Consent To Treatment
Telehealth involves the use of secure electronic communications, information technology, or other means to enable a healthcare provider and a patient at different locations to communicate and share individual patient health information for the purpose of rendering clinical care. This “Telehealth Informed Consent” informs the patient (“patient,” “you,” or “your”) concerning the treatment methods, risks, and limitations of using a telehealth platform.
Some of our online solutions allow participating medical professionals and health care staff (“Providers”) to communicate with their clients, customers and/or patients (collectively, “Patients”) to provide health care related services online and perform virtual house calls via Internet connection. We are not responsible for internet connectivity or lack thereof or problems or issues related to the use thereof. We are not a medical service provider, health insurance company, nor licensed to sell health insurance. The Services are not intended for use by Providers and/or Patients in connection with active patient monitoring so as to allow immediate clinical action or continuous monitoring.
The Providers who deliver services through our Service are independent professionals practicing with Telehealth providers. We do not practice medicine or any other licensed profession, and do not interfere with the practice of medicine or any other licensed profession by Providers, each of whom is responsible for his, her or their services and compliance with the requirements applicable to his/her/their profession and license.
Information provided by Providers and/or Patients is merely transmitted via the Services, not verified or endorsed by us, and is provided on an “as-is” basis and we disclaim all warranties, either express or implied, including but not limited to the implied warranties of merchantability and fitness for particular purpose. We shall in no event be liable to you or to anyone for any decision made or action taken by any party (including, without limitation, any Service user) in reliance on information about Providers or Patients on the Service.
You hereby certify that you are not a Medicare or Medicaid beneficiary. If you provide false or deceptive information to us, including without limitation regarding your Medicare or Medicaid enrollment status, we reserve the right to terminate all current or future use of the Services by you.
A health care provider’s ability to use our services is not an endorsement or recommendation of that health care provider by us. Neither we nor any third parties who promote the Services or provide you with a link to the Services shall be liable for any professional advice you obtain from a Provider via the Services. The medical advice provided by your Provider is not under our control, nor is it provided to you by us. If you are a Patient, you accept responsibility for yourself in the use of the Services. You acknowledge that your relationship for health care services is with your health care provider, and your obtaining services from the Provider is solely at your own risk and you assume full responsibility for all risk associated therewith, to the extent permitted by law. By using the Service, you agree to not hold us liable in any way for any malpractice or substandard treatment the Provider may render.
We reserve the right, but not the obligation, to confirm certain credentials of Providers using our Services, such as validating that they are in good standing with their respective licensure board(s). The Providers utilizing or featured on the Service are independent practitioners practicing on their own behalf, not our employees. Any opinions, advice, or information expressed by a healthcare facility, professional or specialist or other Provider using or featured on the Service are of the facility, professional, specialist or other Provider alone. They do not reflect our opinions.
We do not recommend or endorse any specific tests, Providers, products, procedures, medications, devices, opinions, or other information that may be mentioned on the Service or by a Provider or licensee of ours. We do not make any representations or warranties about the training or skill of any Providers who provide services via the Service. You will be provided with a list of available providers located in the U. S. based solely on the information you provide to us. You are ultimately responsible for choosing your particular Provider. The inclusion of Providers on the Service or in any professional directory located on the Service does not imply recommendation or endorsement of such Provider nor is such information intended as a tool for verifying the credentials, qualifications, or abilities of any Provider contained therein.
To the extent medical advice is provided to you by a Provider through the Services, such medical advice is based on your personal health data as provided by you to the Provider and the local standards of care for your presenting symptoms, based on the information you provide.
Patients may be required to provide certain Personal Information, including: name, date of birth, gender, address, email, mobile and work phone, as well as a user id and password. Patients may also provide certain optional information, including middle name or initial, home phone and other contact info, pharmacy name and contact details, picture and communications preferences. In addition, the Patient can communicate other health-related information to the Provider during a video consultation via the Services. Patient medication history is a list of prescriptions that healthcare providers have prescribed for you. A variety of sources, including pharmacies and health insurers, contribute to the collection of this history. By using the Services, you give your permission to allow your particular Provider to obtain your medication history, specifically for use in providing care. Optional information is not required to register for an account but may be helpful to us in providing you with a more customized experience when using the Site or its Services.
