Consent for Telehealth with

East Coast Telepsychiatry

The following is a consent for Telehealth with East Coast Telepsychiatry. You acknowledge that you have read and agreed to these Terms and Conditions. If you do not agree to these terms and conditions, do not use the Telehealth Service. By accepting these Terms and Conditions, you grant Agency Authority to any party who uses the Service on your behalf.

​Purpose

The purpose of this consent form (“Consent”) is to provide you with information about telehealth and to obtain your informed consent to the use of telehealth in the delivery of healthcare services to you by physicians, physician assistants, and nurse practitioners (“Providers”) using the online platforms owned and operated by East Coast Telepsychiatry (the “Service”). By acknowledging this Consent, you are agreeing that we may deliver health care services to you through the Service rather than in person at a provider’s office. You understand that your ability to receive care through telemedicine depends upon your location, the availability of local providers, and other factors.

Telehealth

Telehealth may be used for diagnosis, treatment, follow-up, and/or patient education, and may include, but is not limited to, one or more of the following: electronic transmission of medical records, photo images, personal health information, or other data between a patient and a healthcare provider; interactions between a patient and healthcare provider via audio, video and/or data communications (such as secure messaging); use of output data from medical devices, sound and video files. Alternative methods of care may be available to you, such as in-person services, and you may choose an alternative at any time. Always discuss alternative options with your Provider.

Benefits

Telehealth offers several important benefits. The use of telehealth may make it easier and more efficient for you to access medical care and treatment for the conditions treated by your Provider(s). You may also be able to interact with your Provider(s) without the necessity of an in-office appointment. Telehealth offers benefits for patients, including access to specialized medical expertise, distant diagnostics, laboratory testing and data collection, provider recommendations, and reduced office visits.

Potential Risks

While telehealth can provide many benefits to patients, there are also risks associated with its use. These risks include but are not limited to Quality, accuracy, and effectiveness may be limited; Mechanical failure of equipment or software; The limits of technology may impact your Provider’s ability correctly diagnose or treat your medical condition;

Your Provider(s) may not be able to conduct certain tests or assessments in person, including but not limited to, vital signs and physical examinations. If a physical examination is required, your Provider(s) may need to consult with an expert at another institution (via teleconference). This approach may be used for some of your tests including but not limited to biopsies, blood tests, chest X-Rays, and CT scans. Your Provider(s) may also be unable to provide medical treatment for conditions that require observation of symptoms or other assessment of risk factors beyond what can be obtained through communication.

Emergencies

If you require urgent or emergent care, you must seek care at an emergency room facility or other provider equipped to deliver urgent or emergent care. If a technical failure prevents you from communicating with your Providers through the Platforms, call 1-(843)-299-2033 for assistance or the Contact Us page.

Data Privacy and Protection

A variety of security mechanisms will be used to protect the privacy and security of your information. These include network and software security protocols, which will include measures to safeguard data against intentional or unintentional corruption. Personal information that identifies you, or contains protected health information, will not be disclosed to any third party without your consent unless required by law or as otherwise outlined in your Provider’s Notice of Privacy Practices.

Acknowledgments

Healthcare services provided to you by Providers via the Service will be provided by telehealth. Certain technology, including the Service, may be used while still in a beta testing and development phase, and before such technology is a final and finished product. The technology used to deliver care, including the Service, may contain bugs or other errors, including ones that may limit functionality, produce erroneous results, render part or all of such technology unavailable or inoperable, produce incorrect records, transmissions, data, or cause records, transmissions, data or content to be corrupted or lost.

You may use telehealth services, which may include the Service, to communicate with your Provider(s), including receiving a diagnosis, treatment plan, and specific information about your condition. The delivery of healthcare services using telehealth is an evolving field and uses of technology different from those described in this Consent or not specifically described in this Consent may be used by the Provider(s). You have the opportunity to discuss the use of telehealth including the benefits and risks of such use.

Electronic Communications

You understand that the use of telehealth involves electronic communication of your personal medical information to Provider(s). You have the right to withdraw your consent to the use of telehealth in the course of your care, without prejudice to any future care or treatment and without risking the loss or withdrawal of any health benefits to which you are entitled, but you understand that the Providers who utilize the Service do not offer in-person treatment. Any withdrawal of your consent will be effective upon receipt of written notice to your Providers, except that such withdrawal will not have any effect on any action taken by East Coast Telepsychiatry or your Provider(s) in reliance on this Consent before it received your written notice of withdrawal. Any withdrawal of your consent will not affect any other provision of this Consent, and you will continue to be bound by this Consent.

Obligations

You are obligated to provide truthful, complete, and accurate information about any treatment you may be receiving from healthcare providers. The provider may determine whether the condition is suitable for treatment using telehealth technology or needs monitoring with a specialist or other health care provider outside of such technology. You are free to obtain your prescription from any pharmacy of your choice, however, East Coast Telepsychiatry has a commercial relationship with several partner pharmacies. East Coast Telepsychiatry has a financial relationship with the entity that employs or contracts with your provider; these companies will benefit financially if you use telehealth technology to get your prescriptions filled through their pharmacies.