Telehealth Informed Consent
Please read this entire document carefully before receiving telehealth services from IntegrityYou
1. Introduction
IntegrityYou PLLC ("IntegrityYou") is a telemedicine clinic specializing in weight management services for residents of Texas and Massachusetts. This informed consent document explains the nature of telehealth services, the benefits and potential risks involved, and your rights and responsibilities as a patient receiving virtual medical care from IntegrityYou.
What is Telehealth? Telehealth refers to the delivery of medical services through electronic communication technologies, including video conferencing, telephone consultations, and electronic messaging, rather than through in-person office visits.
IntegrityYou's Telehealth Model: IntegrityYou provides weight management consultations, medical evaluations, prescription services, and follow-up care entirely through secure telehealth platforms. Our physicians evaluate your health status, medical history, and weight management goals through virtual consultations and may prescribe appropriate medications based on their professional medical judgment.
About IntegrityYou
Medical Director: Dr. Jane Mattei, MD
Licensed in Texas and Massachusetts
Clinic Manager: Carlos Cano
Website: integrityyou.com
Service Areas: Texas and Massachusetts
Specialization: Weight Management via Telemedicine
2. Nature of Telehealth Services
IntegrityYou offers the following telehealth services:
- Initial Consultations: Comprehensive virtual evaluations including medical history, physical assessment questions, lifestyle review, and weight management goal-setting via secure video conferencing.
- Follow-up Appointments: Regular check-ins with your healthcare provider to monitor progress, assess medication effectiveness, review side effects, and make adjustments to your treatment plan.
- Electronic Prescriptions: Prescription of FDA-approved medications for weight management, including GLP-1 receptor agonists (semaglutide and tirzepatide), sourced from FDA-registered licensed compounding pharmacies when appropriate.
- Remote Monitoring: Assessment of your progress through patient-reported outcomes, vital signs you provide, and periodic communication with your healthcare provider.
- Prescription Refills: Renewal of existing prescriptions based on your continued care and provider assessment.
- Electronic Communication: Secure messaging with clinical staff regarding non-emergency questions or concerns.
3. Benefits of Telehealth
Telehealth services offer several advantages:
- Convenience: Receive medical care from the comfort of your home or any private location without traveling to a physical office.
- Accessibility: Access specialized weight management care regardless of geographic location within our service areas (Texas and Massachusetts).
- Time Efficiency: Reduce time spent commuting and waiting in office waiting rooms.
- Continuity of Care: Maintain regular contact with your healthcare provider for ongoing management and support.
- Flexibility: Schedule appointments at times that accommodate your work and personal schedule.
- Expanded Provider Network: Access to specialists without geographic barriers.
- Reduced Exposure: Minimize exposure to illness in medical office settings.
4. Risks and Limitations of Telehealth
While telehealth offers many benefits, it is important to understand potential risks and limitations:
Technology Failures
Telehealth depends on reliable internet and electronic communication technology. Potential technical issues include:
- Internet connectivity disruptions or poor connection quality
- Video or audio failures during appointments
- Delays in secure messaging systems
- Power outages or equipment failures
IntegrityYou is not responsible for technology failures beyond our control. However, we maintain backup communication methods and will reschedule appointments if technical issues prevent adequate consultation.
Limitations of Remote Medical Examination
Telehealth consultations have inherent limitations compared to in-person examinations:
- Physical examination is limited to visual assessment and patient-reported information
- No ability to perform certain hands-on clinical assessments
- No ability to perform laboratory testing during the appointment
- Reduced ability to assess non-verbal communication and physical findings
- Dependent on patient accuracy in self-reporting symptoms and measurements
Your provider may request that you obtain in-person laboratory work, imaging, or physical examination if deemed medically necessary for your care.
Not Appropriate for Emergencies
Telehealth is NOT an appropriate service for medical emergencies. If you experience any of the following, you must call 911 or go to the nearest emergency room immediately:
- Chest pain or pressure
- Severe shortness of breath
- Severe allergic reactions
- Loss of consciousness
- Severe bleeding
- Thoughts of harming yourself or others
- Signs of stroke (facial drooping, arm weakness, speech difficulty)
- Severe trauma or injury
Other Limitations
- Cannot adequately assess complex acute illnesses
- May not be suitable for patients with severe mental health conditions requiring immediate intervention
- Limited ability to assess medication side effects requiring physical examination
- Patient must be able to communicate clearly and provide accurate information
- Requires patient participation and commitment to the care plan
5. Your Rights as a Patient
As a patient receiving telehealth services from IntegrityYou, you have the following rights:
- Right to Privacy: All patient information will be maintained as confidential and protected under HIPAA and state privacy laws.
