Vida Telehealth | Care For What Matters To You

OFFICE POLICIES

This document serves as a general overview of our clinic policies at Vida Telehealth. Feel free to clarify any areas of confusion or concern by contacting us directly.

YOUR RIGHTS:

To be treated with dignity and respect at all times.
To access medical care and habilitation regardless of your race, religion, gender, ethnicity, age, or sexual orientation.
To have your treatment and other patient information kept private.
To know about all treatment choices, regardless of the cost, and to participate in the choice of treatment.
To consent or refuse treatment. Consent can be withdrawn at any time. Refusal cannot be sole grounds for termination by the provider.
To obtain a copy of your treatment plan by completing a release form.
To request a Good Faith Estimate for cost of out-of-network care per https://www.cms.gov/nosurprise...

YOUR RESPONSIBILITIES:

To give your provider any information relevant to your care.
To notify your treating provider if or when there are concerts about your treatment plan.
To notify your treating provider of any medication changes, including over the counter medication, medications prescribed for you by other healthcare professionals, and supplements.
To present on time for all scheduled appointments.
To ensure refill requests are made at appointments. If any refills are needed outside of appointment times, 72 hours notice is required.
To act in a mutually respectful manner with all representatives of Vida Telehealth.
To ask your treating provider any questions you may have about your care so that you can better understand your care and your role in it.
To follow your treatment plan and instructions for your care, once that care has been agreed upon by you and your treating provider.
To pay for clinical care fees in full prior to appointment.

APPOINTMENTS:

Services are by appointment only. This time slot has been reserved just for you. In the event of an emergency, every effort will be made to work you into the schedule. It is recommended that you plan to login to your appointment early to avoid being charged.

CANCELLATIONS or LATE ARRIVALS:

Cancellations for non-emergencies must be made 24 business hours in advance. In the event that you need to cancel an appointment on a Monday, cancellation must be done on Friday by 5 PM in order to avoid being charged. Cancellations made less than 24 hours in advance will be charged a $50 fee. If you have incurred this fee, it will be taken automatically from a credit card on file as all patients are expected to keep a zero balance. Follow-up appointments will not be made if there is a balance on your account.

MISSED APPOINTMENTS:

In the event that you need to miss your appointment for a non-emergency, we ask that you notify the office so that we may late cancel your appointment. If you miss your appointment without notifying the office, the card on file will be automatically charged up to the full fee of your appointment. Excessive missed appointments may result in discharge from the practice.

REQUESTS FOR RECORDS:

If you have an appointment with another provider or request medical information for any reason, you must notify Vida Telehealth at least five days before they are needed. This will allow your provider sufficient time to prepare documentation for you. In the event that you need records sooner, a fee may be charged.

BILLING:

Adrian Thompson, PA-C and Vida Telehealth is not currently accepting insurance at this time. A superbill will be provided that you may submit to your insurance for possible "out of network" benefits.

A Good Faith Estimate will be provided to inform you of your cost of care.

PAYMENT POLICY:

Adrian Thompson, PA-C Vida Telehealth, requires payment in full prior to yourappointment. This is auto-charged to the card on file 24 hours prior to your appointment. You are required to keep a credit card on file. Payment may be made in the form of cash, check (to AdrianThompson PA-C ) ACH transfer (bank to bank) or credit card. It is your responsibility to notify the office if the card on file needs to be updated. Any returned checks or failed credit card payments will incur a $25 fee. It is required to have a credit card authorization form and current method of payment on file with our office.

FEES:

Fee structures are subject to change based on the severity of presenting concerts, appointment length, and services provided. The providers at Vida Telehealth have your best interest in mind and alter their scheduling to accommodate meeting your needs. Fees may be added to your account for both direct and indirect patient care for the following purposes listed below. We value you as a patient of the practice and should you have any questions or concerns, please feel free to discuss any pricing or financial issues with us.

Adrian Thompson, PA-C Vida Telehealth will complete applicable forms or paperwork for any patient that has been seen in the last four weeks. There is a $75 fee for paperwork to be completed outsideof your scheduled office visit. We will make every attempt to complete forms during your office visit if time allows for this, but cannot guarantee this can be completed. In the event that these formsrequire more time and resources, additional fees may occur; however, you will be notified prior to being charged. In the event that you need a form completed with less than 72 hours notice, you maybe charged an additional fee. No forms for medical leave or school withdrawal will be completed at a new patient appointment. No school or work accommodation letters are provided.

