Patient Consent/ Acknowledgement

The undersigned patient, hereby consent to receive in-home medical services provided by The Care Team Primary Care Providers.

I understand that these services may include, but are not limited to, medical assessments, evaluations, treatments, medication management, and other necessary medical care provided by licensed medical providers and healthcare professionals.

I acknowledge that:

1. I have been informed that in-home medical services carry certain risks, including, but not limited to, potential injury, complications, or adverse reactions to treatments.
2. .I have been given the opportunity to ask questions and have received satisfactory answers regarding the nature and purpose of the in-home medical services.
3. I understand that I have the right to refuse any recommended treatment or service and that it is my responsibility to communicate my preferences and concerns to the healthcare provider.
4. I authorize The Care Team Primary Care Providers to access and exchange my medical information with other healthcare providers involved in my care, as necessary for treatment, payment, or healthcare operations, including referrals to specialists.
5. I consent to payment authorization coverage and assignment of medical insurance benefits directly to The Care Team Primary Care Providers for services rendered.
6. I have received and reviewed the Notice of Privacy Practices provided by The Care Team Primary Care Providers and understand my rights regarding the privacy of my protected health information (PHI).
7. I consent to the use of photography or videography for the purpose of documenting my medical condition or treatment progress, understanding that my identity will be protected and such materials will only be used for medical purposes.
   
   HIPAA Disclaimer:
   The Care Team Primary Care Providers strictly adheres to the guidelines set forth by the Health Insurance Portability and Accountability Act (HIPAA). We are committed to protecting the privacy and security of your health information. Your PHI will only be used or disclosed as permitted under applicable federal and state laws, including for treatment, payment, and healthcare operations purposes.
   
   By signing this form, I confirm that I have read, understood, and agree to the above terms.