Telehealth Informed Consent

PRIME Medical Group PLLC Effective Date: May 27, 2026

Introduction

This Telehealth Informed Consent ("Consent") explains the nature of telehealth services provided by PRIME Medical Group PLLC ("PRIME," "we," "us," or "our") and your rights as a patient receiving telehealth care. Please read this document carefully before your telehealth appointment.

By scheduling or participating in a telehealth appointment with PRIME Medical Group PLLC, you acknowledge that you have read, understood, and agree to the terms of this Consent.

1. What Is Telehealth?

Telehealth involves the use of electronic communications — including video conferencing, telephone, secure messaging, and other digital platforms — to enable healthcare providers to deliver clinical services to patients at a distance.

Telehealth services offered by PRIME Medical Group PLLC may include:

  • Initial consultations and medical evaluations
  • Follow-up appointments and protocol reviews
  • Lab result consultations and treatment adjustments
  • Hormone therapy monitoring and management
  • Weight loss program consultations and check-ins
  • Medication management and prescription renewals
  • Health coaching and wellness consultations
  • Other clinical services as determined by your provider

2. Benefits of Telehealth

Telehealth services offer significant benefits, including:

  • Access to medical care from your home, office, or any location
  • Elimination of travel time and waiting room delays
  • Flexible scheduling options including early morning and evening appointments
  • Continuity of care for patients traveling or relocating
  • Access to PRIME Medical Group PLLC providers nationwide through our LabCorp partnership
  • Discreet, private consultations from your preferred location

3. Risks & Limitations of Telehealth

You understand and acknowledge that telehealth has potential risks and limitations, including:

A. Technical Limitations

  • Disruptions in video or audio quality may affect the consultation
  • Technical failures may require rescheduling or switching to a phone call
  • Internet connectivity issues may interrupt or delay care

B. Clinical Limitations

  • Telehealth consultations cannot fully replace in-person physical examinations
  • Certain diagnostic procedures require in-person evaluation
  • Your provider may determine that an in-person visit is necessary and refer you accordingly
  • Emergency situations cannot be managed via telehealth

C. Information Security

  • Despite our use of HIPAA-compliant platforms, electronic communications carry inherent security risks
  • You are responsible for using a private, secure location and internet connection during telehealth appointments
  • You should not participate in telehealth appointments from public locations or using public Wi-Fi

D. Prescription Limitations

  • Federal and state laws restrict the prescribing of certain medications via telehealth
  • Controlled substances may not be prescribed via telehealth except as permitted by law
  • Certain treatments may require an in-person evaluation before prescribing

4. Your Rights as a Telehealth Patient

You have the right to:

  • Refuse telehealth services at any time without affecting your right to receive in-person care
  • Request an in-person appointment at any time
  • Stop a telehealth session at any time
  • Be informed of all persons present during the telehealth consultation
  • Request that no additional persons be present during your consultation
  • Receive the same standard of care via telehealth as in an in-person visit
  • Have your health information protected in accordance with HIPAA
  • Receive a copy of your telehealth consultation notes upon request

5. Confidentiality & Privacy

A. HIPAA Compliance

All telehealth communications are conducted through HIPAA-compliant platforms. Your protected health information (PHI) is protected in accordance with our HIPAA Notice of Privacy Practices, available at primemedicalhrt.com/hipaa-notice.

B. Recording Policy

Telehealth sessions are not recorded without your explicit written consent. PRIME Medical Group PLLC staff will never record your telehealth session without informing you and obtaining your prior written authorization.

C. Your Responsibility

You are responsible for:

  • Ensuring you are in a private location during your telehealth appointment
  • Using a secure internet connection
  • Not recording the session without written consent from PRIME Medical Group PLLC
  • Ensuring no unauthorized persons are present or able to overhear during your consultation

6. Technology Requirements

To participate in telehealth appointments, you will need:

  • A device with a camera and microphone (smartphone, tablet, or computer)
  • A stable internet connection (minimum 5 Mbps recommended)
  • A current web browser or the telehealth platform app installed
  • A private, quiet location with adequate lighting

PRIME Medical Group PLLC uses OptiMantra and other HIPAA-compliant telehealth platforms. Instructions for accessing your telehealth appointment will be provided at the time of scheduling.

