Telehealth Medical Consent
Last Updated:
Version: 1.2
Consent to Telehealth
PlexusDx | Care with Lone Star Providers
Please read this document before agreeing to receive telehealth services through PlexusDx and Lone Star Providers. It explains how telehealth works, its benefits and limitations, and your rights and responsibilities. You may ask questions before giving consent.
1. Who provides my care
I voluntarily consent to telehealth care from Lone Star Virtual Health, PLLC and its licensed healthcare professionals, collectively called Lone Star Providers. PlexusDx supports the program, technology, and administrative services. PlexusDx is not the medical practice and does not direct or override my provider’s clinical decisions. My treating provider will be identified to me.
Lone Star is paid for clinical consultations, whether treatment is approved or declined. Provider compensation is not based on issuing a prescription, selecting a product or pharmacy, or the amount I spend. Enrollment, payment, test results, or automated recommendations do not guarantee treatment or a prescription.
2. Telehealth methods and the care relationship
Telehealth may include live video or telephone visits and asynchronous care, where my provider reviews questionnaires, history, photographs, records, or messages after I submit them. I consent to evaluation, clinical communication, and prescribing through these methods when clinically appropriate and permitted by law.
Creating an account or paying alone does not establish a clinical relationship. That relationship begins when a Lone Star Provider undertakes my clinical evaluation or care in accordance with applicable law. My provider may require additional information, testing, a live visit, or examination in person before making a decision.
3. Benefits, limitations, and alternatives
Telehealth can improve access, reduce travel, and make follow up more convenient. It may limit physical examination. Incomplete information, poor image quality, technical problems, or delayed communication can cause missed findings or delayed or incorrect diagnosis. No outcome is guaranteed. I may request care in person or seek another qualified provider. Telehealth does not replace all of my ongoing healthcare needs.
4. Adult eligibility, identity, and accurate information
This program is for adults age 18 or older. I confirm that the patient is at least 18 and that consent is given by the patient or a verified legally authorized representative. I will provide accurate identification, contact information, and physical location and report location changes during an evaluation. My provider must be authorized to practice where I am located.
I will provide truthful, complete health information and promptly correct errors. Missing or inaccurate information, or unresolved identity concerns, may require clarification, delay care, or make telehealth unsuitable. I will ask for help with unclear questions.
Communication, privacy, and follow up
5. Messages and the medical record
Clinically relevant questionnaires, uploaded information, and messages exchanged with the care team become part of my medical record. My provider remains responsible for documenting the evaluation and clinical decisions; my consent does not replace that responsibility.
I will use the patient portal for clinical concerns, follow the agreed care plan, complete recommended follow up or testing, and report new or worsening symptoms. Response times may vary. If I cannot reach the team and my concern cannot safely wait, I will seek local medical care. I may change text or email preferences through the care team or available unsubscribe instructions. Essential care communication may need another method.
6. Technical problems and urgent care
If a connection fails, I will reconnect or contact the care team. My provider may use another appropriate method, reschedule, or direct me to care in person. Messages are not continuously monitored and must not be used for emergencies.
For a medical emergency or immediate danger, I will call 911 or seek emergency care immediately. For a mental health or suicide crisis, I may call or text 988. I will not wait for an online response if symptoms worsen or urgent help is needed.
7. Privacy, security, and the privacy notice
My health information may be transmitted and stored electronically. Safeguards reduce but cannot eliminate risks of unauthorized access, technical failure, or data loss. Information may be used or shared for care, payment, healthcare operations, or other purposes permitted or required by law. Additional authorization will be obtained when required.
Lone Star’s Notice of Privacy Practices explains its handling of health information and my privacy rights. It will be provided separately, with a separate acknowledgment of receipt. I may request access to, correction of, or appropriate transfer of my records. This telehealth consent is not permission for unrestricted disclosure, marketing, or research.
8. Participation and care coordination
I will protect my login and use a private setting when possible. Ordinary texts or email may be less private than the portal. Visit participants will be identified, and my permission will be sought for observers. Recording requires separate disclosure and permission.
I may choose to have a visit summary sent to my primary care clinician or another treating clinician using the sharing preference below. I will provide accurate recipient information. If a prescription is appropriate, I may request a pharmacy of my choice, subject to availability and legal requirements. Any relevant program pharmacy business relationship will be disclosed separately.
My choices and consent
9. Questions, withdrawal, and continuity of care
Participation is voluntary. I may ask questions, request an interpreter or communication assistance, decline treatment, or withdraw consent to future telehealth care by notifying the practice. This does not affect prior care or required record retention. If telehealth becomes unsuitable or care ends, Lone Star will provide appropriate notice and transition guidance consistent with clinical needs and applicable law.
For assistance, records, withdrawal, or complaints, contact the care team through the portal or contact@lonestarvirtualhealth.com. I may also contact the relevant professional licensing board without first contacting the practice. These channels are not for emergencies. I do not waive my legal rights or my provider’s professional responsibilities.
10. Additional consent and financial terms
This document covers telehealth. Any additional consent or disclosures needed for a particular treatment, genetic test, or other procedure will be addressed separately. Fees, subscriptions, refunds, and cancellation terms are also separate. This consent does not authorize recurring charges.
11. Acknowledgment
I have read and understand this document and had the opportunity to ask questions and receive answers. My electronic selections are recorded with my identity, the document version, and the date and time. I may save or request a copy. Telehealth consent applies until withdrawn; additional or renewed consent will be obtained when required.
Telehealth consent
I have read and understand the Consent to Telehealth and voluntarily consent to receive telehealth services from Lone Star Providers.
Privacy notice acknowledgment
I acknowledge receipt of the Lone Star Virtual Health, PLLC Notice of Privacy Practices. This acknowledges receipt, not agreement to additional uses or disclosures.
Visit summary sharing preference
Select one: Share with my named treating clinician; do not share; or I do not have a treating clinician.
If sharing, provide the clinician’s name and secure contact information in the intake. I may change this preference. Other disclosures remain subject to applicable privacy requirements.
Lone Star Virtual Health, PLLC • Version 1.2 • October 5, 2026
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