reverse an opioid overdose and is available at most pharmacies without a prescription. Reaching out for help is always the right call.

Telehealth Informed Consent

What telehealth is

Telehealth is the delivery of health care using electronic communications between you and your clinicians when you are not in the same place. Your care may include live video or audio visits, secure messaging with your care team, structured check ins and questionnaires, photographs or information you submit, and asynchronous care, which means your clinician may review information you provide and respond at a later time. Asynchronous review is a routine part of how your prescription refill cycle works.

Anticipated benefits

Access to specialized addiction medicine care from home, without travel, time off work, or waiting rooms; care that fits your schedule, with messaging between visits and a regular refill rhythm; and privacy, since you choose where you are during your visits.

Potential risks and limits

Information transmitted electronically may be insufficient for clinical decision making, and an in person evaluation may sometimes be needed. Your clinician cannot perform a hands on exam or take vital signs remotely, which in some cases may delay diagnosis or treatment or require you to seek care elsewhere. If we lack access to your complete medical records, there is a risk of adverse drug interactions, allergic reactions, or other errors in judgment, which is why we ask about every medication and condition and request your consent to retrieve your medication history. Technology can fail, and delays can occur. Security protections including encryption and authentication are built into our systems, but no electronic system is perfectly secure, and a privacy breach is possible despite safeguards.

Telehealth is not for emergencies

Our service is not an emergency service and is not continuously monitored. In a medical or mental health emergency, call 911 or go to the nearest emergency department; in crisis, call or text 988. Some conditions are not appropriate for telehealth, including severe withdrawal. Withdrawal from alcohol can be medically dangerous and sometimes life threatening; if your clinician believes you are at risk of complicated withdrawal or otherwise need a higher level of care, they will tell you, explain why, and help direct you to in person or emergency care.

Your clinicians

Your care may be provided by physicians, nurse practitioners, and physician associates or physician assistants licensed in your state. Advanced practice clinicians practice in collaboration with or under the supervision of physicians as your state requires. You may ask at any time about the license and credentials of any clinician involved in your care.

Recording, automated note taking, and artificial intelligence

With your knowledge, your visits may be recorded or transcribed, including through an automated note taking tool operating under a confidentiality agreement, solely to create your medical record and support quality of care. We will tell you when recording or transcription is active in a visit, and you may decline at any time, during any visit, by telling your clinician; declining will not affect your care. We do not record visits for marketing, and we never sell recordings.. Where artificial intelligence tools support care operations, any output that influences a decision about your care or access to treatment is reviewed by a human.

No guarantee of results, and your rights

No outcome can be guaranteed, and in some cases a condition may not improve or may worsen. You may withhold or withdraw consent to telehealth at any time without affecting your right to future care, though withdrawal will end care delivered through this service. You may seek in person care as an alternative at any time, and we encourage you to maintain a primary care provider: our care is an addition to, not a replacement for, primary care. You have the right to access and receive a copy of your medical records as provided by law. Your health information is protected by federal and state law, and we have adopted the heightened federal confidentiality standard for substance use disorder records, 42 CFR Part 2, as our own policy for every patient record, as described in our Notice of Privacy Practices. Disclosures without your consent are limited to narrow exceptions such as medical emergencies, mandatory child abuse reporting, and court orders, and we will never consent to the use of your records in legal proceedings against you and will assert every available protection if your records are sought.

State specific notices

Notices required by your state, and your state medical board's complaint contacts, appear in Appendix A: State Specific Notices, published alongside this consent. During intake, the app shows you the notice for your state.

Open Payments Notice

For informational purposes: the Open Payments database is a federal tool used to search payments made by drug and device companies to physicians and teaching hospitals. It can be found at https://openpaymentsdata.cms.gov.