# Telehealth and Remote Care Consent Template

> **Customization required.** This template is provided for policy operations and counsel review. Replace every `NEXQ-reviewed value`, verify every factual statement, and confirm applicability before publication. The template is not legal advice and does not create an attorney-client relationship.

**Effective date:** September 18, 2024  
**Last updated:** September 18, 2024  
**Owner:** NEXQ privacy, security, and legal operations  
**Applies to:** NEXQ websites, web applications, protected workspace surfaces, mobile app surfaces, APIs, secure healthcare and healthtech workflow demonstrations, quantum encryption, diagnostics, oncology, longevity, research collaboration, support, and related services

This template supports telehealth workflows enabled by NEXQ but must be customized by licensed healthcare providers.

## 1. Telehealth description
Telehealth may involve video, audio, asynchronous messaging, remote monitoring, patient-generated data, AI-assisted documentation, and electronic records. The provider remains responsible for clinical care.

## 2. Consent
By using telehealth, patients consent to receive services through electronic communications, subject to provider policies and state law. Consent may be withdrawn, but withdrawal may affect telehealth availability.

## 3. Risks and limitations
Telehealth may involve technology failures, privacy risks, incomplete information, delays, and limitations compared with in-person care. Emergency services should be contacted for emergencies.

## 4. Privacy
Telehealth information may be used and disclosed under the provider’s Notice of Privacy Practices, consent forms, HIPAA, state law, and payer requirements.

## 5. Patient responsibilities
Patients should provide accurate information, use a private location where possible, secure their device, and seek emergency care when needed.