Informed Consent for telehealth Services
Before you give your informed consent to request and receive telehealth services, please be aware of how obtaining health services remotely from our physicians and other licensed health care professionals (together, the “Providers”) through an online telehealth platform developed and maintained by TeleHealthUS, (the “Platform”) differs from in-person care. Some of the risks associated with receiving telehealth services are described in this Informed Consent. There may be other risks to telehealth services that are not currently known.
Our Providers are affiliated with one or more of the following TeleHealthUS professional entities: TeleHealthUS Medical Services, P.C. (NY), TeleHealthUS Medical Services, P.C. (NJ), and Preventive Medicine Associates, P.C. (CA) (collectively, “TeleHealthUS Professional Entities”). If you are connecting with a Provider in NJ or CA, you will be served by our NJ or CA professional entity, respectively. All other locations will be served by TeleHealthUS Medical Services, P.C. (NY). In this Informed Consent, the terms “TeleHealthUS,” “we”, “us”, or “our” refers to the TeleHealthUS Professional Entities and TeleHealthUS, Inc. The terms “you” and “yours” refer to the patient using the Platform to request telehealth services from Providers affiliated with the TeleHealthUS Professional Entities. Please read each item carefully.
Emergencies
You understand that you should never use the Platform in a medical emergency. You understand that in a medical emergency you should dial 911 or visit an emergency room. Our services are not designed for acute treatment of severe behavioral health systems. In the event you are experiencing emotional distress, please contact the National Suicide Prevention Hotline: Crisis Text Line at 1-111-123-2233, text 988, or text “Home” to 741-741, to obtain immediate assistance.
Service Description
You understand that TeleHealthUS offers clinical care services through a web-based platform provided by licensed healthcare professionals, which is a part of the primary care practice, including mental health therapy services provided by mental health professionals. The services are voluntary, and you may seek in-person treatment at any time. The platform involves electronic transmission of medical information and other data between you and your treating Provider, which may include asynchronous and synchronous communication.
As a user of the platform, you will be provided with the name and credentials of your treating Provider. If you are receiving treatment from an advanced practice professional and wish to speak to a physician, you may request to do so, but there may be a delay in service. You understand that state medical licensure laws require you to be seen by a Provider licensed to practice in the state where you are located at the time of the service.
You acknowledge that the absence of an in-person physical examination may affect the Provider’s ability to diagnose any potential condition, disease, or injury, and that any diagnosis you receive is provisional and limited. The Services are not intended to replace a full medical evaluation or an in-person visit with a healthcare Provider. You understand that any health information you provide through the platform may be the only source of health information used by Providers during the course of your evaluation and treatment through the platform, and that Providers may not have access to any other health information held by your previous medical providers.
You certify that the information you provide to the platform, including your geographic location, is true, accurate, and complete. You understand that providing false, misleading, or incomplete information may negatively affect your treatment and your health.
You understand that you need to be responsive to ongoing requests for information from your care team, including completion of ongoing assessments about your symptoms and side effects during treatment, and to consent to access to prior medical information, including your prescription history, in order to remain under the care of your care team. If you are not responsive to these requests for information, you understand that you cannot be considered to be under the care of the prescribing Provider or care team. You may choose to stop using the Services and opt for alternative modes of medical care at any time.
Payment and Insurance
If you are enrolled in our Membership Plan(s) (as defined by the Terms of Service), you understand that TeleHealthUS is not an insurance company and any Membership Plan offered by TeleHealthUS does not meet any individual health mandate that may be required by federal law. You further agree and acknowledge that: (i) if you are uninsured you may still be subject to tax penalties under the Patient Protection and Affordable Care Act for failing to obtain insurance; and (ii) that our Membership Plans have exclusions as further described in our Terms of Service. If you are a Medicare or Medicaid enrollee or insured by other health insurance plans, you may be entitled to receive similar digital healthcare services from a provider enrolled in Medicare or your state’s Medicaid program or other arrangements, as applicable, at little or no cost to you. Please review our Terms of Service for additional terms related to Insurance.
