TELEHEALTH CONSENT

Wellness Medical Clinic
Operated by: Intellimed Nutritional Systems, LLC
349 Ave. Felisa Rincón de Gautier, Paseo Las Cumbres Shopping Center, Ste 204, San Juan, Puerto Rico 00926
Tel.: 787-244-0145 | 787-738-2871
Official contact channel: Contact Us page form
Effective date: March 18, 2026

  1. INFORMED CONSENT FOR TELEHEALTH

Through this document, THE PATIENT acknowledges, understands, and expressly consents to participate in telehealth, telemedicine, teleservices, audio-only telehealth, clinical video calls, remote communications, and other modalities of remote care that Wellness Medical Clinic and Intellimed Nutritional Systems, LLC may offer or facilitate as permitted by law.

This consent is granted freely, knowingly, voluntarily, and with the understanding that remote care has characteristics, risks, limitations, and scope that differ from those of an in-person consultation.

THE PATIENT acknowledges that this consent applies only to the remote provision of services that the Clinic, through a licensed professional, considers appropriate for the specific case. The existence of technological availability or a remote appointment does not obligate the Clinic or its professionals to provide all evaluation, diagnosis, treatment, follow-up, or intervention through telehealth, nor does it limit their right to require in-person evaluation, additional testing, supplementary documentation, identity verification, or any other step deemed necessary to comply with the law, clinical standards, or prudent patient safety criteria.

The Puerto Rico Department of Health guidance establishes that every consultation must begin with informed telemedicine consent.

  1. SCOPE AND NATURE OF REMOTE SERVICES

Telehealth may include video consultations, audio consultations, specialized platforms, remote tools compatible with distance care, synchronous or asynchronous clinical communication, exchange of information, preliminary evaluation, follow-up, guidance, record review, clinical coordination, and other components that a licensed professional determines appropriate.

HHS confirms that telehealth services provided by covered entities must comply with HIPAA and that the technologies used must be handled in accordance with privacy and security rules.

THE PATIENT understands and accepts that the clinical scope of a remote session may vary depending on the nature of the issue, the quality of the connection, the available information, the professional’s ability to adequately evaluate the case, and the limitations inherent to the remote medium.

The Clinic does not guarantee that all health matters can be managed through telehealth, nor that a remote consultation will be sufficient to establish, maintain, or modify a complete clinical strategy without additional in-person evaluation when such evaluation is necessary, prudent, or legally appropriate.

  1. NO GUARANTEE OF AVAILABILITY, SUFFICIENCY, OR CLINICAL APPROPRIATENESS

THE PATIENT acknowledges that the availability of telehealth does not imply that this modality is always appropriate, sufficient, or preferable for their condition.

The Clinic and the treating professional retain full discretion to determine whether a remote interaction is clinically appropriate, whether it should be interrupted, whether it requires transition to an in-person modality, whether it should be limited to specific matters, or whether, for medical, technological, regulatory, or safety reasons, it should not continue under a remote modality.

THE PATIENT accepts that no representation on the website, in messages, forms, calendars, advertisements, service pages, or preliminary communications constitutes a guarantee that the case can be fully evaluated or managed through telehealth.

Any decision by the professional or the Clinic to not continue remotely, to require in-person evaluation, or to modify the scope of the interaction shall be binding, reasonable, and shall not in itself constitute breach, negligence, or failure of service.

  1. PRIVACY AND SECURITY RISKS

THE PATIENT acknowledges that, although the Clinic will implement reasonable and prudent safeguards to protect the privacy and security of information during remote services, all telehealth technology carries inherent risks, including connection failures, unauthorized access, human error, platform unavailability, third-party vulnerabilities, unintentional exposure by the patient, device misconfiguration, use of unsecured networks, visibility by third parties in the patient’s physical environment, and other residual risks.

HHS maintains that telehealth services provided by covered entities must comply with HIPAA privacy, security, and breach notification rules.

THE PATIENT further understands that part of the protection of their information depends on circumstances under their own control, including the security of their phone, computer, network, accounts, credentials, email, video platform, physical environment, use of headphones, visible notifications, and third-party access to their device.

To the maximum extent permitted by law, the Clinic shall not be responsible for disclosures, access, or exposures predominantly caused by the patient’s own configuration, environment, or negligence, nor for risks associated with technologies or infrastructures outside the Clinic’s reasonable control.

