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Conditions for Treatment

Important consents and responsibilities every patients should know.

Treatment Telehealth Valuables Financial Responsibility Benefits Assignment Communications

This page explains patient understanding and consent to healthcare services and medical treatment provided by ChristianaCare. This information is available as a downloadable PDF via the following language options:

Any reference to “ChristianaCare” in this consent means the ChristianaCare hospitals, medical providers, and other facilities which are part of Christiana Care Health System, Inc. If I am the patient receiving treatment, I consent to the terms listed below, unless they are withdrawn in writing, and understand my financial responsibilities for the treatment provided. If I am the parent, guardian, custodian, or temporary caregiver of the patient (“Patient Representative”), I consent to the terms below, unless they are withdrawn in writing, and I will pay or facilitate payment or, where legally authorized, arrange for payment for the treatment provided. The “Patient” means me, my child, charge, custodian, dependent and/or ward.

Consent for Treatment

ChristianaCare may do the following:

  • Obtain health and insurance coverage information, including healthcare treatment and prescription history, and may provide health services.
  • Not guarantee any specific outcomes for treatment provided.
  • Share information with other healthcare providers for professional consultation.
  • Provide professional services to the Patient from providers who are not the employees or agents of ChristianaCare but instead private physicians who maintain privileges to care for their patients at ChristianaCare facilities and/or independent contractors who will be providing their specialized services on the Patient’s behalf.
  • Allow medical students and clinical trainees to participate in the Patient’s care since ChristianaCare is a teaching healthcare system.
  • Use photographic, video, electronic, or audio recordings for medical purposes (including but not limited to diagnosis, care, and treatment) and patient identification, and such recordings may become part of the Patient’s medical record. The audio and video recordings may be used for performance improvement, documentation assistance, and/or training and reviewed by healthcare professionals but will not become part of the medical record and will be erased after review.
  • Release medical information in accordance with ChristianaCare policies and applicable federal and state laws.

Telehealth and Communication Technology-Based Services

  • “Telehealth” (which includes “teletherapy” and other behavioral health services) is how healthcare services are provided using digital communication technology to help evaluate, diagnose, consult, educate, monitor, and manage care and treatment without being in the same physical location as the provider.
  • Telehealth may include communication technology-based services (CTBS) for the remote evaluation of images/videos, virtual check-ins, E-visits (patient-initiated visits using ChristianaCare’s online patient portal), and communication with collaborating providers for the purpose of assisting in the diagnosis and/or management of the Patient’s care.
  • The quality of the digital connection may affect the provider’s ability to care for the Patient through telehealth.
  • The Patient may not be treated through telehealth unless their condition supports the use of this technology since the provider will not be able to complete a full physical examination.
  • Digital communication technology may include, but is not limited to, real time two-way audio, video, or other telecommunications or electronic communications, including remote patient monitoring, secure video conferencing, and/or secure texting with the care team.
  • The benefits to using telehealth services include, but are not limited to, convenient medical evaluation and management.
  • The risks to using telehealth include, but are not limited to, interruption in the audio/video connection. This may result in the visit being postponed until a later time, and/or performed through an alternate method, and, in rare cases, unauthorized access to the Patient’s confidential information.
  • The provider may not be able to help modify or address issues with the location or environment that may interfere with receiving telehealth services. In the event of a technical failure, the Patient should immediately contact their provider’s office, or, if it is an emergency, dial 911.
  • Laws protecting the confidentiality of medical information also apply to telehealth. ChristianaCare uses security protocols to help protect the Patient’s privacy and confidential communications are sent only to the intended care team.
  • ChristianaCare will not record the video or audio of the telehealth visit without the Patient’s consent.
  • ChristianaCare obtains health information and provides healthcare services through telehealth communications when and where the provider or qualified member of the care team determines it is appropriate and necessary.
  • The provider may collaborate with other professionals while using telehealth services. The provider may not be aware of all collaborating professionals’ knowledge, experiences, and qualifications, but will use the same professional judgment and skill when working with other professionals, similar to an in-person visit.
  • As with in-person visits, the provider may have other persons present with them to assist with the telehealth visit. The provider has informed the Patient of all persons who will be present with them during the telehealth visit, the role of each person, and the Patient consents to the provider sharing health information in their presence.
  • The Patient’s healthcare providers may ask information technology support staff, or other healthcare trained technicians, to help troubleshoot or resolve technical issues.
  • As with in-person visits, the Patient may choose and consent to having other people present during the telehealth visit and may hear the health information given by the provider.
  • The Patient may refuse or stop participating in telehealth services and request alternate services, such as an in-person visit, at any time.

Release from Liability for Valuables

  • Patients should avoid bringing valuables to ChristianaCare facilities. ChristianaCare will not be responsible for patient valuables unless they are placed in a hospital safe. Patients that choose to bring valuables, should give them to family members for safekeeping.
  • The Patient is responsible for loss or damage to their personal property brought to a ChristianaCare facility, except for valuables placed in the hospital’s safe. The Patient releases ChristianaCare from all claims for lost, stolen or damaged personal property not placed in the safe.
  • If the Patient is hospitalized, the Patient agrees that the maximum amount the hospital will pay for lost valuables in the hospital safe is limited to $300, unless the hospital gives the Patient a written receipt for a greater amount.

