Consultation Policy
Licensure and Credentials
Vital Source Health, PLLC is led by Robert Piedra, BSRS, BSN, RN, FMACP. Robert is a Registered Nurse licensed in the state of Florida License Number: RN9544157 and a certified Functional Medicine Academy Practitioner. These credentials are maintained in good standing through ongoing education and adherence to professional standards.
VITAL SOURCE HEALTH, PLLC SERVICES POLICIES
THE SERVICES WE PROVIDE COMPLEMENT ANY EXISTING HEALTHCARE PROGRAMS CURRENTLY ENROLLED OUTSIDE OF VITAL SOURCE HEALTH, PLLC.
While we operate independently within our scope of practice, we maintain professional relationships with other healthcare providers. When necessary and with your consent, we may collaborate with or refer you to other healthcare professionals to ensure comprehensive care. This collaborative approach allows us to provide holistic support while ensuring you receive appropriate medical care when needed.
Vital Source Health, PLLC (VSH) Intent:
Referral Process
If during the course of our services, we identify health concerns that fall outside our scope of practice or require specialized medical attention, we will promptly refer you to an appropriate healthcare provider. We will assist in coordinating your care to ensure continuity and comprehensive support for your health needs.
The intent of any and all services offered and/or nutritional protocols or lifestyle recommendations suggested by Vital Source Health, PLLC practitioners and the VSH team is designed to support the natural physiological & biochemical processes of the human body. The purpose is not to diagnose, treat, prevent, or cure any disease. All suggested protocols are from a holistic health perspective. As such, VSH does not act as your primary care physician, and you must continue to have a medical PCP and keep them informed of all your healthcare activities. VSH is not in any insurance network, and we do not carry any hospital privileges. Upon request, patients can be given a receipt that clearly identifies the appropriate service codes (CPT) and diagnostic codes (ICD-10) that they can send into their insurance company for possible reimbursement based on their individual insurance coverage and deductible. It is important to maintain a relationship with a primary care provider, gynecologist and/or internist for those needs as well as any specialists you are currently seeing. Vital Source Health, PLLC
DISCLAIMER
While we strive to provide the highest quality of care, Vital Source Health, PLLC and its practitioners, including Robert Piedra, BSRS, BSN, RN, FMACP, cannot guarantee specific outcomes. Our services are not a substitute for emergency medical care or primary healthcare. In case of a medical emergency or for matters beyond the scope of our nursing practice, please contact your primary care provider, visit your local urgent care, or call 911.
THESE STATEMENTS HAVE NOT BEEN EVALUATED BY THE F.D.A. THIS PROMOTION AND FACILITY IS NOT OFFERING ANY MEDICAL PROCEDURES OR SERVICES, NOR DOES IT ELUDE TO DIAGNOSE, TREAT, CURE, PREVENT ANY DISEASE OR MAKE ANY MEDICAL CLAIMS. IT DOES DO NOT SUPPLANT COMPETENT MEDICAL CARE, NOR DOES IT DISSUADE ANYONE FROM SEEKING COMPETENT MEDICAL ATTENTION FOR ANY INJURY, ILLNESS OR OTHER PHYSICAL CONDITION. PATIENTS ARE ENCOURAGED TO SEEK ADVICE FROM THEIR PRIMARY CARE PHYSICIAN BEFORE BEGINNING ANY NEW EXERCISE, DIETARY OR NUTRITIONAL PROGRAM. THE PATIENT AND ANY OTHER PERSON RESPONSIBLE FOR PAYMENT HAS THE RIGHT TO REFUSE TO PAY, CANCEL PAYMENT OR BE REIMBURSED FOR PAYMENT FOR ANY OTHER SERVICE, EXAMINATION OR TREATMENT WHICH IS PERFORMED AS A RESULT OF AND WITHIN 72 HOURS OF RESPONDING TO THE ADVERTISEMENT FOR THE FREE, DISCOUNTED OR REDUCED FEE SERVICES, EXAMINATION OR TREATMENT. NON-PATIENTS WISHING TO MAKE PURCHASES MUST AGREE TO BECOMING A GENERAL NUTRITION PATIENT OF DR. LORI PUSKAR , NO FEE REQUIRED.
