The purpose of consent forms is to document that a discussion took place and that the patient was informed and was able to understand the information provided.

Before the consent discussion

  • Mail or use your patient portal to send the form in advance, so patients can review it ahead of time.
  • Arrange for a qualified interpreter if your patient does not speak English very well. Use the interpreter for the entire consent discussion.

During the consent discussion

  • Use the consent form as a checklist to make sure you discussed all the information required by informed consent rules.
  • Use easy-to-understand language.
  • Use the teach-back method to confirm patient understanding.
    • Document teach-back with the Telehealth Consent Teach-back Documentation sheet (Word, 19 KB).
    • Start with a phrase like, “It’s my job to explain things clearly. To make sure I’m doing a good job, I ask every patient to tell me what you understand about telehealth and how it might help you.”
    • “Chunk and Check.” Don’t wait until the end to start teach-back. Chunk out information into small segments and have your patient teach it back. For example, ask patients, “Could you tell me in your own words what will happen to you if you decide you don’t want a telehealth visit?” Repeat several times during the discussion.
    • Clarify and check again. If teach-back uncovers a misunderstanding, explain things again using a different approach. Ask patients to teach-back again until they are able to correctly describe the information in their own words. If they parrot your words or read the form back to you, they may not have understood.

Before asking patients if they agree to a telehealth visit

  • Ask patients if they have questions. You could say, “We covered so much information, I’m sure you have questions. What would you like to hear more about?”
  • Avoid asking questions that will elicit yes and no answers, such as, “Do you have any questions?” and “Do you understand?”
  • Offer to read the form aloud to all patients. For example, you could say, “I’d like to read aloud a summary of our talk about telehealth.”

After the consent discussion, document it

  • Document patients’ ability to teach the information back correctly in the medical record.
  • If patients do not consent, note it in their medical records.
  • If patients consent:
    • Mail them a copy of the consent form to keep.
    • Obtain patients’ consent verbally and note it in the medical record. If you need a signed form, use your patient portal or the mail to get a signature.
      • If patients can sign the consent form in your patient portal, ask whether they are able to access the portal. If they are, direct them to staff who can walk them through how to consent online.
      • If patients can’t use the patient portal, mail consent forms (one to sign and return, one to keep) and a stamped return envelope, and ask patients to sign and mail back the form.
      • You do not need to wait to get a consent form signed. You can have telehealth visits with your patients based on their giving their consent verbally.

Telehealth Consent Teach-back Documentation

Name of Patient: _____________________________________________ Date: _____________

Name of Clinician: _____________________________________________________________

Name of Interpreter: ___________________________________________________________

(If patient does not speak English very well, use an interpreter)

 Was the patient able to teach-back the information in their own words?
 1st attempt2nd attempt3rd attempt4th attempt
What telehealth is Yes No Yes  No Yes  No Yes  No
How telehealth could help (benefits) Yes  No Yes  No Yes  No Yes  No
How telehealth could be bad (harms and risks) Yes  No Yes  No Yes  No Yes  No
Privacy of telehealth (risks) Yes  No Yes  No Yes  No Yes  No
Alternative of office visit (options) Yes  No Yes  No Yes  No Yes  No
Ability to withdraw consent (no penalty) Yes  No Yes  No Yes  No Yes  No
Cost Yes  No Yes  No Yes  No Yes  No
Obligation to sign (voluntariness) Yes  No Yes  No Yes  No Yes  No

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