Financial Responsibility

  • Unless otherwise stated, the Patient agrees to be financially responsible to ChristianaCare and to non-ChristianaCare providers including, without limitation, Anesthesiology providers, for all charges for healthcare services provided to them. The Patient understands that services by non-ChristianaCare providers may be billed separately.
  • The Patient understands that cost-sharing will apply to CTBS, so they may be billed for a portion of CTBS even when there is not a face-to-face meeting with the collaborating provider.
  • The Patient understands that ChristianaCare only recognizes commercial and/or government healthcare plans as insurance coverage and does not recognize cost-sharing programs as commercial insurance coverage.
  • If the services are covered under a commercial insurance and/or government health plan, the Patient may be responsible for co-pays, co-insurance and/or deductibles, if any, under these plans. If the Patient is not covered by Medicare, Medicaid, and is not a self-pay patient, the Patient has been given the opportunity to review the No Surprises Act (Balance Billing) Disclosure.
  • The Patient understands that if they are not covered by a commercial insurance or government health plan, the Patient will be considered a self-pay patient and will be responsible for all charges regardless of their participation in a cost sharing program, or any information set forth on a membership card, and any restrictions set forth on a payment instrument by the cost sharing program. Upon getting the bill for services, if the Patient does not meet their financial responsibility by the payment due date, the Patient understands that they may be responsible for additional fees associated with the collection of any unpaid amount.
  • Enforcement. If the Patient does not meet their financial responsibility obligation, ChristianaCare may pursue payment collection activities or legal action. The Patient understands they are responsible for paying ChristianaCare for all costs and expenses, including collections and attorneys’ fees incurred in that action or proceeding, in addition to any other relief or fees ChristianaCare may be entitled.

Assignment of Benefits

  • The Patient assigns and authorizes direct payment to ChristianaCare, or any affiliated providers rendering services on behalf of ChristianaCare, of any and all health insurance benefits, government healthcare benefits (including Medicare, Medicaid, and TRICARE), or other third-party payments otherwise payable to the Patient for services provided. The Patient understands that this assignment covers all services rendered by or under the direction of ChristianaCare and its affiliates, including inpatient, outpatient, and emergency services. The Patient agrees that this assignment will remain in effect until revoked in writing.
  • The Patient authorizes ChristianaCare to pursue all necessary claims, appeals, or legal actions to recover such payments and to release any necessary information to process claims under applicable privacy laws. The Patient acknowledges that they are financially responsible for any charges not covered or paid by this assignment, except as otherwise limited by applicable law or contract.
  • Where Medicare benefits apply, the Patient confirms that the information provided by them, in applying for payment under Title XVIII of the Social Security Act, is correct.
  • The Patient requests payment of authorized Medicare benefits to ChristianaCare and its contracted services and physician groups for any services they receive.

Authorization to Release Information to Obtain Insurance Benefits

The Patient authorizes ChristianaCare to release their health and financial information, as necessary, to any state agency or its designated contractor for the purpose of assisting in the preparation, submission, and processing of applications for federal or state healthcare benefits, including but not limited to Medicare, Medicaid , PATHS (Physician and Tactical Healthcare Services), and other public assistance programs.

Patient Communications

  • The Patient consents for ChristianaCare, and any subcontractor acting on behalf of ChristianaCare, to communicate by mail, phone, email, or text message to the patient’s telephone number, email address, or home or postal address. The Patient understands there is a risk of an unintentional disclosure of information, including their protected health information, to a third party. The Patient also understands that their wireless cell phone carrier may charge them for text messages.
  • The Patient consents and authorizes ChristianaCare, and any subcontractor acting on behalf of ChristianaCare, to use their email and telephone number for patient satisfaction surveys, delivery of healthcare information, visit followups, billing, and payment collections on the Patient’s accounts.
  • The Patient consents and authorizes ChristianaCare, and any subcontractor acting on behalf of ChristianaCare, to use their telephone number and email to communicate with them using (i) an automatic telephone dialer and/ or (ii) pre-recorded calls and/or (iii) text messages in compliance with federal and state laws.
  • The Patient understands that they have a right to confidential communications and can opt out of other patient communication methods mentioned above. The Patient understands that if they choose to exercise these rights, they will be required to provide their preferred method of communication.
  • This consent applies to all past, present and future communications from ChristianaCare until the Patient revokes this consent in writing.
  • The Patient understands their Primary Care Physician will be notified of their admission to or discharge or transfer from the hospital unless the Patient chooses to opt-out of notifying their Primary Care Physician during the registration process.

Notification and Acknowledgment of Financial Assistance Program

The Patient has been offered the opportunity to receive and review the “Financial Assistance Program Summary.”

Notice of Privacy Practices

The Patient has received a copy or has been given the opportunity to review the ChristianaCare “Notice of Privacy Practices.”

The Patient agrees that any lawsuit or legal action pursued by the Patient or on the Patient’s behalf, which is in any way related to the medical care or treatment the Patient receives, will be filed in the county where all or substantially all medical care or treatment was provided.

Consent

The Patient understands that this consent cannot be modified. Any handwritten changes to this form shall not be legally binding or enforceable. The Patient has read this document, or it has been read to them, and they understand their responsibility.

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