The laws that protect the confidentiality and privacy of medical information also apply to Virtual Visits. No information obtained in the use of a Virtual Visit that identifies you can be disclosed to researchers or other entities without consent. 

You have the right to withdraw your consent to the use of a Virtual Visit in the course of your care at any time, without affecting your right to future care or treatment. 

In the event that any potential ethical concerns or issues come up as a result of a Virtual Visit, you can make a formal complaint to Tia’s HIPAA compliance officer.

You understand that you may expect the anticipated benefits from the use of a Virtual Visit in your care, but that no results can be guaranteed or assured.

You understand there are potential risks with the use of technology in your medical care that include but are not limited to interruption or disconnection of the Zoom link, a picture that is not clear enough to meet the needs of the visit, and/or electronic tampering. If any of these risks occur, the procedure might need to be stopped and you can reach out to your Tia Care Coordinator for further instructions or call the Tia Clinic directly at 332-203-0933.