- Right to Access Medical Records: You may request copies of your medical records and to receive an explanation of your medical condition and treatment.
- Right to Withdraw Consent: You may withdraw consent for telehealth services at any time and request referral for in-person care.
- Right to In-Person Referral: You may request a referral to an in-person provider at any time for any reason.
- Right to Information: You have the right to receive clear information about your diagnosis, treatment options, risks, and benefits before treatment begins.
- Right to Decline Treatment: You may decline any recommended treatment or medication.
- Right to Ask Questions: You may ask questions about your care, and we will provide clear, understandable answers.
- Right to File a Complaint: You may file complaints with IntegrityYou or with state medical boards regarding your care.
- Right to Know Provider Credentials: You may request information about your provider's medical license, qualifications, and areas of expertise.
6. Your Responsibilities as a Patient
For telehealth services to be effective, you must:
- Provide Accurate Information: Supply honest and complete information about your medical history, current medications, allergies, and health conditions. Failure to disclose relevant medical information may impair diagnosis and treatment.
- Disclose All Medications: Inform your provider of all medications you are taking, including over-the-counter drugs, supplements, and herbal products, as these may interact with prescribed medications.
- Attend Appointments Punctually: Arrive on time for scheduled appointments. Chronic missed appointments may result in discharge from care.
- Follow Medical Advice: Follow your provider's instructions regarding medication use, dosing, and lifestyle recommendations.
- Maintain a Suitable Environment: Ensure you are in a private, quiet location during appointments to protect your privacy and allow for proper consultation.
- Use Appropriate Technology: Ensure your device has adequate camera and microphone function and that you have reliable internet connectivity.
- Comply with Testing Requirements: If instructed to obtain laboratory work, imaging, or in-person examinations, you are responsible for scheduling and completing these services.
- Report Side Effects: Inform your provider promptly of any adverse reactions or side effects from prescribed medications.
- Maintain Contact Information: Keep your phone number and email address current and notify us of any changes.
- Respect Clinic Policies: Comply with all IntegrityYou policies regarding appointment scheduling, payment, and professional conduct.
7. Prescribing Practices and Medication Information
IntegrityYou prescribes FDA-approved weight management medications based on a thorough medical evaluation. The following information applies to all prescriptions issued by our providers:
Medical Evaluation
All medications prescribed by IntegrityYou are based on:
- A comprehensive medical history and review of systems
- Assessment of your current health status and weight management goals
- Discussion of potential benefits and risks of the medication
- Consideration of your specific medical conditions and contraindications
- Professional medical judgment of the treating physician
GLP-1 Receptor Agonists
IntegrityYou may prescribe GLP-1 receptor agonists, including semaglutide and tirzepatide, for appropriate patients with weight management needs. These medications:
- Indication: Are approved by the FDA for chronic weight management and diabetes management
- Mechanism: Work by increasing feelings of fullness, reducing hunger, and improving blood glucose control
- Benefits: Have demonstrated effectiveness in weight loss and metabolic improvement
- Sourcing: Are obtained from FDA-registered licensed compounding pharmacies that meet all regulatory requirements
- Quality: Meet all FDA standards for pharmaceutical quality, safety, and efficacy
Common Side Effects
GLP-1 medications may cause side effects including:
- Nausea or vomiting
- Diarrhea or constipation
- Abdominal pain
- Headache
- Fatigue
- Loss of appetite
Most side effects are mild to moderate and tend to improve over time. You should report any concerning side effects to your provider immediately.
Contraindications and Precautions
GLP-1 medications are not appropriate for all patients. They may not be prescribed if you have:
- Personal or family history of medullary thyroid cancer
- History of multiple endocrine neoplasia type 2
- Severe pancreatitis or history of pancreatic disease
- Severe kidney disease
- Certain types of diabetic retinopathy
- Active suicidal ideation
- Pregnancy or plans to become pregnant
Your provider will assess these contraindications during your initial evaluation.
