Consent to Treat
Telehealth/telemedicine is a service that has become a common means of diagnosing and/or treatment of a number of common medical conditions. Telehealth offers remote care, most often via video conferencing, but also via voice and electronic exchange of data.
Please Note: While telehealth can address a wide range of issues, it is not appropriate to use in the case of a medical emergency. If you are experiencing a medical emergency, please call 911 or go to the nearest emergency room.
Electronic Exchange of Data
Telehealth connects you to healthcare providers that are in a different physical location and requires the use of electronic media to communicate with your care provide and to exchange information relevant to your treatment. Information exchanged electronically can include, but not limited your current symptoms, existing medical conditions, past medical history, electronic copies of labs and imaging studies, diagnosis, treatment plan and any other information that you or your provider deem relevant to your care.
Information provided during your telehealth visit and any supplemental information that you upload prior to or after your visit will be added to your permanent medical record and stored electronically. Your data will be stored as long as legally required by relevant state and federal agencies.
- Equipment - Proper treatment via telehealth is dependent on electronic hardware in good working order and stable internet or cellular connectivity. A failure in hardware or software may impact your telehealth outcomes. Poor video quality or insufficient bandwidth may reduce or eliminate your provider’s ability to provide effective treatment where visual inspection of symptoms are required.
- Information – In order to provide effective care, your care providers will need access to a complete and accurate description of your current condition and your full medical history. Failure to provide an accurate history could have a negative affect on your diagnosis and treatment plan and in rare cases can result in negative drug interactions or allergic reactions.
- Distance – In some cases, treatment will require physical examination that cannot be overcome with telehealth. In such cases, your care provider may direct you to in person care or advise you to consult your primary care physician.
By checking the box you are agreeing to the terms of this Consent to Treat and you acknowledge that you understand and agree with the following:
- I understand that the laws that protect privacy and the confidentiality of medical information apply to telemedicine, and that no information obtained in the use of telemedicine, which identifies me, will be disclosed to other entities without my written consent. However, information may be released without my consent in cases of medical and mental health emergency, abuse, neglect, court order, insurance billing claims requirements, adult and program evaluation, and where otherwise legally required.
- I understand that I have the right to withhold or withdraw my consent to the use of telemedicine in the course of my care at any time, without affecting my right to future care or treatment.
- I understand the alternatives to telehealth consultation as they have been explained to me, and in choosing to participate in a telehealth consultation, I understand that some parts of the exam involving physical tests may be conducted by individuals at my location, or at a testing facility, at the direction of the consulting health care provider.
- I understand that telemedicine may involve electronic communication of my personal medical health information to other medical practitioners who may be located in other areas, including out of state.
- I understand that I may expect the anticipated benefits from the use of telemedicine in my care, but that no results can be guaranteed or assured.
- I understand that my health care information may be shared with other individuals for scheduling and billing purposes. Others may also be present during the consultation other than my health care provider and consulting health care provider in order to operate the video equipment. The above mentioned people will maintain the confidentiality of the information obtained. I further understand that I will be informed of their presence in the consultation and thus will have the right to request the following: (i) omit specific details of my medical history/physical examination that are personally sensitive to me; (ii) ask non-medical personnel to leave the telemedicine examination room; and/or (iii) terminate the consultation at any time.
I have read this Informed Consent form (including, but not limited to, the risks and benefits associated with teleconferencing by video, audio, or other electronic means) and I understand it. All of my questions have been answered to my satisfaction and I hereby give my informed consent to participate in a telemedicine visit under the terms described herein.
I understand and acknowledge that my ability to access the telemedicine service is conditional upon the above-mentioned criteria of my informed consent, and that telemedicine health care providers are relying upon this informed consent in order to interact with and facilitate health care services to me.
HealthPoint Plus recognizes the importance of protecting your personal information, and we are committed to safeguarding your privacy online. We appreciate your interest regarding the use we make of the personal information that you supply or which may be collected while you utilize this site.
Information We Collect
We may occasionally uses alphanumeric identifiers ("cookies") which would be transferred to your computer's hard drive through your Web browser to enable our system to recognize your browser when you return to this Web site and to monitor traffic patterns. You may modify your Web browser to prevent it from accepting new cookies, to notify you when a cookie is received, or to disable cookies entirely. Doing so, however, may prevent you from utilizing certain features of this Web site.
How We Use And Share Non-Health Information
The Non-Health Information is used to process requests, to provide services, and to develop new services.
Marketing, Promotion, and Market Research
The Non-Health Information may be used by HealthPoint Plus or its agents to personalize your experience, improve our Web site (we continually strive to improve our Web site offerings based on Non-Health Information and feedback from you), or improve customer service. The Non-Health Information may also be used to market and promote the services of HealthPoint Plus and its affiliated companies, and to conduct market research. This means you may be contacted by telephone, direct mail or e-mail regarding products and services offered by HealthPoint Plus, its affiliated companies or third parties.
HealthPoint Plus does not sell your Non-Health Information to third parties except as noted under "Transfer and Sale" below. However, HealthPoint Plus may selectively provide certain Non-Health Information to other companies or organizations that have products or services we think may interest you. HealthPoint Plus may also disclose Non-Health Information to third party agents we contract with to perform various tasks on our behalf and to affiliated companies and to third parties with whom we have a business relationship. These third parties may have Web sites that have separate and independent privacy policies. We therefore have no responsibility or liability for the content and activities of these linked sites. Nonetheless, we seek to protect the integrity of our site and welcome any feedback about these sites.
Third Party Plug-ins
Transfer and Sale
We will not sell your personal Non-Health Information, except in conjunction with a corporate sale of our business, merger, dissolution, or acquisition.
We may also release your Non-Health Information when we believe release is appropriate to comply with the law, enforce our site policies, or protect ours or others' rights, property or safety. As such, HealthPoint Plus may disclose any Non-Health Information received or collected to a law enforcement agency, a government or regulatory entity, or as determined by HealthPoint Plus to protect its rights and the rights of its affiliated companies, including without limitation, participating or conducting investigations of fraud, harassment or other types of unauthorized activities.
Access From Non-U.S. Locations
Our site is not intended for children under the age of 16. Use of HealthPoint Plus services directly by children between the ages of 16 and 18 requires the consent of a parent or legal guardian. Parents or guardians may access the HealthPoint Plus Services on behalf of their children under 16 through their own accounts. HealthPoint Plus will only collect Non-Health Information from or about persons under the age of 18 for the purposes of providing services with the consent of a parent or legal guardian.
What are cookies?
Cookies are simple text files that are stored on your computer or mobile device by a website’s server. Each cookie is unique to your web browser. It will contain some anonymous information such as a unique identifier, website’s domain name, and some digits and numbers.
What types of cookies do we use?
Necessary cookies allow us to offer you the best possible experience when accessing and navigating through our website and using its features. For example, these cookies let us recognize that you have created an account and have logged into that account to access the content.
Functionality cookies let us operate the site in accordance with the choices you make. For example, we will recognize your username and remember how you customized the site during future visits.
These cookies enable us and third-party services to collect aggregated data for statistical purposes on how our visitors use the website. These cookies do not contain personal information such as names and email addresses and are used to help us improve your user experience of the website.
How to delete cookies?
If you want to restrict or block the cookies that are set by our website, you can do so through your browser setting. Alternatively, you can visit www.internetcookies.org, which contains comprehensive information on how to do this on a wide variety of browsers and devices. You will find general information about cookies and details on how to delete cookies from your device.
HealthPoint Plus, Inc
Attn. Privacy Coordinator
120 Washington St, Suite 202
Salem, MA 01970