Patient Consent to Medical Services and Telehealth
Last Updated: October 28, 2022
YOU UNDERSTAND THAT BY CHECKING THE “AGREE” BOX FOR THE PATIENT CONSENT ON THE SITE YOU ARE AGREEING TO THE TERMS OF THIS PATIENT CONSENT AND THAT SUCH ON-GOING ACTIONS IN USING THE MEDICAL SERVICES CONSTITUTE A LEGAL SIGNATURE AND ON-GOING AGREEMENT TO THE TERMS OF THIS CONSENT.
THIS PATIENT CONSENT IS IN ADDITION TO THE TERMS OF SERVICE THAT YOU AGREE TO BY BOOKING THROUGH OUR PLATFORM. DO NOT BOOK A SERVICE THROUGH THIS PLATFORM IF YOU DO NOT AGREE TO THE TERMS OF THIS CONSENT.
As noted in our Terms of Service, Mobile Medical Parent LLC (“Mobile Medical” or “we”), the owner of this website and app (the “Platform”) providing the booking platform and related services (the “Service”), only operates the Platform and booking service and contracts with medical entities and medical providers who deliver the medical services, but Mobile Medical is not itself a medical entity or provider and is not responsible for providing any medical services.
We provider users of our Platform with access to medical groups and medical providers throughout the United State and the world who are appropriately licensed in the applicable state or jurisdiction (the “Medical Groups”). The Medical Groups employ or contract with physicians, and allied health professionals, including nurses, physician assistants and other licensed healthcare providers who offer certain healthcare services permitted in their local state or jurisdiction (“Providers”). You acknowledge and agree that any services you receive from the Medical Groups and Providers that were booked through the Platform are also subject to this Consent, and that the Medical Groups and Providers, Labs, and Pharmacies are third-party beneficiaries of this Consent. You further agree that Mobile Medical is not responsible or liable for the provision of any medical services and you release Mobile Medical and its owners, officers, members, managers, employees and agents from any and all liability relating to the provision of any medical services.
We only schedule your requested service(s) and bill you on behalf of the Medical Groups and Providers. We do not provide medical care services. Our booking service is not engaged in the practice of medicine, and we are not responsible for providing healthcare services or making any determinations about your care.
We do not control or interfere with the practice of medicine by the Medical Groups or any Providers, each of whom is solely responsible for directing the medical care and/or treatment they provide to you. By accepting this Agreement, you acknowledge and agree that Mobile Medical is not a medical corporation or healthcare provider and that by using the Service, you are not entering into a doctor-patient or other health care provider-patient relationship with Mobile Medical. By using the Service, you may, however, be entering into a doctor-patient or other health care provider-patient relationship with a Medical Group and/or one or more Providers.
Each time to choose to receive the medical services provided by the Medical Groups and Providers booked through our Service, you hereby give consent to any of the Medical Groups and Providers to assess and medically care for you. You may withdraw this consent at any time by no longer seeking medical services from the Medical Groups and Providers booked through this Platform.
By booking the medical service, you accept and agree to the following:
No Guarantees: You understand that there are no guarantees or results of receiving the Medical Services.
Potential Risks: You understand that there are potential risks to any medical treatment that can be booked through this Platform. The Medical Groups and Providers will inform you of the potential risks and benefits of treatment so that you may make an informed decision about whether to proceed with care.
Consent to Telehealth: You consent to receiving a medical screening via Telehealth Services and understand that there are certain risks associated with receiving care through Telehealth Services as described below.
COVID-19 Risks: You understand that you are assuming the risk of exposure to COVID-19 (or other public health risk) by having medical services provided to you in-person. Moreover, by inviting Providers into my home or workplace, you understand that there may be an increase in risk to exposure to other individuals who you are in contact with. You agree to inform the Medical Group or Provider immediately if either you or anyone you are in contact with displays any symptoms consistent with the COVID-19.
Complete Medical History: You understand that some treatments may be inappropriate and unsafe if you have certain health conditions or take certain medications or supplements, whether prescribed or over-the-counter. For this and other reasons, you understand that it is vital that you truthfully and accurately disclose all relevant health information to the Providers providing care to you through Medical Groups and notify them of any important changes. You understand that failure to do so may negatively affect my treatment outcome and the safety of any treatments you receive, and you understand that there shall be no liability on any Provider or Medical Group should you fail to do so.
Notice to All Female Clients Capable of Conceiving and Breastfeeding: Some treatments could present a risk during pregnancy and breastfeeding. Therefore, you agree that you will notify your Provider immediately if you are or suspect that you are pregnant, are planning to become pregnant, or if you are breastfeeding.