The use of the Service by any entity or individual to verify the credentials of Providers is prohibited.
INFORMED CONSENT & RISKS. As with any medical procedure, there are potential risks associated with the use of telemedicine or any other Services. We believe that the likelihood of these risks materializing is very low. These risks may include, without limitation, the following: Delays in medical evaluation and consultation or treatment may occur due to deficiencies or failures of the equipment which may include poor video and data quality. Security protocols could fail, causing a breach of privacy of personal medical information. Lack of access to complete medical records may result in adverse drug interactions or allergic reactions or other negative outcomes.
You understand that the laws that protect privacy and the confidentiality of medical information also apply to telemedicine. You understand that telemedicine may involve electronic communication of your personal medical information to medical practitioners who may be located in other areas, including out of state. You understand that you may expect the anticipated benefits from the use of telemedicine, but that no results can be guaranteed or assured. You understand that all information will be part of your medical record and available to you by printing the summary from the visit. This information will have the same restrictions on dissemination without your consent. Except to the extent already relied upon, you understand you may withdraw your consent at any time by contacting us as set forth herein to withdraw your consent and inactivate your account. You understand that your healthcare information may be shared with other individuals for treatment, payment and healthcare operations purposes. Psychotherapy notes are maintained by clinicians but are not shared with others, while billing codes and encounter summaries are shared with others. If you obtain psychotherapy services, you understand that your therapist has the right to limit the information provided to you if in your therapist’s professional judgment sharing the information with you would be harmful to you. You further understand that your healthcare information may be shared in the following circumstances: When a valid court order is issued for medical records. Reporting suspected abuse, neglect, or domestic violence. Preventing or reducing a serious threat to anyone’s health or safety.
Electronic Transmissions: The types of electronic transmissions that may occur using the telehealth platform include, but are not limited to:
Appointment scheduling;
Completion, exchange, and review of medical intake forms and other clinically relevant information (for example: health records; images; output data from medical devices; sound and video files; diagnostic and/or lab test results) between you and your Provider via: asynchronous communications; two-way interactive audio in combination with store-and-forward communications; and/or two-way interactive audio and video interaction;
Treatment recommendations by your Provider based upon such review and exchange of clinical information;
Delivery of a consultation report with a diagnosis, treatment and/or prescription recommendations, as deemed clinically relevant;
Prescription refill reminders (if applicable); and/or
Other electronic transmissions for the purpose of rendering clinical care to you.
Service Limitations:
The primary difference between telehealth and direct in-person service delivery is the inability to have direct, physical contact with the patient. Accordingly, some clinical needs may not be appropriate for a telehealth visit and your Provider will make that determination.
Providers do not address medical emergencies. If you believe you are experiencing a medical emergency, you should dial 9-1-1 and/or go to the nearest emergency room. After receiving emergency healthcare treatment, you should visit your local primary care provider.
Our providers are an addition to, and not a replacement for, your local primary care provider. Responsibility for your overall medical care should remain with your local primary care provider, if you have one, and we strongly encourage you to locate one if you do not.
Security Measures: The electronic communication systems used will incorporate network and software security protocols to protect the confidentiality of patient identification and imaging data and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption. All the Services delivered to the patient through telehealth will be delivered over a secure connection that complies with the requirements of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).
Possible Risks:
Delays in evaluation and treatment could occur due to deficiencies or failures of the equipment and technologies, or provider availability.
In rare events, your Provider may determine that the transmitted information is of inadequate quality, thus necessitating a rescheduled telehealth consult or an in-person meeting with your local primary care doctor.
In very rare events, security protocols could fail, causing a breach of privacy of personal medical information.
Patient Acknowledgments: I further acknowledge and understand the following:
(1) As part of my telehealth visit, I have selected a provider from the list in our help center or I have elected to visit with the next available provider and have been given my Provider’s credentials.
(2) The provider will take responsibility for my care only after I have created an account, answered all the required health questions and provided a photo and/or have had a video chat and made payment, and the provider has subsequently received my request for treatment and my responses to all the required health questions and any photos and/or information received from a video chat, reviewed all my information, and then subsequently determined that I am a good candidate for the telehealth services. I understand that the provider’s duty of care does not begin at the point of me answering questions or making payment or starting a video visit but at the point at which the provider accepts the duty of care.
