Consent for the Use of Telehealth in Providing Care:
By selecting the "agree" or accepting this Consent in any other way, you acknowledge that you have read, accepted, and agreed to abide by this Consent and that this acceptance is considered a legally binding signature. You also confirm that you will provide accurate and comprehensive information to the best of your understanding.
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 affiliate physicians ("Providers") using the online platforms owned and operated by Tastermonial, Inc..
All capitalized terms used in this Telehealth Consent but not defined herein have the meanings assigned to them in the Terms of Service. For the avoidance of any doubt, the terms "Tastermonial," "we," "us," or "our" refer to Tastermonial, Inc., and the terms "you" and "yours" refer to the person using the Service.
Nature of Telehealth Services:
Tastermonial does NOT provide medical or healthcare services, including via the Sites or Services. Tastermonial facilitates consultation between affiliated Providers and you. This Telehealth Consent is strictly between you and the Providers (although Tastermonial is a third-party beneficiary of certain releases).
Telemedicine is the use of electronic communications to enable healthcare providers at different locations to share individual patient medical information to improve patient care. The information may be used to determine eligibility for a prescription and, where indicated, to provide such prescription.
Possible Benefits of Telehealth
- Improved access to medical care;
- More efficient medical evaluation and management;
- Possibility of selecting a convenient time and location for appointments.
Possible Risks of Telehealth
There are potential risks associated with the use of telehealth. These risks include, but may not be limited to:
- Insufficient information transmitted for appropriate medical decision-making by the provider;
- Provider may not be able to treat your specific conditions;
- Regulatory limitations on treatment options, including prescriptions;
- Delays in evaluation and treatment due to technology deficiencies or failures;
- Security protocol failures resulting in privacy breaches of personal medical information.
Tastermonial will securely share the data from the Medical Consult questionnaire with a Provider to review and determine your eligibility for a CGM prescription.
As a patient utilizing telehealth services and by accepting this agreement, I understand the following:
- I have read and understand the information provided above regarding the benefits and risks of telehealth.
- I understand that Tastermonial does not provide medical care or treatment.
- I give my informed consent to the use of telehealth by Providers.
- I understand that privacy and confidentiality laws also apply to telehealth.
- I have the right to withhold or withdraw my consent to the use of telehealth at any time by emailing Tastermonial (firstname.lastname@example.org).
- This consent will be renewed upon further consultations unless I explicitly withdraw consent over email.
- I have the right to inspect all information obtained and recorded during a telehealth interaction and may receive copies for a reasonable fee.
- I understand that no results from telehealth services can be guaranteed.
- I understand that a telehealth consultation may not be suitable for me as determined by the Provider.
- I authorize the Provider to share information about my telehealth consultation and exam with others for treatment, payment, and operations.
- I authorize the Provider to release information regarding my consultation and exam to its affiliates.
- I release and hold harmless Tastermonial and any Provider from any loss or misappropriation of data or information arising from the telehealth service.
- I agree and consent to receive electronic communications pertaining to my care from Tastermonial, our affiliates, or the Provider(s), which may include Protected Health Information, acknowledging that not all such communications are end-to-end encrypted, such as SMS (text messaging).