Telehealth consent

“Telehealth Services” may include remote prescribing, appointment scheduling, health information sharing, and non-clinical services, such as patient education. The information you provide may be used for diagnosis, treatment, follow-up and/or patient education, and may include any combination of the following: (1) review of health records and test results; (2) images and asynchronous communications; (3) live two-way audio and video; (4) interactive audio with store and forward; and (5) output data from medical devices and sound and video files.

Telehealth Services have many benefits, including:

• You do not have to leave the privacy of your home to receive a medical consultation. This can save you time and money.
• It is easier and more efficient to access health care providers online when you need them, rather than waiting weeks and possibly months for an appointment.
• You can easily schedule follow-up consultations with your HCP from the convenience of your PC or phone.

There are possible risks to using Telehealth Services, though, including:  

• It may be more difficult for HCPs to diagnose you without seeing you in person. For example, it may be more difficult for a HCP to perform a physical assessment, to check vitals, and/or to perform diagnostic tests.
• In some instances, your HCP may determine that the transmitted information is of inadequate quality, thus necessitating a rescheduled telehealth consult or a meeting with your local primary care provider.
• In some instances, a lack of access by your HCP to your complete medical records may result in adverse drug interactions, allergic reactions, or other judgment errors.
• There can be delays in evaluation and treatment in the event of a disruption in communication between you and your HCP if the online connection is interrupted for some reason, or if you or your HCP experience technical difficulties.  
• While our Platform includes security features to protect your information, there is still a risk that unauthorized access to your information can occur. In rare instances, security protocols could fail, causing a breach of privacy of your personal medical information.  

Any “Telehealth Services” are in addition to, and not a replacement for, care you receive or received from a local primary care provider and other health care providers on whom you may rely for medical services. 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. You may contact the HCPs with follow-up questions with respect to the Telehealth Services and treatment provided by the HCPs. However, if you are experiencing a medical emergency, you should dial 911 or go to your nearest emergency room or urgent care center immediately.

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In order to proceed, you must confirm that you have read, understand, and agree to this Consent for Telehealth Services.

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By proceeding, I confirm that:

1. I understand the risks and benefits of the Telehealth Services offered through the Platform. I also understand that none of the benefits of the Telehealth Services are guaranteed and that the treatment provided may not necessarily improve any of my medical conditions.

2. I understand that Telehealth Services do not replace the overall medical care provided by my local primary care provider. I understand that, in the case of a medical emergency, I should dial 911 or go to the nearest emergency room immediately.

3. I understand that I am responsible for providing the HCPs with complete, truthful, and accurate information, and I acknowledge that the HCP will rely on the information I provide in the delivery of Telehealth Services to me. I understand that the inaccuracy of any information I provide to the HCP may impact the efficacy of the Telehealth Services. I understand that a HCP will determine whether or not my specific needs are appropriate for a telehealth encounter, and may decide I need to seek treatment from a different provider.

4. I understand that there is a risk of technical failures during the Telehealth Services that may be beyond MEDCO23’s control. I agree to hold MEDCO23 and the HCPs harmless for any delays in evaluation or for information lost due to such technical failures.

5. I understand there may be side effects from certain medications prescribed, and that my HCP will specifically address these risks when prescribing such medications. I further understand that there is no guarantee that I will be given any prescription for medication.

6. I understand that federal and state laws require health care providers to protect the privacy and security of health information. I understand that MEDCO23 and the HCPs will take reasonable and appropriate steps to make sure that my health information is not seen by anyone who should not see it. I understand that telehealth may involve electronic communication of my personal medical information to other health practitioners who may be located in other areas, including other states.

7. I understand that 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.

8. I give my informed consent to telehealth as an acceptable form of delivering health care services to me, and I understand that this consent will cover any and all Telehealth Services provided to me through MEDCO23.

9. I understand that either I or the HCP may discontinue any telehealth encounter.

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Questions and Comments

MEDCO23 commits to resolve questions and comments about your privacy and our collection and use of your information. Individuals with inquiries or comments should contact MEDCO23 at: customercare@rugiet.com.

MEDCO23, LLC
310 Comal Street
Ste 270
Austin, TX 78702

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