Telehealth Home Visit Eligibility Checklist

Patient Criteria

• Patient meets age requirements
• Patient resides within service area
• Patient has access to stable internet connection
• Patient has access to a compatible device for telehealth

Clinical Criteria

• Medical condition is appropriate for telehealth assessment
• No concerns regarding patient safety or emergencies
• Relevant medical records available for review

Consent and Understanding

• Patient (or caregiver) understands telehealth process
• Patient agrees to privacy and security terms

Notes