  1. LIMITATIONS OF DIAGNOSIS AND REMOTE EVALUATION

THE PATIENT acknowledges and accepts that telehealth may limit the professional’s ability to perform a complete physical examination, comprehensive clinical observation, direct measurements, reliable vital sign collection, palpation, auscultation, immediate intervention, access to real-time diagnostic testing, or full verification of the environment and certain clinical findings.

These limitations may affect the accuracy, depth, timeliness, or sufficiency of the remote evaluation and may require in-person examinations, laboratory testing, imaging, referrals, or additional follow-up.

The Puerto Rico Department of Health has indicated in its guidance that each telemedicine consultation must take into account the privacy and confidentiality of protected information and that the physician must personally conduct patient screening to identify condition, urgency, and severity, without delegating it to administrative staff.

Accordingly, THE PATIENT accepts that a remote session may not allow for a definitive diagnosis, complete management, or safe intervention, and that the treating professional may limit conclusions, defer decisions, require additional information, or refer to in-person care without this constituting negligence, breach, or service failure.

  1. PATIENT IDENTITY, LOCATION, AND ENVIRONMENT

As an essential condition for the provision of telehealth services, THE PATIENT agrees to provide truthful and current information regarding their identity, physical location at the time of the session, backup contact number, emergency information when requested, and any other information that the Clinic or the treating professional considers necessary for safety, compliance, and proper case management.

Telehealth in Puerto Rico is governed by the Law for the Use of Telemedicine in Puerto Rico, as indicated by the Department of Health.

THE PATIENT acknowledges that physical location during a remote session may have clinical, operational, emergency, professional licensing, or referral relevance.

If THE PATIENT fails to disclose their real location, provides false or incomplete information, or moves to another jurisdiction without informing the Clinic, the Clinic may suspend, limit, or terminate the session and shall not be responsible for complications, delays, or inability to manage the case resulting from such omission or misrepresentation.

  1. DO NOT USE TELEHEALTH AS A SUBSTITUTE FOR EMERGENCY CARE

THE PATIENT acknowledges that telehealth does not substitute emergency services, urgent in-person intervention, or hospital evaluation when circumstances require it.

Although a remote session may serve for guidance or management in certain contexts, it is not designed to replace immediate care in high-risk events, acute deterioration, respiratory distress, severe pain, loss of consciousness, suicidal ideation, severe reactions, acute neurological symptoms, or other emergencies.

If during a remote session the professional determines that the case requires immediate attention, or if THE PATIENT experiences emergency symptoms before, during, or after the interaction, THE PATIENT must call 911, go to the nearest emergency room, or seek immediate in-person medical care.

THE PATIENT agrees that the Clinic shall not be responsible for damages, worsening conditions, loss of therapeutic opportunity, or adverse consequences resulting from the improper use of telehealth as a substitute for emergency care.

  1. TECHNOLOGY, CONNECTION FAILURES, AND CONTINUITY OF SERVICE

THE PATIENT acknowledges that the provision of telehealth depends on devices, software, electrical power, internet, audio, video, third-party platforms, account configurations, updates, and other technological elements that may fail, degrade, be interrupted, or become incompatible.

HHS has issued specific guidance on audio-only telehealth and on the use of remote technologies consistent with HIPAA, including considerations after the end of pandemic enforcement discretion.

The Clinic does not guarantee uninterrupted connection, consistent audio/video quality, perfect synchronization, or full continuity of remote service.

THE PATIENT agrees that if technology fails or proves insufficient, the Clinic may interrupt, reschedule, convert the session to another modality, or require an in-person visit.

To the maximum extent permitted by law, the Clinic shall not be responsible for failures attributable to internet providers, third-party platforms, patient devices, insecure networks, outdated software, local configurations, or similar events outside its reasonable control.

  1. PATIENT RESPONSIBILITIES DURING TELEHEALTH

THE PATIENT agrees to connect from a reasonably private, secure, and appropriate environment; to use a functional device; to maintain their credentials and equipment protected; not to allow the presence of unauthorized third parties without disclosure; to follow reasonable technical and clinical instructions; and to cooperate in good faith during the remote session.