Physician Discretion
The final decision to prescribe, continue, modify, or discontinue any medication rests solely with your healthcare provider based on their professional medical judgment. Your provider may decline to prescribe requested medications if they determine it is medically inappropriate or unsafe for your individual situation.
Important Medication Information: These medications require ongoing medical supervision. Regular follow-up appointments and communication with your provider are essential for safe and effective treatment. Never start, stop, or change your medication dosage without provider approval.
8. Emergency Situations and Urgent Care
It is critical that you understand when to seek emergency services:
When to Call 911
Seek immediate emergency care if you experience:
- Chest pain, pressure, or tightness
- Severe shortness of breath
- Severe allergic reactions with difficulty breathing or swelling
- Severe or uncontrolled bleeding
- Sudden severe headache
- Signs of stroke or transient ischemic attack
- Loss of consciousness or severe confusion
- Severe trauma or injury
- Thoughts of harming yourself or others
Important: IntegrityYou's telehealth service is NOT an emergency service and CANNOT respond to life-threatening emergencies. If you have a medical emergency, call 911 immediately and do not rely on telehealth communication.
Urgent Non-Emergency Issues: If you have an urgent issue that is not life-threatening (e.g., severe medication side effects, concerning symptoms), contact IntegrityYou immediately by phone at (346)542-8174 or email contato@integrityyou.com. Our staff will prioritize your concern and connect you with your provider if necessary. If we cannot adequately address your urgent concern, we will refer you to an urgent care facility or emergency room.
9. Privacy, Confidentiality, and Data Security
IntegrityYou is committed to protecting your privacy and the security of your medical information.
HIPAA Compliance
IntegrityYou complies with all requirements of the Health Insurance Portability and Accountability Act (HIPAA) and applies the highest standards of privacy protection to your health information. Your medical records are protected and will not be disclosed to any third party without your written authorization, except as required by law.
Secure Communication
All telehealth consultations are conducted through secure, encrypted platforms. Video conferencing, messaging, and data transmission are encrypted to prevent unauthorized access to your information.
Record Keeping
Medical records from your telehealth consultations will be maintained securely and in accordance with state and federal regulations. Records will be maintained for a minimum of 5 years from your last appointment, unless otherwise required by law.
Limits to Confidentiality
Your healthcare provider may be required by law to disclose information in the following situations:
- Suspected abuse or neglect of a child, elder, or dependent adult
- Your intent to harm yourself or others
- Communicable disease reporting requirements
- Court-ordered disclosure
- Workers' compensation or insurance claims as necessary
- Consultation with other healthcare providers for your care
For complete information about privacy practices, please review our Privacy Policy at integrityyou.com/privacy.html
10. Technology Requirements
To participate in telehealth consultations with IntegrityYou, you must have:
- Device: A computer, tablet, or smartphone with a functioning camera and microphone
- Internet Connection: Reliable, high-speed internet connection (minimum 1 Mbps recommended for video)
- Software: A compatible web browser or approved telehealth application
- Location: A private, quiet space where you can speak confidentially without interruption
- Lighting: Adequate lighting so that your provider can see you clearly
- Privacy: Ensure that others cannot view your screen or overhear your conversation
Responsibility: You are responsible for ensuring your technology is functional and secure. IntegrityYou is not responsible for technical issues on your end, including poor internet connection, device malfunction, or software incompatibility. If technical problems prevent adequate communication, we will reschedule your appointment.
11. State-Specific Telehealth Requirements
IntegrityYou operates in Texas and Massachusetts in compliance with state-specific telehealth regulations. The following information applies:
Texas Requirements
- Dr. Jane Mattei, MD, is licensed to practice medicine in Texas
- Telehealth services are provided in accordance with Texas Medical Board telehealth standards
- An appropriate physician-patient relationship is established through the initial telehealth consultation
- Prescriptions are issued under the provider's medical license
- You may verify provider credentials through the Texas Medical Board website
Massachusetts Requirements
- Dr. Jane Mattei, MD, is licensed to practice medicine in Massachusetts
- Telehealth services comply with Massachusetts Board of Registration in Medicine requirements
- An appropriate physician-patient relationship is established through the initial telehealth consultation
- Prescriptions are issued under the provider's medical license
- You may verify provider credentials through the Massachusetts Board of Registration in Medicine
Physician-Patient Relationship
A valid physician-patient relationship is established when:
- You schedule a consultation with IntegrityYou
- You complete the intake process and medical history
- The physician conducts an initial telehealth evaluation
- The physician determines that telehealth is appropriate for your care
This relationship allows the physician to issue prescriptions, provide medical advice, and direct your care through telehealth.