THIS CONTENT IS FOR INFORMATIONAL AND EDUCATIONAL PURPOSES ONLY. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE OR TO TAKE THE PLACE OF SUCH ADVICE OR TREATMENT FROM A PERSONAL PHYSICIAN. ALL READERS/VIEWERS OF THIS CONTENT ARE ADVISED TO CONSULT THEIR DOCTORS OR QUALIFIED HEALTH PROFESSIONALS REGARDING SPECIFIC HEALTH QUESTIONS. THE OWNER OR PUBLISHER OF THIS CONTENT TAKES RESPONSIBILITY FOR POSSIBLE HEALTH CONSEQUENCES OF ANY PERSON OR PERSONS READING OR FOLLOWING THE INFORMATION IN THIS EDUCATIONAL CONTENT. ALL VIEWERS OF THIS CONTENT, ESPECIALLY THOSE TAKING PRESCRIPTION OR OVER-THE-COUNTER MEDICATIONS, SHOULD CONSULT THEIR PHYSICIANS BEFORE BEGINNING ANY NUTRITION, SUPPLEMENT OR LIFESTYLE PROGRAM.
DEFINITIONS:
"Products" - Items offered that are for external use only and are not considered a dietary supplement.
"Supplements" - Items offered that are for internal/external use and are considered a dietary supplement.
GENERAL AND ONLINE PATIENT AGREEMENT
Professional Boundaries
We maintain professional boundaries in all our interactions. Our relationship is that of healthcare provider and patient, focused on your health and wellness goals. We do not engage in personal relationships with patients outside of our professional capacity. All communications and interactions are conducted with the utmost respect for your privacy and dignity.
I request that I be allowed to participate in Vital Source Health, PLLC’s “Online and/or General Nutrition Patient Program”, a program which allows me to purchase supplements online, be in control of my own natural health program and supplement purchases.
I authorize Vital Source Health, PLLC to recommend general nutrition not related to nor for the handling of any symptoms, conditions, diagnosis, and/or to treat or cure any illness or disease. This includes but is not limited to conditions of cancer, AIDS, Infections, or any/all other medical conditions.
I understand that no, guarantee or health improvement will be made regarding any recommendation or statement from any article, employee, or educational material from Vital Source Health, PLLC.
I will not hold, Robert Piedra, his LLC, or any of its direct or indirect; associates, affiliates, representatives and/or vendors, liable for any situation regarding my body or health, and any purchase from Vital Source Health, PLLC.
I understand that if my health situations do not improve, I am always eligible to participate in Vital Source Health, PLLC‘s Personalized Natural Health Improvement Programs to get at the root cause of my health situation(s) and correct them once and for all. I understand that my information will be kept secure in keeping with Vital Source Health, PLLC’s PRIVACY POLICY & HIPAA STATEMENT.
I agree to Vital Source Health, PLLC full disclaimer at https://drloripuskar.com/disclaimer-privacy-terms-1
I have read and understand the foregoing and agree that by filling out and electronically signing the form below, this gives my consent and applies to all previous paragraphs and any/all future transactions with Vital Source Health, PLLC of any kind.
TELEMEDICINE
I understand that telemedicine is the use of electronic technology for communication for the purpose of providing healthcare services wherever the doctor and the patient are located. I understand that the institution is based in Florida and likewise uses telemedicine to conduct a consultation with their patients. I understand that with the use of telemedicine, the interaction shall be done through real-time audio-video communication. I understand that the laws that protect privacy and confidentiality, as well as the confidentiality of medical information through the Health Insurance Portability and Accountability Act (HIPPA) also apply to telemedicine. I understand that I will be responsible for any payments or coinsurances that apply to my telemedicine visit. I understand that I have the right to withhold or withdraw my consent to the use of telemedicine in the course of my care at any time, without affecting my right to future care or treatment; I have the right to access my information and to inspect my medical information that was transmitted through telemedicine; I have the right to privacy where it shall be necessary to seek my consent in order to disclose my information unless those that are permitted by law to disclose without the need of my consent. I understand any lawsuit airing out of this agreement or service shall be brought to the courts of the state of Florida, to the exclusion of other states.
With the pronouncements above:
I authorize Vital Source Health, PLLC to provide me their health assessment, observations, recommendations regarding my condition through telemedicine. Whenever necessary, I authorize the Vital Source Health, PLLC to consult with other physicians or specialists whom they believe to have full knowledge and skills that can address my case. I have read and understood the information provided above, my rights, and obligations regarding telemedicine. I have had the opportunity to ask questions and all of which were answered to my satisfaction. Therefore, I hereby give my consent to the use of telemedicine for medical care.