THE PATIENT also agrees not to record, retransmit, intercept, publish, or share the session or its components without prior written authorization from the Clinic, unless a non-waivable law provides otherwise.

THE PATIENT acknowledges that lack of cooperation, bad faith, delay, connection from insecure environments, use of deficient equipment, lack of privacy, interruptions attributable to the patient, or failure to follow reasonable instructions may affect the safety, quality, or clinical usefulness of the session.

The Clinic may document such incidents, limit the scope of care, or suspend the service if it determines that the patient’s environment or conduct prevents a prudent or legally compliant remote provision.

  1. CONSENT FOR COMMUNICATIONS AND RELATED PLATFORMS

THE PATIENT authorizes the use of video platforms, audio systems, secure messaging, portals, access links, electronic reminders, scheduling systems, and technologies reasonably necessary to facilitate telehealth, subject at all times to the Clinic’s applicable policies and legal documents.

HHS indicates that technologies used by covered providers for telehealth must comply with HIPAA.

THE PATIENT acknowledges that different stages of the remote process may involve the use of third-party tools for scheduling, access, confirmation, intake, payment, session links, support, or communication.

The Clinic will seek to select and configure such tools prudently; however, the patient accepts that the use of third-party technology providers is inherent to remote operations and that the Clinic does not guarantee the internal functioning or independent policies of each provider beyond its reasonable efforts of selection, configuration, and compliance.

  1. RECORDS, DOCUMENTATION, AND USE OF INFORMATION

THE PATIENT authorizes that information shared during telehealth, including identifying data, clinical information, observations, documents, messages, access histories, connection logs, and other relevant information, may be used, stored, and protected by the Clinic in accordance with the HIPAA-level Privacy Policy / Notice of Privacy Practices, the Terms and Conditions, and other applicable documents.

HIPAA establishes national standards to protect individually identifiable health information.

The Clinic may document the remote session in the clinical record, retain operational metadata, and preserve evidence related to access, payments, consent, connection, continuity, failures, or disputes for purposes of compliance, security, legal defense, billing, response to chargebacks, and operational continuity.

Nothing in this consent requires the Clinic to record sessions; if any recording is legally permitted and operationally necessary, it must be handled in accordance with the applicable framework and any additional required consent.

  1. PAYMENTS, PREPAYMENTS, RESCHEDULING, AND NO-SHOWS IN TELEHEALTH

THE PATIENT acknowledges that telehealth sessions may be subject to advance payment, no-show policies, cancellations, rescheduling, non-refund rules, and other administrative policies in effect at the Clinic.

The fact that care is remote does not eliminate the reservation of clinical time, allocation of resources, administrative coordination, or operational costs associated with scheduling and case preparation.

Accordingly, THE PATIENT agrees that any dispute regarding charges, refunds, no-shows, cancellations, or perceived quality of the remote format shall be governed by the Terms and Conditions, the Payment & Refund Policy, and the Clinic’s anti-chargeback provisions.

The patient’s inability to connect due to causes attributable to their device, network, environment, or lack of preparation does not obligate the Clinic to issue a refund, credit, or automatic repetition of the session, unless the Clinic decides otherwise at its sole discretion.

  1. NO GUARANTEE OF RESULTS AND NO RELIANCE

THE PATIENT acknowledges that telehealth does not guarantee clinical results, definitive diagnoses, specific improvements, uninterrupted continuity, permanent eligibility, treatment approval, future availability, or an experience equivalent in all respects to in-person care.

Any clinical outcome will depend on multiple factors, including the nature of the case, the sufficiency of the information, patient adherence, individual biological response, and the need for additional studies or in-person care.

THE PATIENT expressly agrees that they will not rely on the mere availability of telehealth or on the occurrence of a remote session as a guarantee of complete clinical management.

The PATIENT also agrees that they will not reasonably claim that the remote modality, by itself, implied a promise of results, an obligation to resolve the case remotely, or an automatic substitution for tests, physical examination, or other clinically necessary in-person components.

  1. LIMITATION OF LIABILITY

To the maximum extent permitted by the laws of the Commonwealth of Puerto Rico and the United States, any claim related to telehealth, audio-only telehealth, remote platforms, video calls, electronic communications, technological failures, remote privacy, diagnostic limitations, session continuity, rescheduling, connectivity, or remote management shall also be subject to the limitations of liability established in the Clinic’s Terms and Conditions, including any validly agreed monetary limitation and exclusion of indirect, incidental, special, punitive, or consequential damages.

