Please Read Carefully Before Your First Telehealth Visit
This document explains what telehealth is, how it works at DeluxMed, the benefits and risks involved, your rights as a patient, and what to do in an emergency. Your signature at the end of this document confirms your informed consent to receive care via telehealth. You may withdraw this consent at any time without affecting your right to continue care through in-person visits.
1 What Is Telehealth?
Telehealth (also called telemedicine or virtual care) refers to the delivery of healthcare services using electronic communications technologies, including secure video conferencing, telephone consultations, and secure electronic messaging. Telehealth allows you to receive clinical evaluation, diagnosis, treatment, prescriptions, and follow-up care from a licensed healthcare provider without being physically present in the same location.
At DeluxMed Primary & Behavioral Health Services, telehealth services are delivered through Tebra — a HIPAA-compliant, encrypted telehealth and electronic health records platform. Telehealth visits at DeluxMed are conducted by our board-certified clinical team and are subject to the same standards of care as in-person visits.
2 The Tebra Platform
Your telehealth visits will be conducted through Tebra, our secure telehealth and practice management platform. Tebra is a Business Associate of DeluxMed Health Group LLC under a signed Business Associate Agreement (BAA) as required by HIPAA.
2.1 How Tebra Works
Call 443-452-3692 or book online at www.deluxmedhealthgroup.com
A Tebra appointment link arrives by email before your visit. No app download is required.
Click the link on any internet-connected device — smartphone, tablet, or computer.
Your provider joins the private, end-to-end encrypted video session at the scheduled time.
Following your visit, your care plan, any prescriptions, and follow-up instructions are sent securely through Tebra.
2.2 Technical Requirements
No additional software or account creation is required. If you experience technical difficulties before or during your appointment, call us immediately at 443-452-3692.
3 Services Available Via Telehealth at DeluxMed
The following services are available via telehealth at DeluxMed, subject to clinical appropriateness as determined by your provider:
Not all conditions can be safely or effectively managed via telehealth. Situations requiring physical examination, diagnostic testing, or emergency intervention must be addressed in person or at an emergency facility. Your clinical team will advise you if an in-person visit or emergency evaluation is necessary.
4 Benefits of Telehealth
Telehealth offers the following potential benefits:
5 Risks and Limitations of Telehealth
By signing this consent, you acknowledge your understanding of the following risks and limitations inherent to telehealth services:
5.1 Technology-Related Risks
- Video and audio quality may be affected by internet speed, device capability, or network congestion
- Technical failures may interrupt or prevent completion of a session, requiring rescheduling
- Electronic communications, despite encryption, carry inherent security risks not present in face-to-face interactions
- Unauthorized access to electronic devices or networks could potentially compromise your privacy
5.2 Clinical Limitations
- Telehealth does not permit physical examination, which is required for certain clinical assessments and diagnoses
- Some diagnostic tests (blood work, imaging, EKGs, biopsies) cannot be performed via telehealth and will require referral to an in-person facility
- Certain prescriptions, particularly for controlled substances, may require an in-person evaluation under applicable federal and Maryland law
- Clinical findings may be less complete than those obtained during an in-person visit, potentially affecting diagnosis or treatment recommendations
5.3 Privacy Risks
- You are responsible for ensuring you are in a private location where others cannot see or hear your session
- If you use a shared device or network, there is potential for unauthorized access by others who share that device or network
- Screenshots or recordings of sessions by unauthorized parties are prohibited but may not be entirely preventable
5.4 Multi-State Considerations
Telehealth availability depends on your provider's state licensure. DeluxMed providers are licensed in Maryland and may hold licensure in additional states. You must be physically located in a state where your provider is licensed at the time of your telehealth visit. Call 443-452-3692 to confirm availability in your state before scheduling.
6 Your Rights as a Telehealth Patient
You retain all your rights as a DeluxMed patient during telehealth visits. The following rights are specifically relevant to telehealth:
You have the right to refuse telehealth services at any time without penalty. You also have the right to withdraw this consent at any time without affecting your right to receive care through other means. To withdraw consent, notify us in writing or by calling 443-452-3692.
If you prefer an in-person visit at any time for any reason, you have the right to request one. Our Baltimore clinic is located at 1503 E North Ave, Baltimore, MD 21213. In-person visits are by scheduled appointment only.
Your telehealth visit is protected under HIPAA and all applicable Maryland privacy laws. Sessions are not recorded without your explicit consent. Your health information is handled in accordance with our Notice of Privacy Practices.
You have the right to ask questions about any aspect of your telehealth visit, including the technology being used, who may be present during the visit, and how your information will be used.