Registered Nurse (RN) and Functional Medicine Academy Certified Practitioner (FMACP):
As a Registered Nurse and Functional Medicine Academy Certified Practitioner, I operate within the scope of practice defined by the Florida Board of Nursing and my functional medicine certification. This includes health assessment, wellness promotion, disease prevention, and management of health problems within the nursing scope of practice. I do not diagnose medical conditions or prescribe medications. My role is to support your overall health and wellness through evidence-based functional medicine approaches that complement, but do not replace, conventional medical care."
Continuing Education and Competency:
At Vital Source Health, PLLC, we are committed to maintaining the highest standards of care. Our practitioners engage in ongoing education and professional development to stay current with the latest advancements in functional medicine and nursing practice. We regularly review and update our protocols to ensure they align with current evidence-based practices.
We adhere to the American Nurses Association Code of Ethics for Nurses, which guides our practice and decision-making. This includes respecting human dignity, maintaining patient confidentiality, advocating for patients' rights, and promoting health and wellness while honoring individual choice.
Our Registered Nurses and Functional Medicine Academy Certified Practitioners specialize in functional medicine and nutrition operating within the scope of their licenses and certifications. Our registered nurses and Functional Medicine Academy Certified Practitioners do not act as a primary care physician and is not on call, nor are any the Vital Source Health, PLLC practitioners regardless of license type. Please maintain a positive, working relationship with your medical doctor, keep him/her informed of your healing activities and continue your regular medical care and check-ups. This applies to all providers/practitioners with Vital Source Health, PLLC.
Benefits of Functional Medicine and Scope of Practice:
The team at Vital Source Health, PLLC use diagnostic and treatment methods that - in addition to conventional health care - are known as preventative, complementary, alternative, functional, naturopathic, or integrative medicine (collectively, "Functional Medicine"). Functional Medicine focuses on nutritional and metabolic imbalances, diet, exercise, environmental influences, and psycho-social stressors based on the premise that they directly relate to the development and maintenance of illness. Functional Medicine evaluates these influences and then specifically tries to remedy them. It encourages patients to give up negative lifestyle patterns and establish more positive ones, regardless of the type of medical conditions for which they are seeking treatment.
I understand that, as with any health treatment, Functional Medicine is not without risk. Potential risks of treatment include, but are not limited to, allergic reactions, sensitivities, adverse effects from, or in response to, natural supplements or dietary measures, failure to improve or worsening of my condition, and difficulty adjusting to lifestyle modifications. I agree to inform Practice's clinical staff of all known factors that might affect treatment, including, but not limited to, all medications, drugs, drug sensitivities and allergies, history of seizures, fits or fainting, presence of a pacemaker, bleeding disorder, use of anti-coagulants, damaged heart valves or occluded vessels, immune deficiencies, or other special risks of infection, as well as any other significant factors within my knowledge. I further agree to inform Practice's clinical staff of any disorder or state of mind that might affect my capacity to make informed health decisions, and should any such impairment exist, I will provide information regarding a surrogate decision maker.
Consent to Participate in Telemedicine/Telehealth:
By scheduling with Vital Source Health, PLLC and by signing this agreement I acknowledge that I am agreeing to participate in telemedicine/telehealth consultation with the practitioners and/or staff at (VSH). I am seeking this consultation for my own purposes and not on behalf of any third party. I understand the risks, benefits, limitations, and alternatives to tele-consults and have chosen of my own free will to participate in tele-consults with (VSH). I understand I am a participant in the decision-making process, and I am free to decline any service/treatment/recommendation/suggestion offered by the VSH practitioners at any time. I understand that tele-consults typically involve the use of audio and/or video or other technology between me and the practitioner. Due to the nature of tele-consults, visits are largely educational and rely heavily on the patient history and laboratory findings. Exams and vital findings via video or phone are limited in nature vs an in-person examination. I agree to bring to the attention of Practice's clinical staff, if, at any time, I have any lack of understanding of such risks, benefits, and alternatives, and inquire of clinical staff for further explanation until I have a full understanding before giving consent to any procedure or treatment.
Scheduling:
It is mandatory that all new patients complete their initial functional medicine intake forms and consents at least 48 hours before their scheduled appointment time. Your provider requires this information to complete your medical history review prior to your scheduled appointment. \
Cancellations:
We request a minimum of 48 hours advance notice for any cancellation or rescheduling of your appointment. This is a consideration for our practitioners. Failure to notify us of your need to cancel or reschedule your appointment within 48 business hours of your scheduled appointment will result in a no-show fee. The charge for a canceled or rescheduled appointment will be 50% of the cost of the scheduled appointment.
