1. Nature of telehealth
Your visit may be with Nicholas Atudonyang, MD, or a Texas-licensed nurse practitioner who works with him under a prescriptive authority agreement; you will be told your clinician's name and credentials before or at the start of the visit. Telehealth allows a clinician and patient in different locations to exchange medical information and provide care using electronic communications. Americare Telehealth visits are scheduled appointments conducted by telephone (audio) or audio-video. Electronic messages, if offered, are used only for scheduling and administrative follow-up and do not replace a visit.
2. Age, location, and identity
You must be at least 18 years old and physically located in Texas at the time of each visit. You agree to provide your true identity, date of birth, current physical location, and accurate contact information, and to confirm your location at the start of each visit. We may ask you to verify your identity.
3. Phone visits and video visits
Telehealth refill evaluations are ordinarily conducted by secure video using Google Meet. Your clinician may recommend a different clinically appropriate method or an in-person evaluation when necessary to meet the standard of care.
4. Medication history, laboratory results, imaging, and relevant medical records
Safe prescribing may require information beyond what you can recall during the visit. By consenting, you give Americare Telehealth permission to obtain, access, review, and exchange health information reasonably necessary to evaluate and treat you. This may include your current and prior medication list, pharmacy dispensing or fill history, prior prescriptions, allergies, relevant diagnoses, laboratory results, imaging reports, and other medical records related to the care you are requesting.
For these purposes, Americare Telehealth may contact or request information from your pharmacy; primary care physician; current or prior prescribers; laboratories, including Labcorp and Quest Diagnostics; hospitals; urgent care centers; imaging centers; and other health care providers involved in your care. Where available and permitted, we may also use secure electronic prescribing networks, medication-history services, health information exchanges, laboratory portals, or other health-information systems used by health care providers.
We may use this information to confirm the medication and dose, identify duplications or interactions, review allergies and prior treatment, determine whether monitoring is current, assess whether a refill is clinically appropriate, coordinate follow-up, and support continuity of care.
Limits and your choices.
- This permission is limited to information reasonably related to your evaluation, treatment, medication safety, and care coordination. It is not a blanket request for unrelated records.
- Information we obtain may become part of your medical record and is protected as described in our Notice of Privacy Practices.
- Some information has additional legal protections. If a source requires a separate written authorization before releasing particular records, including specially protected records, we will ask you to complete the authorization that is required.
- Access is not guaranteed. A pharmacy, laboratory, hospital, or other provider may require its own process, may not participate in an electronic network, or may be unable to release information immediately. You may be asked to obtain or securely upload a copy yourself, including results from a Labcorp, Quest, hospital, or imaging patient portal.
- You may ask us not to contact a particular provider or source, and you may withdraw this permission in writing for future requests. A restriction or withdrawal does not affect information already obtained or actions already taken, and your clinician may be unable to prescribe or refill safely if information considered necessary for care cannot be verified.
5. Benefits
Potential benefits include improved access to care, convenience, and reduced travel. Telehealth allows review of your history, medications, home readings, laboratory results, photographs, and other clinically relevant information.
6. Risks and limitations
A remote examination may not provide all the information available during an in-person examination. Technology can fail, audio or video can be interrupted, and security risks cannot be eliminated completely. Your clinician may decide that telehealth is not appropriate and may recommend in-person evaluation, testing, urgent care, an emergency department, or another clinician.
7. Standard of care and prescribing
Telehealth does not lower the standard of care. Any prescription must be for a legitimate medical purpose and clinically appropriate based on the information available. A telehealth visit does not guarantee that a medication will be prescribed, renewed, changed, or continued.
8. Refill service scope
The refill service is intended for selected established, non-controlled maintenance medications when telehealth review is appropriate. Controlled substances and other excluded medication categories are not provided through this service.
9. Follow-up care
At the end of your visit, your clinician will give you guidance on appropriate follow-up care, such as when to have labs or readings checked, when to see your primary care physician, and what symptoms need prompt attention.
10. Sharing your visit with your primary care physician
If you have a primary care physician and you agree, we will send a report of your visit, including the assessment and any treatment, to that physician within 72 hours after your visit. You will make this choice in our intake (see the end of this page).
You can change this choice at any time by contacting us.
11. Records and privacy
Information from your visit becomes part of your medical record. We handle protected health information according to applicable law and our Notice of Privacy Practices. Please take your visit from a private location and avoid public or unsecured networks when possible.
12. Communications
Appointment reminders and administrative messages may be sent by phone, text, or email using the information you provide. Standard text and ordinary email may not be secure. Do not send detailed health information, including photos of prescription labels, through text or ordinary email; use the secure intake instead.
