CONSENT TO USE OF “TELEHEALTH” OR INTERNET BASED MEDICAL CARE
YOU HEREBY GRANT AGENCY AUTHORITY TO ANY PARTY WHO CLICKS ON THE “I AGREE” BUTTON OR OTHERWISE INDICATES ACCEPTANCE TO THIS CONSENT ON YOUR BEHALF.
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 (“Provider”) using the online platforms owned and operated by Planet Medical LLC (the “Service”).
Teleheath is the use of electronic media to interact with a Provider. A more typical interaction with a Provider includes a physical examination. For many types of Provider interactions, however, a telephonic or video interaction is sufficient to make a diagnosis and treat. Many states permit such an interaction without a physical examination, but the patient must consent to, and understand, the limitations.
Telehealth is a well-accepted method of delivering health care that is easier for the patient to use. Travel to the doctor’s office is eliminated. Scheduling can usually be more at the patient’s convenience. Telehealth is also generally less expensive. All of these improve access to medical care.
There are also well-appreciated risks. These risks include, among other things, the absence of a face-to-face encounter may decrease the quality or accuracy of the healthcare Provider’s assessment. Much like an electronic visit with a friend or family member via media such as by the telephone or secure online video call may provide a lesser encounter, the Provider may miss important clues and thus, lessen the ability to correctly diagnose or treat your medical condition. A Provider’s assessment can be influenced by subtle direct visual or physical examination signs. Laboratory tests or other tests like x-rays may be important to fully assess your condition.
You should be aware of these potential issues which place a burden on you to be more prepared and thorough in your response to questions as well as knowledgeable about your past medical history, your current medications, allergies, past encounters with Provider, and your symptoms – not just the symptoms related to this encounter but symptoms or problems that you have with other things. Examples would be breathing difficulties, pain, or difficulties with your bowels, eating, or urinating. You must answer all questions accurately, completely, and honestly. If you need to check something, it is more important to do that than to rush the Provider’s assessment.
The Provider we identify are aware of this risk. If the Provider is concerned that a face-to-face encounter is required, then the Provider may decide that you should see your own doctor or another doctor or specialist. If the Provider has any doubt about the ability to provide medical treatment for your particular condition, the Provider may end the session and tell you that you have to seek alternative healthcare. That judgement is made solely and exclusively by the Provider in consultation with you. This is another risk of telehealth – that you interact with the doctor but the doctor decides that he or she cannot treat you using telehealth.
As with all electronic communications in today’s world, data can be hacked. There is a risk that your data or information could be lost or stolen. We will do our best to limit that possibility and to notify you if we identify any breach.
To ensure a degree of safety, the doctors are told by Planet Medical to provide a prescription only in the event that the Provider believes that the telehealth session permits such a prescription under the appropriate standard of care.
Some state laws prohibit providing medical care unless there is at least one face-to-face communication or examination by a Provider licensed in that state. Others permit such care but only if the patient is aware that the examination will be limited to internet-based verbal (telephone) or visual (video chat) communication. Others limit telehealth to evaluation of specified conditions. In those states that permit telehealth without a previous face-to-face encounter, as said the beginning, patients must understate and be informed of the risks of that limitation and then consent. This document is that consent.
The Provider will also review the risks and benefits of telehealth with you directly. If you have further question about the risks or benefits, they should be addressed to the Provider. We will notify the Provider that you may have such questions.
You understand these risks and consent to the telehealth services. You have read this Consent to Telehealth carefully. You understand these risks and benefits. You consent to telehealth services by Planet Medical.
Planet Medical has a financial relationship with the entity that employs or contracts with our Provider. Planet Medical services are only available through our Providers. Planet Medical will use its pharmacy partner to fulfill your order directly to your door. You are free to obtain your prescription from any pharmacy of your choice by contacting our support team.
If the situation is an emergency, call 911. Telehealth is not an appropriate method of care. If you require immediate or urgent care, you must seek care at an emergency room facility or other healthcare provider equipped to deliver urgent or emergent care. If you are not experiencing an emergency or do not require immediate or urgent care, you can communicate with Planet Medical’s Providers through our secure message service. If a technical failure prevents you from communicating with the Provider, you can call the following number:
Phone: 888-523-1005 (M-F 9AM – 5PM EST)
Last updated: June 15, 2020