THE PATIENT expressly acknowledges that the Clinic assumes a duty of reasonable and prudent care in the provision of telehealth, not an absolute guarantee of technological perfection, uninterrupted continuity, exhaustive remote diagnosis, or total absence of risk.

This consent constitutes a material allocation of risk between the parties and shall be interpreted, to the maximum extent permitted by law, in favor of the reasonable protection of the Clinic against claims based on inherent limitations of the remote medium or on circumstances outside its reasonable control.

  1. INDEMNIFICATION, IMPROPER USE, AND DEFENSE OF THE CLINIC

THE PATIENT agrees to indemnify, defend, and hold harmless the Clinic, Intellimed Nutritional Systems, LLC, and its directors, officers, physicians, employees, agents, contractors, affiliates, and representatives from and against claims, losses, costs, damages, disputes, or expenses, including reasonable attorneys’ fees, arising from false information provided by the patient, concealment of location, improper use of platforms, unauthorized recordings, participation of undisclosed third parties, failure to follow reasonable security instructions, or any improper use of the remote modality.

The Clinic shall retain all remedies available at law or in equity, including suspension of access, mandatory rescheduling to in-person modality, session cancellation, collection of amounts owed, injunctive relief, damages, and attorneys’ fees where applicable.

Nothing in this consent limits the Clinic’s right to preserve evidence, suspend the service, or take immediate action if a patient’s conduct threatens the security, privacy, operational integrity, or legal position of the Clinic.

  1. REVOCATION OF CONSENT AND CLINIC’S RIGHT TO SUSPEND

THE PATIENT may prospectively revoke this telehealth consent by providing reasonably clear notice to the Clinic, using the Contact Us form or the channel designated by the Clinic.

Revocation shall not affect actions already validly performed based on this consent, shall not invalidate clinical documentation already created, and shall not obligate the Clinic to delete information that must be retained by law, for compliance, for recordkeeping, or for legal defense.

The Clinic, in turn, may suspend, deny, or terminate the remote modality at any time if it reasonably determines that there is clinical risk, technical risk, lack of verifiable identity, lack of privacy, abusive conduct, patient non-compliance, improper use, relevant diagnostic limitations, legal restrictions, or any other circumstance that makes it imprudent to continue via telehealth.

Such determination shall not, by itself, constitute breach, discrimination, or negligence, provided that it is based on reasonable criteria of safety, law, or clinical judgment.

  1. EXPRESS ACKNOWLEDGMENT AND ACCEPTANCE BY THE PATIENT

By selecting “Accept,” “I Consent,” “Continue,” “Book Telehealth,” “Proceed,” “Submit,” or any equivalent button, THE PATIENT acknowledges, understands, and expressly agrees that:

(1) they are consenting to receive services via telehealth when the Clinic and the treating professional consider it appropriate;
(2) the remote modality involves privacy and technology risks;
(3) telehealth has inherent diagnostic and clinical limitations; and
(4) remote care does not substitute in-person evaluation when such evaluation is necessary.

THE PATIENT further agrees that they have had a reasonable opportunity to read this consent, that they understand its material terms, that they may ask questions before consenting, and that their acceptance constitutes informed, voluntary, binding, and legally enforceable consent to the maximum extent permitted by law.

  1. UPDATE, INTEGRATION, AND SURVIVAL

The Clinic may update this consent to reflect technological, regulatory, operational, or clinical changes, and may integrate it with other legal documents, including Terms and Conditions, HIPAA-level Privacy Policy / NPP, AI Disclaimer, WhatsApp / Messaging Consent, and Payment & Refund Policy.

Provisions regarding limitation of liability, indemnification, preservation of evidence, payments, non-refunds, dispute resolution, and other compatible protections shall remain in effect according to their nature.

The temporary absence of a visible copy on a specific page, or a technical display error, shall not constitute a general waiver of the protections of this consent.

The Clinic may request new acceptance when it deems it prudent. Continued use of telehealth after publication of an updated version may constitute acceptance of the new version, to the extent permitted by law.

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