13. Emergencies
Americare Telehealth is not an emergency service. If you have chest pain, severe shortness of breath, stroke symptoms, a severe allergic reaction, severe abdominal pain, thoughts of suicide, or another emergency, call 911 or go to the nearest emergency department. You can also call or text 988 for crisis support.
14. Alternatives and your right to withdraw
You may choose in-person care with another provider instead of telehealth. You may ask questions about telehealth before or during the visit. You may withdraw your consent at any time before services are provided; withdrawal does not affect care already delivered or records already created.
15. Your responsibilities
- Provide complete and accurate medical, medication, allergy, pharmacy, and contact information.
- Provide relevant records, home readings, prescription-label photos, or laboratory results when requested.
- Tell your clinician if your symptoms change or if you believe you need urgent or emergency care.
- Follow instructions for follow-up, testing, or in-person evaluation.
16. Complaints
You may raise concerns with us at 469-952-8052 or info@americaretelehealth.us. You may also contact the Texas Medical Board (physicians) or the Texas Board of Nursing (nurse practitioners):
NOTICE CONCERNING COMPLAINTS
Complaints about physicians, as well as other licensees and registrants of the Texas Medical Board, including physician assistants, acupuncturists, surgical assistants, medical radiologic technologists, non-certified radiologic technicians, respiratory care practitioners, medical physicists, and perfusionists may be reported for investigation at the following address:
Texas Medical Board, Attention: Investigations, 1801 Congress Avenue, Suite 9.200, P.O. Box 2018, Austin, Texas 78768-2018.
Assistance in filing a complaint is available by calling the following telephone number: 1-800-201-9353.
For more information please visit our website at www.tmb.state.tx.us.
AVISO SOBRE LAS QUEJAS
Quejas sobre médicos, así como sobre otros profesionales médicos de la Junta Médica de Texas, incluyendo asistentes médicos profesionales, acupunturistas, asistentes quirúrgicos, tecnólogos médicos en radiología, técnicos radiólogos no certificados, profesionales de cuidados respiratorios, físicos médicos, y perfusionistas se pueden presentar en la siguiente dirección para ser investigadas:
Texas Medical Board, Attention: Investigations, 1801 Congress Avenue, Suite 9.200, P.O. Box 2018, Austin, Texas 78768-2018.
Si necesita ayuda para presentar una queja, llame al: 1-800-201-9353.
Para obtener más información, visite nuestro sitio web en www.tmb.state.tx.us.
Complaints about nurse practitioners
Complaints about nurse practitioners and other nurses may be reported to the Texas Board of Nursing, 1801 Congress Avenue, Suite 10-200, Austin, Texas 78701. Phone: (512) 305-7400 (enforcement: 512-305-6838). Email: complaints@bon.texas.gov. Website: www.bon.texas.gov.
Intake acknowledgment and consent
In our secure intake you will complete the following. The required box and the primary care physician choice must be completed before your first visit.
Required — care and policy acknowledgment
- ☐ I am 18 or older and will be physically located in Texas during my visit. I acknowledge that I received or had the opportunity to review Americare Telehealth's Notice of Privacy Practices and Telehealth Consent, and I agree to the Terms of Service and Cancellation & Refund Policy. I consent to receive telehealth care, ordinarily by secure video, from Family Medicine and Research Center, PA d/b/a Americare Telehealth, including care from a physician or a nurse practitioner working under a prescriptive authority agreement. I understand that a prescription or refill is never guaranteed and will be issued only when clinically appropriate.
Required — clinical records and care-coordination permission
- ☐ I give Americare Telehealth permission to obtain, access, review, and exchange health information reasonably necessary for my care, including my medication and pharmacy history, prior prescriptions, laboratory results, imaging reports, and relevant medical records. This may include contacting my pharmacy, primary care physician, current or prior prescribers, Labcorp, Quest Diagnostics, hospitals, imaging centers, and other treating providers, and using secure electronic prescribing or health-information networks where available and permitted. I understand that this permission is limited to information reasonably related to my care, that some records may require a separate authorization, and that I may restrict or withdraw this permission for future requests as described in section 4.
Required choice: visit report to my primary care physician (see section 10)
- ◯ Yes, send a report of each visit to my primary care physician.
- ◯ I do not have a primary care physician.
- ◯ No, do not send a report.
Optional
- ☐ Send me appointment reminders and scheduling messages by text. Message and data rates may apply. Reply STOP to opt out.
Only if you have a health plan we participate with and choose not to use it
- ☐ I choose to pay the self-pay price for this visit and ask Americare Telehealth not to bill my health plan or share information about this visit with my plan for payment.
Patient name: ____________________ Date of birth: __________
Electronic signature: ____________________ Date and time: __________
These fields are completed in our secure intake, not on this web page. We keep a record of your responses and the version of each document in effect when you agreed.