You have the right to have a support person, caregiver, or interpreter present during your telehealth visit. Please inform your provider at the start of the session if anyone else is present.
You have the right to seek a second opinion or consult with another healthcare provider at any time.
7 Emergency Protocol During Telehealth
MEDICAL EMERGENCY — CALL 911
IF YOU ARE EXPERIENCING A MEDICAL EMERGENCY AT ANY TIME, CALL 911 IMMEDIATELY OR GO TO YOUR NEAREST EMERGENCY ROOM. DO NOT WAIT FOR YOUR TELEHEALTH APPOINTMENT.
If a medical emergency arises during a telehealth visit, your provider will:
Direct you to call 911 or instruct you to proceed to the nearest emergency room immediately
Request your physical location to assist emergency services if needed — always have your address available during telehealth visits
Remain on the call to assist until emergency services arrive, where technically possible
Notify emergency services directly where permitted and appropriate
Your responsibility: Always have your physical address readily available during telehealth sessions. If you are in a location other than your home address, provide your current address at the start of your session.
8 Confidentiality and Privacy
All telehealth visits at DeluxMed are subject to the same confidentiality protections as in-person visits under HIPAA and Maryland law. Your health information will not be disclosed without your authorization except as required by law or permitted by our Privacy Policy.
8.1 Session Recording
No telehealth session will be recorded by DeluxMed without your explicit written consent. You agree not to record any portion of your telehealth session without the prior written consent of your provider. Unauthorized recording may violate Maryland wiretapping and privacy laws.
8.2 Behavioral Health Telehealth Privacy
Telehealth visits involving mental health evaluation, psychiatric medication management, or behavioral health counseling are subject to the enhanced confidentiality protections described in our Privacy Policy, including Maryland Health-General Article §4-307 and, where applicable, 42 CFR Part 2 for substance use disorder services. These protections apply equally to in-person and telehealth delivery of these services.
8.3 Third-Party Presence
Your provider may be accompanied by a student, resident, or supervising clinician during your visit. You will be informed if any such third party is present. You have the right to request that no third party be present during your session.
9 Prescriptions Via Telehealth
Many medications may be prescribed via telehealth following a clinical evaluation. Electronic prescriptions are transmitted directly to your preferred pharmacy.
Controlled Substances — Ryan Haight Act
Federal law (the Ryan Haight Act) and Maryland regulations restrict the prescribing of controlled substances via telehealth without a prior in-person evaluation in most circumstances. Your provider will advise you if an in-person evaluation is required before a controlled substance can be prescribed. Requirements may change based on applicable law at the time of your visit.
10 Insurance and Billing for Telehealth
Most insurance plans accepted by DeluxMed, including Medicare and Maryland Medicaid, cover telehealth visits for primary care and behavioral health services. Telehealth coverage varies by plan and visit type.
- Call 443-452-3692 before your visit to verify telehealth coverage under your specific plan
- Your explanation of benefits (EOB) from your insurer will reflect any cost-sharing obligations
- Self-pay rates for telehealth visits are consistent with our standard self-pay fee schedule
- You will be notified of your expected cost-sharing prior to your appointment
11 Geographic Coverage
Telehealth services are available to patients physically located in Maryland and in any other state where your DeluxMed provider holds an active license at the time of your visit. You must disclose your physical location at the time of each telehealth appointment.
If you are located outside Maryland, please call 443-452-3692 before scheduling to confirm that telehealth services are available in your state. Availability may change as provider licensure status is updated.
12 Contact Information and Questions
If you have questions about this consent, your telehealth visit, or the Tebra platform before or after your appointment, please contact us:
13 Patient Acknowledgment and Consent
By signing below, I confirm and acknowledge that:
- I have read and understood this Telehealth Informed Consent in its entirety.
- I have had the opportunity to ask questions and have received satisfactory answers.
- I understand what telehealth is, how it works at DeluxMed through the Tebra platform, and the technology requirements.
- I understand and accept the benefits, risks, and limitations of telehealth services as described in this document.
- I understand my rights as a telehealth patient, including my right to refuse or withdraw consent at any time.
- I understand the emergency protocol and have my physical address available for all telehealth sessions.
- I understand that my telehealth visits are subject to HIPAA and Maryland privacy laws, and that sessions will not be recorded without my written consent.
- I consent to receive telehealth services from DeluxMed Primary & Behavioral Health Services through the Tebra platform.
- I understand that this consent remains in effect for all future telehealth visits at DeluxMed until I withdraw it in writing.
Patient
Patient Signature
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Patient Printed Name
Date
If patient is a minor (under 18 years of age)
Parent / Legal Guardian Signature
Date
Parent / Legal Guardian Printed Name & Relationship to Patient
Date