Acknowledgement of Receipt of HIPAA Notice of Privacy Practices: You acknowledge receipt of the Medical Groups’ HIPAA Notice of Privacy Practices which can be found at the Drip Hydration website at any time. Top of Form
Laboratory Products and Services: Certain healthcare services provided to you by Providers may require that you complete an at-home diagnostic test. These diagnostic tests are provided by third-party laboratories, and neither Mobile Medical, the Medical Groups nor your Provider(s) can guarantee the accuracy or reliability of these tests. These laboratory tests can provide false negative, false positive, or inconclusive results that could impact your Provider(s) ability to correctly diagnose or treat your medical conditions.
Consent to Telehealth Services
The purpose of this section is to inform you about Telehealth Services which may be provided by the Medical Groups.
“Telehealth” is the delivery of healthcare services using technology when the healthcare provider and patient are not in the same physical location, and/or the virtual delivery of healthcare services, including by a medical provider or via digital or automated tools, including without limitation tools for medical or health-related diagnosis and treatment. The Telehealth Services may be used for diagnosis, treatment, care, follow-up and/or patient education, and may include, without limitation, the following: electronic transmission of patient medical records, medical images, and/or other patient data or information; synchronous (i.e., “real time”) and asynchronous (i.e., non-“real time”) interactions via audio, video, text, and/or data or other electronic communications; automated, electronic or digital tools or services for diagnosis, care, treatment and/or communication pertaining to healthcare or medical matters; and output, transmission or exchange of data from medical devices, sound and video files.
Possible Benefits of Telemedicine
- Can be easier and more efficient for you to access medical care, examination and treatment.
- You can obtain medical care and treatment at times that are convenient for you.
- You can interact with providers without the necessity of an in-office appointment.
Possible Risks of Telemedicine
- Providers consulting with you via telehealth may not have the benefit of information that would be obtained by examining you in person and observing your physical condition. Information transmitted via telehealth technologies may not be sufficient (e.g. poor resolution of images) to allow for appropriate medical or health-care decision making by the Provider. The inability of your Provider(s) to conduct certain tests or assess vital signs in-person may in some cases prevent the Provider(s) from providing a diagnosis or treatment or from identifying the need for emergency medical care or treatment for you. To reduce the risk to you of this limitation, we strongly encourage you to provide all relevant information and discuss any and all diagnosis and treatment options with a health care provider.
- Your Provider may not be able to provide medical treatment for your particular condition via telemedicine and you may be required to seek alternative care.
- Delays in medical evaluation/treatment could occur due to failures of the technology.
- A lack of access to your medical records may result in adverse drug interactions or allergic reactions or judgment errors.
- Providers utilizing Telehealth Services may be limited by state law in prescribing certain medications to you without first conducting an in-person physical examination; and
- Although the electronic systems we use incorporate network and software security protocols to protect the privacy and security of health information, those protocols could fail, and there could be a breach of privacy of your health information. Unfortunately, the transmission of information via the internet is not completely secure. Although we take commercially reasonable steps designed to protect your personal information, we cannot guarantee the security of your personal information transmitted to, or through, our Telehealth Services.
By using the Telehealth Services, you acknowledge and agree that you are aware of these limitations and agree to assume the risk of these limitations. Furthermore, you agree and accept that: (i) the Telehealth Services provided by Medical Groups are not intended in any case to replace a full medical evaluation or an in-person visit with a health care provider; (ii) a Provider providing Telehealth Services may not have important information that is usually obtained through a “hands-on” physical examination; and (iii) the absence of a physical examination may affect the health care provider’s ability to diagnose any potential condition, disease, or injury.
You acknowledge that it is your duty to inform any Provider you see of your medical history to ensure your Provider has your full clinical background when making treatment decisions. Providers reserve the right to deny treatment if they believe a patient may be better served by an in-person health care provider, or for any other reason according to their professional judgment. You understand that a variety of alternative methods of medical care may be available to you, and that you may decide to stop using Telehealth Services and choose one or more of these alternative modes of care at any time.
Further, you understand that it may be possible that your condition cannot be treated via the Telehealth Services, or that information transmitted through the Telehealth Services may not be sufficient or of too poor of image quality, or insufficient information or data to allow for appropriate medical decision making. Accordingly, a Provider may determine in his or her sole discretion that your condition is not suitable for treatment using telemedicine, and you may be required to seek additional in-person medical care, alternative healthcare or emergency services.
You understand that the laws that protect privacy and the confidentiality of medical information also apply to Telehealth Services. Please see the Notice of Privacy Practices which explains how Drip Hydration Medical Groups may use and disclose confidential health information for treatment, payment, and healthcare operations.
If you have any questions about this Patient Consent, please contact email@example.com.