Informed Consent to Telehealth
Last Updated on April 1, 2021
The types of electronic transmissions and communications that may occur via our telehealth platform include:
· Non-clinical services such as appointment scheduling and patient education.
· 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.
The electronic communication systems we use 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.
Group physicians and nurse practitioners (each a “provider” and collectively, our “providers”) are an addition to, and not a replacement for, your primary care physician. Responsibility for your overall medical care should remain with your local primary care doctor, if you have one, and we strongly encourage you to locate one if you do not.
· Improved access to care by enabling you to remain in your home while the Group provider consults and obtains test results at distant/other sites.
· More efficient care evaluation and management.
· Obtaining expertise of a specialist as appropriate.
· Delays in evaluation and treatment could occur due to deficiencies or failures of the equipment and technologies.
· In rare events, our provider may determine that the transmitted information is of inadequate quality, thus necessitating a rescheduled telehealth consult or a meeting with your local primary care doctor.
· In very rare events, security protocols could fail, causing a breach of privacy of personal medical information.
· In rare events, a lack of access to complete medical records may result in adverse drug interactions or allergic reactions or other judgment errors.
If you need to receive follow-up care, assistance in the event of an adverse reaction to the treatment, or in the event of an inability to communicate as a result of a technological or equipment failure, please contact Group at Hi@GetCurex.com or call us at 856-474-3380.
By clicking the button titled "I Agree and Consent" or checking the related checkbox, you acknowledge that you understand and agree with the following:
- Group and its providers offer telehealth-based medical services, but these services do not replace the relationship between me and my primary care doctor. I also understand it is up to the Group provider to determine whether or not my specific clinical needs are appropriate for a telehealth encounter.
- The Group 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 Group 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 doctor accepts the duty of care.
- 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 doctor-patient relationship. Group provider reserves the right to deny care if, in the professional judgment of the Group provider, the provision of the telehealth services is not medically or ethically appropriate.
- 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.
- There is a risk of technical failures during the telehealth encounter beyond the control of Group. I agree to hold harmless Group for delays in evaluation or for information lost due to such technical failures.
- 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. I understand that I may suspend or terminate use of the telehealth services at any time for any reason or for no reason.
- If I am experiencing a medical emergency, that I will be directed to dial 9-1-1 immediately and that the Group providers are not able to connect me directly to any local emergency services.
- Group does not have any in-person clinic locations. I understand I may elect to seek services from a medical group with in-person clinics as an alternative to receiving a telehealth consultation. I understand that some parts of the services involving tests (e.g. labs or bloodwork) may be conducted by individuals at my location, or at a testing facility, at the direction of the Group provider.
- I may expect the anticipated benefits from the use of telehealth in my care, but that no results can be guaranteed or assured.
- The Group provider will explain my diagnosis and its evidentiary basis, and the risks and benefits of various treatment options.
- My healthcare information may be shared with other individuals for scheduling and billing purposes. Persons may be present during the consultation other than the Group provider in order to operate the telehealth technologies. I further understand that I will be informed of their presence in the consultation and thus will have the right to request the following: (1) omit specific details of my medical history/examination that are personally sensitive to me; (2) ask non-medical personnel to leave the telehealth examination; and/or (3) terminate the consultation at any time.
- I will not be prescribed any narcotics for pain, nor is there any guarantee that I will be given a prescription at all.
- If I participate in a telehealth consultation, I have the right to request a copy of my medical records which will be provided to me at reasonable cost of preparation, shipping and delivery. I can request to obtain or send a copy of my medical records to my primary care or other designated health care provider by contacting Group at: Hi@GetCurex.com.
Group providers do not address medical emergencies via telehealth.
IN CASE OF AN EMERGENCY, YOU SHOULD SEEK IMMEDIATE MEDICAL ATTENTION OR EMERGENCY CARE BY CALLING 911.
YOU AGREE TO INDEMNIFY AND HOLD HARMLESS THE GROUP, ITS EMPLOYEES, AGENTS, DIRECTORS, MEMBERS, MANAGERS, SHAREHOLDERS, OFFICERS, REPRESENTATIVES, ASSIGNS, PARENTS, PREDECESSORS, AND SUCCESSORS FROM AND AGAINST ANY AND ALL LOSS OR DAMAGE, INCLUDING ANY AND ALL INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL OR EXEMPLARY DAMAGES, EXPENSES, LIABILITIES, CLAIMS, OR DEMANDS WHATSOEVER ARISING OUT OF OR RELATED TO ANY FAILURE OF TECHNOLOGY OR EQUIPMENT IN CONNECTION WITH THE PROVISION OF TELEHEALTH, WHETHER OR NOT ANY SUCH LOSS, DAMAGE, EXPENSE, LIABILITY, CLAIM, OR DEMAND ARISES FROM OR RELATES TO THE GROUP'S NEGLIGENCE.