Confidential Information Release and Authorization for Telehealth Services

By participating in a telehealth session hosted by The Baby Academy, I acknowledge and consent to the following:

• My personal information and protected health information (“PHI”), as defined by the Health Insurance Portability and Accountability Act (“HIPAA”), (collectively, “Confidential Information”), may be shared with other participants during this session, especially if I voluntarily share my Confidential Information during the session.
• Other participants may also share their PHI during this session, and I agree not to disclose their Confidential Information outside of this setting.
• Each participant in this session has signed a similar authorization, but I understand that neither The Baby Academy nor the session host can guarantee the confidentiality of my Confidential Information received by the other participants.
• I understand that this session is being conducted via telehealth, which involves the use of electronic communication to provide educational and support services remotely.
• I acknowledge that telehealth has limitations, including but not limited to potential technical disruptions, privacy risks, and the lack of in-person interactions.
• I consent to receiving services via telehealth and understand that I can choose not to participate if I do not agree to these terms.

If you do not consent to the above, please do not agree to this authorization or participate in the session.