(3) I understand that making a request for treatment (by completing a visit in the mobile app or website and making payment, including providing photos and/or initiating a video chat) or sending a message through the mobile app or website does not in and of itself create a duty of care or create a clinician-patient relationship. Provider reserves the right to deny care if, in the professional judgment of the provider, the provision of the telehealth services is not medically or ethically appropriate.
(4) If I am experiencing a medical emergency, I will be directed to dial 9-1-1 immediately. I understand that my Provider is not able to connect me directly to any local emergency services.
(5) I may elect to seek services from a medical provider with in-person clinics as an alternative to receiving telehealth services.
(6) I have the right to withhold or withdraw my consent to the use of telehealth in the course of my care at any time without affecting my right to future care or treatment.
(7) Federal and state law requires health care providers to protect the privacy and the security of health information. I am entitled to all confidentiality protections under applicable federal and state laws. I understand all medical reports resulting from the telehealth visit are part of my medical record.
(8) Telehealth may involve electronic communication of my personal health information to other health practitioners who may be located in other areas, including out of state. I consent to TeleHealth Provider using and disclosing my health information for purposes of my treatment and care coordination, to receive reimbursement for the services provided to me, and for the healthcare operations.
(9) Dissemination of any patient identifiable images or information from the telehealth visit to researchers or other educational entities will not occur without my affirmative consent.
(10) There is a risk of technical failures during the telehealth visit beyond the control of the Telehealth Provider. I AGREE TO HOLD HARMLESS TELEHEALTH PROVIDER AND ITS EMPLOYEES, CONTRACTORS, AGENTS, DIRECTORS, MEMBERS, MANAGERS, SHAREHOLDERS, OFFICERS, REPRESENTATIVES, ASSIGNS, PARENTS, PREDECESSORS, AND SUCCESSORS for delays in evaluation or for information lost due to such technical failures.
(11) In choosing to participate in a telehealth visit, I understand that some parts of the Services involving tests (e.g., labs or bloodwork) may be conducted at another location such as a testing facility, at the direction of my Provider.
(12) Persons may be present during the telehealth visit other than my Provider in order to operate the telehealth technologies. If another person is present during the telehealth visit, I will be informed of the individual’s presence and his/her role.
(13) My Provider will explain my diagnosis and its evidentiary basis, and the risks and benefits of various treatment options.
(14) I have the right to request a copy of my medical records. I can request to obtain or have a copy of my medical records sent to my primary care or other designated health care provider by contacting the Telehealth provider.
(15) A copy of my medical record will be provided to me at a reasonable fee (which fee shall include the costs of preparation, shipping and delivery of the medical record).
(16) It is necessary to provide my Provider a complete, accurate, and current medical history. I understand that I can log into my Message Portal at any time and send a message to access, amend, or review my health information.
(17) There is no guarantee that I will be issued a prescription and that the decision of whether a prescription is appropriate will be made in the professional judgment of my Provider. If my Provider issues a prescription, I have the right to select the pharmacy of my choice.
(18) There is no guarantee that I will be treated by a provider. My Provider reserves the right to deny care for potential misuse of the Services or for any other reason if, in the professional judgment of my Provider, the provision of the Services is not medically or ethically appropriate.
BY USING THE SERVICES AND/OR AGREEING TO THESE TERMS, YOU AGREE AND CONSENT THAT YOU HAVE READ AND UNDERSTAND THE INFORMATION PROVIDED HEREIN, AND UNDERSTAND THE RISKS AND BENEFITS OF TELEMEDICINE, AND BY ACCEPTING THESE TERMS OF USE YOU HEREBY GIVE MY INFORMED CONSENT TO PARTICIPATE IN A TELEMEDICINE VISIT UNDER THE TERMS DESCRIBED HEREIN. YOU ARE CONSENTING TO RECEIVING CARE VIA THE SERVICE. THE SCOPE OF CARE WILL BE AT THE SOLE DISCRETION OF THE PROVIDER WHO IS TREATING YOU, WITH NO GUARANTEE OF DIAGNOSIS, TREATMENT, OR PRESCRIPTION. THE PROVIDER WILL DETERMINE WHETHER OR NOT THE CONDITION BEING DIAGNOSED AND/OR TREATED IS APPROPRIATE FOR A TELEHEALTH ENCOUNTER VIA THE SERVICE.