Consent to Telehealth
Consent to Telehealth
“Telehealth” consists of the use of electronic information and communication technologies by providers to deliver health care services to patients not at the same physical location, which may include the assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a patient. Such communication can include electronic transfer of medical records, images/photographs, health information, or other Personal Information between you and the Providers, live conversations or other interactions between you and the Providers via audio, video, and/or media, and use and analysis of output data from medical or wearable devices, sound, video, and other related files.
While the provision of health care services using telehealth may offer certain potential benefits, there are also potential risks associated with the use of telehealth, which are listed in more detail below. The telehealth services are not a substitute for in-person health care in all cases. In order to use the Services, you are required to review and agree to this Consent to Telehealth.
The telehealth services provided through the Sites and as a part of the Services allow you to engage in virtual nutrition and wellness coaching and consultations with the Providers and your weight and health coaches and use our platform to track your health progress and goals. The use of telehealth services may provide an easier and more efficient way to obtain health care services at a time and place most convenient for you, and you can interact with the Providers without the necessity of an in-office appointment. This means that the Provider will be interacting with you by video over the computer or smartphone instead of in person. You will be able to speak with the Provider and ask any questions during your visit. The Provider will be able to assess your medical condition, provide medical advice, and prescribe treatment (e.g., medication), as appropriate.
As with any in-person health care encounter, there are potential risks associated with the use of telehealth. These risks may include, but are not limited to:
- Limitations on the availability and/or appropriateness of specific health services that may be hindered as a result of the Services being offered remotely (e.g., information transmitted to the Providers may not be sufficient to allow for appropriate medical decision making by the Providers and the inability of your Providers to conduct certain tests or assess vital functions and signs in-person may prevent the Providers from providing a diagnosis or treatment)
- Confidentiality and security of your health information, including Personal Information, through use of potentially unsecure electronic and telecommunication technologies
- Technological issues during your telehealth visit (but note that alternative communication methods may be provided if you are having connectivity issues)
- Given regulatory requirements in certain jurisdictions, the Provider’s treatment options, especially pertaining to certain prescriptions, may be limited
By accepting this Consent to Telehealth, you acknowledge your understanding and agreement to the following:
- I give my informed consent to the use of telehealth by the Providers
- I have read the above information and have had an opportunity to ask questions
- I understand the benefits and risks of receiving telehealth services
- I understand that the Provider may determine in his or her sole discretion that my condition is not suitable for treatment using telehealth, and that I may need to seek medical care and treatment in-person or from an alternative source
- I understand that I have the right to withhold or withdraw my consent to the use of telehealth in the course of my care at any time by contacting Calibrate at firstname.lastname@example.org with such instruction; otherwise, this consent will be considered renewed upon each new telehealth encounter with the Providers
- I understand that while the use of telehealth may provide potential benefits to me, as with any medical care service no such benefits or specific results can be guaranteed
- I understand that I have the right to access my health and wellness information pertaining to the Services delivered via telehealth in accordance with applicable laws and regulations
- I agree and authorize my Provider to share information regarding the telehealth exam with other individuals for treatment, payment, and health care operations purposes
- I agree and authorize the Providers to release information regarding the telehealth exam to Calibrate and its affiliates