Payment of Services:
As a Registered Nurse providing functional medicine services, our offerings may not be covered by traditional health insurance plans. Patients are responsible for all fees at the time of service. Upon request, we can provide a detailed receipt that you may submit to your insurance provider for possible reimbursement, but we cannot guarantee coverage. We recommend checking with your insurance provider regarding coverage for telehealth nursing services.
Payment in full is expected at the time of scheduling or at the time of service. Vital Source Health, PLLC receives payment in credit cards only. There are no service refunds. You agree that your credit card on file will be automatically charged for any Vital Source Health, PLLC invoice generated such as your visit fee or if a supplement order or lab order is requested. You also authorize Vital Source Health, PLLC to automatically charge your credit card for any missed appointments or late cancellations of less than 48 hours in advance at the full-service fee. There is no charge for rescheduling or canceling appointments more than 48 hours in advance. I am also responsible for any chargeback fees if for some reason my credit card is declined. This authorization is part of my records and will be treated with privacy, confidentiality, and respect.
Refunds: Supplements and Lab work is purchased through outside vendors and VSH cannot issue any refunds, please only purchase items you intend to use. At VSH you may receive a refund for an individual service that was prepaid but not used and canceled with 48-hour notice before the appointment. You may receive a refund for a prepaid visit if VSH cancels the appointment and you do not wish to reschedule.
This excludes program packages agreed and purchased in advance and excludes programs purchased under a payment plan. There is no refund for program services purchased with a payment plan in which the patient decides to discontinue appointments prior to appointment(s) fulfillment or before completion of program duration. There is no refund for a purchase bought as a set of visits/services/package/program plan unless there are extenuating circumstances discussed and agreed upon with Robert Piedra BSRS, BSN, RN, FMACP. There are no refunds for services that have already been fulfilled (ex. after a visit).
Photo release, Social Media release, Website and Marketing release:
You agree to authorize Vital Source Health, PLLC use of any public reviews (ex. Google, Yelp, Facebook, etc) that you submit, or a review emailed to us. These reviews may be used for marketing activities and other online promotions via social media, websites and all printed or digital publications and media in perpetuity. You acknowledge that participation is voluntary, there is no financial compensation, and this includes photos, graphics, and testimonials. You released Vital Source Health, PLLC and Robert Piedra BSRS, BSN, RN, FMACP of any liability or claims by me or any third party related to the use of photographs, graphics or testimonials in printed or digital media.
Updates to VSH Policies graphics, updates to our Policies will be immediately applicable to you & all previous signers and posted on the Vital Source Health, PLLC website and in our Practice Better software. You may view them there or request an updated copy emailed to you at any time.
Stopping Medication:
Vital Source Health, PLLC practitioners will NOT take you off any medication, which can only be done with your prescribing physician. If your goal is to decrease your need for medication, we can suggest a protocol to encourage health and then you may work with your primary physician to monitor your progress and see if you are able to lower or eliminate your medication dosage over time. Keep your primary physician informed.
Emergencies:
In case of an emergency, call your PCP, visit your local urgent care or call 911.
INFORMED CONSENT FOR FUNCTIONAL MEDICINE & NUTRITION CARE (Which includes all items mentioned above).
INFORMED CONSENT
You may or may not be utilizing all of the services mentioned below:
To the patient (or their legal guardian, court-appointed conservator, or agent): Please read this entire form prior to signing it. Please ask any questions prior to signing this form if you are unclear about anything in this form. Diet and Health Release Because some of the information on the Service may relate to modifications to your diet, you agree to use your good judgment and reasonable care, including seeking counsel from your healthcare providers, prior to making any changes to your diet or lifestyle. No information on the Service is intended as medical or healthcare information or advice. Please consult your healthcare professional(s) regarding all matters related to your diet and health, including without limitation herbal and nutritional supplements or products. You agree not to rely on any information on the Service to make health-related decisions.
Other Procedures
There are a number of other procedures used by Robert Piedra BSRS, BSN, RN, FMACP that may be utilized. Treatment may include physical therapy modalities (such as nutrition, health coaching & exercise recommendations, etc.). Additionally, there may be referrals to other associated practitioners in the VSH office or outside doctors/practitioners as necessary, and their treatment should involve the same informed consent with disclosure of risks and benefits as is being done here.