We value our time with our patients and want to make sure that you are able to discuss what you need during your appointment. Your initial evaluation is generally 60 minutes long and follow-ups are typically 30 minutes. In the event that you need or want additional time, there is a $40 extended service fee for each 15 minutes past your appointment end time if scheduling allows. If there is no time for the extension, an additional follow up appointment may be needed

A provider is available to you 24 hours a day, 7 days a week by phone for urgent matters only. Please note that any issues that require longer than 10 minutes will be charged at a rate of $35 per ten minute interval. If you are in crisis, please call 911 or go to the nearest emergency department.

Fees for speaking or legal depositions will be at the rate of $400 an hour.

CONFIDENTIALITY:

What is shared between you and your provider will be held in strict confidence. Please see the Patient Privacy Notice for more specific details about your Private Health Information. Information will only be shared if the patient has signed a release of information. Please be aware that the following circumstances are exceptions to confidentiality: a) Patient is a physical danger to self b) Patient is a physical danger to others c) Child or elder abuse/neglect is suspected.

TELEMEDICINE:

I understand that telemedicine is different from traditional medicine in that sessions will occur remotely via the HIPAA-compliant video teleconference (VTC) platform Zoom or equivalent (e.g. Doxy.me, Spruce, Virtual Therapy Connect, etc). I am familiar with the technology required for conducting telemedicine sessions and I will conduct all sessions from a private, well-lit location. I understand that some benefits of telemedicine include increased access to medical care and my personal convenience. As with any medical procedure, there are potential risks associated with the use of telemedicine. These risks include, but my not be limited to:In rare cases, information transmitted may not be sufficient to allow for appropriate medical decision making by the provider. Delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment. In very rare instances, security protocols could fail, causing a breach of privacy of personal medical information. In rare cases, a lack of access to complete medical records may result in adverse drug interactions or allergic reaction or other judgment error.

I will not record any session without Adrian Thompson, PA-C’s written permission and I understand that Adrian Thompson PA-C will not record any session without my written permission. I will notify my medical provider of my exact location and identity prior to and at the onset of eachtelemedicine session. Due to federal and state laws, healthcare providers are only able to provide services to patients physically located in states in which they are licensed. AdrianThompson, PA-C is currently licensed to practice in Virginia. As such, patients must be located within the boundaries of these states during the appointments. If a patient presents to an appointment while out of state without sufficient notice, a no-show fee will apply.

I will notify my provider if any other person can hear or see any part of any telemedicine session. It is my responsibility to ensure that my equipment and software are operating properly prior to my appointment.

MESSAGES:

All messages will be returned as promptly as possible. No messages will be checked on weekends or standard holidays. If you need urgent assistance, you may call the provider on call at 571-267-2325. You may incur a fee for phone conversations over 10 minutes in length. In the event of an emergency, call 911 or go to the nearest emergency department fortreatment. Please be aware that providers at Vida Telehealth do not provide inpatient treatment for patients.

PRESCRIPTIONS:

Payment for and completion of a telemedicine session is not a guarantee of a prescription; prescriptions are offered only under appropriate clinical conditions determined by Adrian Thompson, PA-C. Prescriptions will not be ordered or refilled following a missed appointment. Refills will typically be handled during your office visit. No routine prescriptions will be refilled after 5 PM during the week, on weekends, or holidays. Check your medications regularly to be sure that you have enough. We do not respond to prescription requests from the pharmacy. Please call or text our office directly.Please allow 72 hours for prescription refill requests to be processed. If you have any medication questions, please contact the office. If you miss an appointment and need a refill, you will need to be seen prior to a refill being sent to your pharmacy. You are strongly encouraged to have your pill bottles available at each appointment to ensure that you have enough medication. In the event that your refill request is the result of a missed or cancelled appointment, there will be a fee.

CONTROLLED SUBSTANCES:

We prescribe stimulants to some of our ADHD or weight loss patients. We do NOT prescribe any controlled substances such as benzodiazepines (Valium, Xanax, Ativan) or opioids.

COURTESY:

Please provide your full attention during your appointment. If you are not able to provide adequate attention, we reserve the right to reschedule your appointment. Rude or disruptive behavior bythe patient or those accompanying the patient that is directed towards any provider, staff or other people associated with Vida Telehealth could result in termination of the provider-patient relationship.

TERMINATION:

At times, termination between a patient and provider is necessary. Termination of treatment may occur at any time and may be initiated by either the patient or the provider. Reasons for termination by the provider are generally due to non-compliance with treatment, missed appointments, or violation of office policies. In the event that your care needs to be transferred to another provider, Adrian Thompson, PA-C Vida Telehealth will provide assistance as able.

Please feel free to request a copy of this document for your own records if needed.

Thank you,

Adrian Thompson, PA-C

Vida Telehealth