Telehealth/Telemedicine Sample Consent Form

During this COVID-19 pandemic, Medicare and The Department of Health and Human Services (HHS) have approved the expansion of the use of Telehealth/Telemedicine Services. These services are a vital practice that helps to minimize the spread, anxiety, and expense associated with the disease, by allowing residents to be evaluated in their rooms without being transported to the hospital or doctors offices. However, in order to comply with Medicare and HHS requirements concerning these Telehealth services, your facility must adhere to the following:

• The facility must obtain a written or verbal consent from the resident to use Telehealth/Telemedicine services.

• The facility must have a written policy in place for the use of Telehealth/Telemedicine services.

I have drafted a Telehealth/Telemedicine SAMPLE CONSENT FORM AND a Telehealth/Telemedicine SAMPLE POLICY

Below is a Telehealth/Telemedicine Sample Consent Form that you can begin to use for your facility

(*NOTE: I am not a lawyer, this is a sample only. Please have your facility’s legal team review and approve the use of the form before implementation).

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The Telehealth/Telemedicine SAMPLE POLICY is for the members of our Deficiency Free Survey Membership Program.

If you are a member Click HERE to login and download your sample policy.

If you are not a member yet, but would like the policy Click HERE to Join us today!

Be safe and stay well! If you have any comments, questions. or concerns please feel free to contact me at DeficiencyFreeSurvey [at] Gmail.com