HIPAA Notice of Privacy Practices
Vital Source Health, PLLC
Robert Piedra BSRS, BSN, RN, FMACP Ashlyn Alfonso BSN, RN, FMACP
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
In the course of your care as a patient or client with any practitioner at Vital Source Health, PLLC (VSH), we may use or disclose personal and health-related information about you in the following ways:
-Your personal health information, including your clinical records, may be disclosed to another health care provider or hospital if it is necessary to refer you for further diagnosis, assessment, or treatment.
-Your health care records, as well as your billing records, may be disclosed to another party, such as an insurance carrier, an HMO, a PPO, or your employer if they are or may be responsible for the payment of your services.
-Your name, address, phone number, and your health care records may be used to contact you regarding appointment reminders, to provide information about alternatives to your present care, or to provide other health-related information that may be of interest to you.
We may also provide treatment in an “open” or “group adjusting” or "group nutrition" or "group coaching" environment where other patients may be seen and advised at the same time in close proximity to you. This situation would necessitate the discussion of your health, subjective symptoms/treatment, etc. in the presence of other patients. You may always choose to exclusively participate in private appointments. **
You have a right to confidential communications and to request restrictions relative to such contacts. You also have the right to be contacted by alternative means or at alternative locations. Such requests must be made to us in writing. Such requests are not automatic and require the agreement of this office.
If you are not at home to receive an appointment reminder, a message may be left on your answering machine or with a person in your household.
Further, you have the right to inspect or obtain a copy of the information we will use for these purposes. You also have the right to refuse to provide authorization for this office to contact you regarding these matters. If you do not provide us with this authorization, it will not affect the care provided to you or the reimbursement avenues associated with your care.
Under federal law, we are also permitted or required to use or disclose your health information without your consent or authorization in the following circumstances:
-If we are providing health care services to you based on the orders of another health care provider.
-If we provide health care services to you in an emergency.
-If we are required by law to provide care to you and we are unable to obtain your consent after attempting to do so.
-If there are substantial barriers to communicating with you, but in our professional judgment we believe that you intend for us to provide care.
-If we are ordered by the courts or another appropriate agency.
You have a right to receive an accounting of any such disclosures made by this office. Any use or disclosure of your protected health information, other than as described in the examples outlined above, will only be made upon your written authorization. We normally provide information about your health care to you at the time you receive health coaching, functional medicine, nutritional advice, etc from us. We may also mail, email, or text information to you regarding your health care or about the status of your account. If you would like to receive this information at an address other than your home or, if you would like the information in a different form, please advise us in writing as to your preferences. We use a HIPAA compliant EHR system and email but please keep in mind there are inherent risks in electronic communication. If you would prefer to not utilize email as a form of communication, please inform Vital Source Health, PLLC in writing and please do not email the office. Sending an email to and asking questions pertaining to health or your personal information will be presumed as you are granting permission to communicate via email along with this signed HIPAA form.
You have the right to inspect and/or copy your health information for seven years from the date that the record was created for as long as the information remains in our files. In addition, you have the right to request an amendment to your health information. As per allowance by HIPAA recommendations & as a non-covered entity, the charge will be 25 cents per page.
Requests to inspect, copy or amend your health-related information should be provided to us in writing.
We make every effort to follow the state and federal recommendations to maintain the privacy of your patient file and the health protected health information therein.
We also make every effort to follow the state and federal recommendations to provide you with this notice of our privacy practices with respect to your health information. We make every effort to abide by the terms of this notice while it is in effect.
We reserve the right to alter or amend the terms of this privacy notice. If changes are made to our privacy notice, we will notify you in writing as soon as possible following the changes. Any change in our privacy notice will apply to all of your health information in our files.
You also have the right to lodge a complaint with the Secretary of the Department of Health and Human Services at 200 Independence Ave, S.W. Washington D.C. 20201. If you choose to lodge a complaint with this office or with the Secretary your care will continue, and you will not be disadvantaged by this office or our staff in any manner whatsoever.
This notice is effective (updated) as of August 1, 2024. This notice and any alterations or amendments made hereto will expire seven years after the date upon which the record was created.
All current updates to our Privacy Policy will be immediately applicable to you and all previous signers and posted on the Vital Source Health, PLLC website and in our Practice Better software. You may view them there or request an updated copy emailed to you at any time.
Contract Electronically:
You agree that the Terms, combined with your act of using the Site and/or the services offered on or through the Site have the same legal force and effect as a written contract with your written signature and satisfy any laws that require a writing or signature, including any applicable Statute of Frauds. You further agree that you shall not challenge the validity, enforceability, or admissibility of the Terms on the grounds that it was electronically transmitted or authorized. In addition, you acknowledge that you have had the opportunity to print the Terms.
