This document outlines important information about our services and requests your informed consent for treatment.
A. Virtual Intensive Postpartum Care (VIPC) Services
Phia Health provides comprehensive postpartum care through our VIPC program. This includes:
Regular virtual consultations with maternal health specialists
Mental health screening and support
Physical recovery monitoring
Lactation and nutrition guidance
Care coordination services
Benefits may include improved recovery, better emotional well-being, and enhanced maternal-child bonding. Potential risks include temporary discomfort during physical therapy exercises and discussing sensitive emotional topics.
B. Telehealth Services
1. Technology Requirements
Reliable internet connection
Device with video/audio capability
Private, quiet space for sessions
2. Limitations
Physical examinations are limited
Technical difficulties may occur
Emergency situations require in-person care
3. Emergency Protocol
For medical emergencies, call 911 or go to nearest emergency room
For urgent technical issues, alternate contact methods are provided
Your care team will establish backup communication plans
C. Privacy and Records
1. Confidentiality
All sessions and records are confidential
Information shared follows HIPAA guidelines
Records stored securely for 10 years
2. Disclosure Exceptions
Imminent risk of harm to self/others
Suspected abuse/neglect
Legal requirements
Insurance billing purposes
D. Financial Agreement
1. Payment Responsibility
You are responsible for charges not covered by insurance
Payment is due at time of service
Insurance claims handled by Phia Health
2. Cancellation Policy
24-hour notice required
Late cancellation/no-show fees may apply
E. Patient Rights and Responsibilities
1. Your Rights
Receive respectful, high-quality care
Access your medical records
Refuse any treatment
File complaints/grievances
Confidential communication
2. Your Responsibilities
Provide accurate health information
Follow treatment recommendations
Attend scheduled appointments
Maintain current contact information
Notify us of changes in condition
F. Consent Acknowledgment
By accepting this consent, you confirm:
Understanding of VIPC services, benefits, and risks
Agreement to telehealth service delivery
Acknowledgment of privacy practices
Understanding of financial responsibilities
Receipt of patient rights information
Contact Information
For questions about this consent or to report concerns, contact: