Telehealth Informed Consent
Last Modified: February 15, 2024
THE TELEHEALTH PROVIDERS YOU ACCESS THROUGH URWAY HEALTH LLC DO NOT ADDRESS MEDICAL EMERGENCIES. DO NOT PROCEED WITH CLINICAL SERVICES USING THE URWAY HEALTH PLATFORM IF YOU BELIEVE YOU ARE HAVING A MEDICAL EMERGENCY. IF YOU BELIEVE YOU ARE EXPERIENCING A MEDICAL EMERGENCY, YOU SHOULD DIAL 9-1-1 AND/OR GO TO THE NEAREST EMERGENCY ROOM.
IF YOU ARE CONTEMPLATING SUICIDE, CONTACT 911 OR THE NATIONAL SUICIDE PREVENTION LINE BY ONE OF THE FOLLOWING METHODS:
DIAL 1-800-273-TALK
DIAL OR TEXT 988
Go to 988Lifeline.org to chat LIVE
I. Introduction
You are reviewing and acknowledging this Telehealth Informed Consent because you are seeking Healthcare Services utilizing telehealth technologies provided by various organizations and healthcare providers facilitated through the UrWay Health, LLC (“UrWay Health”) website, iOS mobile app, web mobile app or other telehealth technologies collectively the “UrWay Health Platform.” This Telehealth Informed Consent does not modify or supersede any Terms of Use, Privacy Policy, or Notice of Privacy Practices of UrWay Health, telehealth technology organizations or healthcare providers, rather it supplements these terms and documents. In the event of any conflict or inconsistency between this Consent and the aforementioned documents, the provisions of this Consent shall prevail.
By creating an account, starting a consult, clicking “I consent to telehealth,” checking a related box to signify your acceptance, or using any other acceptance protocol presented through the UrWay Health Platform, you indicate that you have reviewed the risks as described herein of receiving services utilizing telehealth technologies and consent to receiving the services. A record of this Telehealth Informed Consent is maintained in the files and records of the applicable Provider delivering your services. Your on-going participation in services by the healthcare provider using telehealth technologies serves as an on-going acknowledgement of your acceptance of this Telehealth Informed Consent. Any updates to this consent will be communicated to you in a timely manner, and your continued use of the services will be deemed as your acceptance of any such updates.
II. What is Telehealth?
Telehealth involves the delivery of health and wellness services using electronic communications, information technology, or other means between a licensed, certified, or registered healthcare professional at one location and a patient in another location about a clinical matter. Telehealth may be used for diagnosis, treatment, follow-up and/or patient education. These telehealth services may involve various modalities, including asynchronous interactions, real-time (synchronous) video and audio encounters, and interactive audio with store and forward. This “Telehealth Informed Consent” informs the patient (“patient,” “you,” or “your”) concerning the treatment methods, risks, and limitations of utilizing telehealth to meet your health and wellness needs.
III. What are the Possible Benefits of Telehealth?
Benefits of telehealth include being easier and more efficient for you to access health and wellness services. You can obtain health and wellness services at times that are convenient for you without the necessity of an in-office appointment, including follow-up care related to your treatment.
IV. What are the Possible Risks of Telehealth?
Information transmitted to your health professional may not be sufficient to allow for appropriate health or wellness services to meet your particular need. Some clinical needs may not be appropriate for a telehealth visit and your Provider will make that determination. The technology necessary to interact with your health professional may fail and delay your services.
In rare events, a lack of access to complete medical records, and/or the quality of transmitted data could result in adverse drug interactions, allergic reactions, and/or other clinical judgment errors. You may stop or decline any on-going Healthcare Services from a provider using telehealth technologies at any time, although you acknowledge that applicable fees may apply if a medical consultation has occurred prior to request to cancel services. Your telehealth provider has no obligation for your on-going care or selection of separate healthcare services in such circumstances.
I understand that certain diagnostic testing services, including laboratory products and services offered through the UrWay Health Platform to support the Healthcare Services of Providers, may contain defects, including ones which may limit functionality or produce erroneous results, any or all of which could limit or otherwise impact the quality, accuracy and/or effectiveness of the medical care or other services that I receive from my Provider(s).
THIRD-PARTY LABORATORY PRODUCTS AND SERVICES To facilitate certain Healthcare Services, Providers may require that you complete diagnostic test(s). These diagnostic tests are provided by third-party laboratories, and neither UrWay Health, 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. A failure or defect of these tests could also impact your Provider(s) ability to correctly diagnose or treat your medical conditions.
V. Patient Acknowledgments
By accepting this Telehealth Informed Consent, you acknowledge you understand and consent to the following:
1. You have reviewed this Telehealth Informed Consent carefully, and understand there are risks, limitations, and benefits of utilizing telehealth.
2. You understand that while the electronic nature of the telehealth services may present some risks to the privacy of your health information, UrWay Health and the Providers are committed to maintaining the confidentiality and security of your health information and will implement appropriate safeguards to protect your health information.
3. In some cases, my Provider may be a nurse practitioner or physician assistant and not a physician.
4. Persons may be present during the telehealth visit other than my Provider in order to operate the telehealth technologies and/or for language translation assistance, if requested. If another person is present during the telehealth visit, I will be informed of the individual’s presence and his or her role.
5. I understand that information I provide as part of any telehealth offering is viewed as accurate, true, and complete.
6. I understand that in certain instances, and in compliance with applicable law, my Provider may determine that it is appropriate to provide my Healthcare Services asynchronously via store-and-forward technology. In such instances, my Provider and I will communicate electronically through the UrWay Health Platform and/or through Physician’s own communication modalities and not via telephone or video. I agree that if my provider makes that determination, I would like to receive Healthcare Services in this manner.
7. I understand that there is no guarantee that I will be given a prescription and that the decision of whether a prescription is appropriate will be made in the professional judgment of my Provider. I understand that while the use of telehealth may provide benefits to me, no such benefits or specific results can be guaranteed, and my condition may not improve.
8. I understand there is a risk of technical failures during the telehealth encounter beyond the control of UrWay Health and my Provider(s). I AGREE TO HOLD HARMLESS URWAY HEALTH AND ITS EMPLOYEES, CONTRACTORS, AGENTS, DIRECTORS, MEMBERS, MANAGERS, SHAREHOLDERS, OFFICERS, REPRESENTATIVES, ASSIGNS, PREDECESSORS, AND SUCCESSORS FOR DELAYS IN EVALUATION OR FOR INFORMATION LOST DUE TO SUCH TECHNICAL FAILURES. I understand there is a risk of technical failures during the telehealth encounter beyond the control of UrWay Health and my Provider(s). However, UrWay Health and its employees, contractors, agents, directors, members, managers, shareholders, officers, representatives, assigns, predecessors, and successors will make reasonable efforts to prevent such technical failures and to rectify any delays in evaluation or loss of information due to such technical failures.
9. I understand that certain diagnostic testing services, including laboratory products and services offered through the UrWay Health Platform to support the Healthcare Services of Providers, may contain defects, including ones which may limit functionality or produce erroneous results, any or all of which could limit or otherwise impact the quality, accuracy and/or effectiveness of the medical care or other services that I receive from my Provider(s).
10. I understand the UrWay Health Platform makes available a specific set of services and I may need to seek other resources for my other health needs. There is no guarantee that I will be approved for treatment by a Provider. My Provider reserves the right to deny care for any reason if, in the professional judgment of my Provider, the provision of the services, including when provided via telehealth is not medically or ethically appropriate. I understand that the Providers, and not UrWay Health, are responsible for the quality and appropriateness of the care they render to me and make all decisions regarding clinical care in their independent discretion without the influence of UrWay Health. I agree to only seek relief against the Provider for any liabilities pertaining to medical or clinical issues arising as a direct result of medical or clinical services accessed through UrWay Health
11. I understand that by using the UrWay Health Platform I am not always speaking or messaging with my Provider in real-time, and there may be a delay before my messages or information is reviewed. I understand that I may need to check the UrWay Platform for messages because this is the primary way that my Provider will communicate important information to me. However, for urgent or time-sensitive information, my Provider will make reasonable efforts to contact me directly via the contact information I have provided. I understand that if I do not check the UrWay Health Platform regularly, then my services may be delayed.
12. I understand that I have the opportunity to discuss the use of telehealth, including the Healthcare Services, with my Provider(s), including the benefits and risks of such use and the alternatives to the use of telehealth. I have the right to withdraw my consent to the use of telehealth in the course of my care, without prejudice to any future care or treatment and without risking the loss or withdrawal of any health benefits to which I am entitled. However, I understand that the Providers who provide Healthcare Services via the UrWay Health Platform may not offer in-person treatment in all circumstances.
13. I understand that I have access to my medical record pertaining to the Healthcare Services of Providers utilizing the UrWay Health Platform in accordance with applicable laws and regulations and that my primary care provider, or other treating provider, may obtain copies of my health and wellness information with my consent.
14. I understand that while the UrWay Health Platform may make available access to pharmacy or diagnostic lab services that are coordinated with the Healthcare Services, I am able to request any pharmacy or lab of my preference.
15. I agree that UrWay Health, in collaboration with the Providers, is a third-party beneficiary of the Telehealth Patient Consent and has the right to enforce it.