License Verification: You may verify Dr. Jane Mattei's medical license at:
- Texas Medical Board: www.tmb.state.tx.us
- Massachusetts Board of Registration in Medicine: www.mass.gov/dph/boards/rm
12. Recording of Sessions
Please be aware of the following regarding the recording and documentation of your telehealth sessions:
Session Documentation
Each telehealth appointment will be documented in your medical record. Documentation includes:
- Chief complaints and presenting symptoms
- Medical history review
- Assessment of your condition
- Treatment plan and recommendations
- Medications prescribed or adjusted
- Follow-up instructions
Session Recording Policy
Sessions are NOT routinely recorded. However:
- Video conferencing platforms may create secure, temporary buffers of sessions that are automatically deleted
- If your provider deems it medically necessary to record your session for quality improvement or clinical purposes, we will request your explicit written consent before recording
- Any recording would be maintained securely and used only for the purposes for which consent was obtained
- You have the right to decline recording, and declining will not affect your care
Important: You should not record your telehealth appointment without the provider's permission, as this may violate privacy laws and clinic policy. Recording without consent is prohibited.
13. Contact Information and Support
If you have questions about this informed consent, your care, or IntegrityYou's services, please contact us:
14. Your Acknowledgment and Agreement
By clicking "I Agree" to this informed consent or by proceeding with your first telehealth appointment with IntegrityYou, you acknowledge and agree to the following:
I acknowledge that:
- I have read and understand this entire Telehealth Informed Consent document
- I understand the nature, benefits, and risks of telehealth services
- I understand that telehealth has limitations and is not appropriate for emergency situations
- I understand that I have the right to request in-person care at any time
- I understand my rights and responsibilities as a patient
- I understand the prescribing practices and medication information provided
- I understand the privacy protections and limits to confidentiality
- I understand the technology requirements and am responsible for adequate technology
- I will provide accurate medical information and follow medical advice
- I consent to receive telehealth services from IntegrityYou and Dr. Jane Mattei
- I have had the opportunity to ask questions and have received satisfactory answers
By providing your consent through the patient portal or by participating in your first appointment, you certify that you have read this informed consent document, understand its contents, and agree to the terms outlined above.
Consent Acknowledgment
Patient acknowledgment of this consent will be documented in your medical record through one of the following methods:
- Electronic signature through the patient portal
- Verbal acknowledgment documented by IntegrityYou staff
- Implicit consent by participating in the initial telehealth appointment
This consent is effective as of the date of your first appointment with IntegrityYou and remains valid for all future telehealth services unless you withdraw consent in writing.
15. Additional Important Information
Changes to Care Plan
Your healthcare provider may recommend changes to your treatment plan, including medication adjustments or additional testing, based on your progress and response to treatment. You have the right to discuss these recommendations and ask questions before implementation.
Third-Party Involvement
During your telehealth appointment, you should ensure that you are in a private location and that no third parties can observe or hear your consultation. If a third party must be present (such as a caregiver or translator), please inform your provider at the beginning of the appointment.
Medication Interactions
You are responsible for informing your provider of all medications, supplements, and herbal products you are taking. Failure to disclose current medications may result in dangerous drug interactions. Inform your provider immediately if you begin any new medications while under care at IntegrityYou.
Lifestyle Modifications
While medications can support weight management, sustainable results require lifestyle changes including proper nutrition, regular physical activity, and behavioral modifications. Your provider will discuss these recommendations, and your commitment to lifestyle changes is essential for optimal outcomes.
Continuation of Care
Telehealth is intended to provide ongoing management and support for your weight management goals. Regular appointments and communication with your provider are necessary to monitor your progress, adjust treatment as needed, and ensure your safety.
16. Final Statement
IntegrityYou is committed to providing high-quality, professional telehealth services that are accessible, safe, and effective. We value your health and wellbeing and are committed to transparency, professional standards, and regulatory compliance.
This informed consent reflects our commitment to informed decision-making and your right to understand your care. If you have any questions or concerns at any time, please do not hesitate to contact us.
Thank you for choosing IntegrityYou for your weight management care.
Document Version 1.0
Last Updated: February 2025
IntegrityYou PLLC