If you experience technical difficulties:

  • Call us at (888) 717-7463 immediately
  • We will attempt to complete your consultation by phone if video is unavailable
  • If the appointment cannot be completed due to technical issues beyond your control, we will reschedule at no charge

7. State-Specific Information

Telehealth services are subject to the laws of the state where you are physically located at the time of the appointment. By consenting to telehealth services, you confirm that:

  • You are physically located in a state where PRIME Medical Group PLLC is authorized to provide telehealth services
  • You understand that your state's laws regarding telehealth, prescribing, and medical practice apply to your care
  • You will inform PRIME Medical Group PLLC if your location changes between appointments

Important for Florida Patients: Florida law requires specific disclosures and consent procedures for telehealth services. By consenting to telehealth services in Florida, you acknowledge that your provider is licensed in the State of Florida and is providing services in compliance with Florida Statute 456.47.

Important for Illinois Patients: Illinois telehealth services are provided in compliance with the Illinois Telehealth Act (410 ILCS 151).

8. Emergency Procedures

Telehealth is not appropriate for emergency situations. If you experience a medical emergency during or after a telehealth appointment:

  1. Call 911 immediately
  2. Go to your nearest emergency room
  3. Notify PRIME Medical Group PLLC after the emergency has been addressed

Your provider will ask for your physical location at the beginning of each telehealth appointment so that emergency services can be contacted on your behalf if necessary.

Crisis Resources:

  • Emergency: 911
  • National Suicide Prevention Lifeline: 988
  • Crisis Text Line: Text HOME to 741741
  • Substance Abuse Helpline: 1-800-662-4357

9. Fees & Billing

Telehealth consultations are billed at the same rate as equivalent in-person services unless otherwise noted. Payment is due at the time of service. Cancellation and no-show policies apply to telehealth appointments as described in our Terms and Conditions at primemedicalhrt.com/terms-and-conditions.

10. Consent for Minors

Telehealth services for patients under the age of 18 require the written consent of a parent or legal guardian. The parent or guardian must be present during the telehealth appointment unless otherwise authorized by the treating provider and permitted by applicable state law.

11. Acknowledgment & Consent

By scheduling or participating in a telehealth appointment with PRIME Medical Group PLLC, you acknowledge and agree that:

  • ☐ I have read and understand this Telehealth Informed Consent
  • ☐ I understand the benefits, risks, and limitations of telehealth services
  • ☐ I understand that telehealth is not appropriate for emergency situations
  • ☐ I understand my rights as a telehealth patient
  • ☐ I consent to the use of telehealth for my medical care by PRIME Medical Group PLLC
  • ☐ I understand that I may withdraw this consent at any time
  • ☐ I confirm that I am physically located in a state where PRIME Medical Group PLLC is authorized to provide telehealth services
  • ☐ I understand that my health information is protected under HIPAA
  • ☐ I have been given the opportunity to ask questions and have had them answered to my satisfaction

12. Withdrawal of Consent

You may withdraw your consent to telehealth services at any time by notifying PRIME Medical Group PLLC in writing at info@primemedicalhrt.com or by calling (888) 717-7463. Withdrawal of consent will not affect your right to receive in-person care at our Chicago or Tampa Bay locations.

13. Contact Information

For questions regarding telehealth services or this Consent:

PRIME Medical Group PLLC 6547 N. Northwest Hwy Chicago, IL 60631

Tampa Bay Location: 8424 4th Street N, Suite F St. Petersburg, FL 33702

Phone: (888) 717-7463 Fax: (312) 429-1851 Email: info@primemedicalhrt.com Website: primemedicalhrt.com

Business Hours: Monday–Friday, 9AM–5PM CST

This Telehealth Informed Consent was prepared for PRIME Medical Group PLLC. This document should be reviewed by qualified legal counsel licensed in Illinois and Florida to ensure compliance with all applicable federal and state telehealth laws, including the Illinois Telehealth Act and Florida Statute 456.47, prior to publication and use.