Telehealth is the use of electronic and telecommunications technologies, including devices used for digital health, asynchronous and synchronous communications, or other methods, to support a range of medical care and public health services (“Telehealth”). Telehealth enables healthcare providers at different locations to share individual patient medical information for the purpose of improving patient care. Telehealth involves the transmission of health information via electronic communications (such as over the internet, through phones, and other electronic mediums), which may include:
By acknowledging my consent below (or through any “I agree” button or prompt), by using the My Allergy App, or providing my data to generate a My Allergy Score, I understand and agree to the following:
I understand that My Allergy Score, LLC (“My Allergy”) provides through its My Allergy Score software application (“My Allergy App”) data services to users of My Allergy App, which collects, stores, processes, analyzes, and transmits health information to healthcare providers (“My Allergy Score”). I understand that My Allergy Score is transmitted to my healthcare provider through store and forward technology and my healthcare provider will not be physically present in the room with me.
The laws that protect the privacy and confidentiality of health and care information also apply to Telehealth. Information obtained during a Telehealth consultation that identifies me will not be given to anyone without my consent except for the purposes of treatment, billing, and healthcare operations. I understand that I have the right to inspect all information obtained and recorded in the course of a remote nursing interaction and I may receive copies of this information for a reasonable fee.
As with any form of electronic communication, I understand that there are potential risks to the use of Telehealth technology, including but not limited to, interruptions, delays, unauthorized access, and other technical difficulties. I understand that either my healthcare provider or I may discontinue use of My Allergy App if the technical connections are not adequate.
I understand that I could seek an in-office medical consultation from a healthcare provider rather than use My Allergy App to track and report my allergy symptoms, and I am voluntarily choosing to participate in Telehealth.
Disruptions of signals or problems with Internet infrastructure may cause broadcast and reception problems that prevent effective transmission of users and consulting healthcare providers. I hereby release and hold harmless My Allergy and all members of my care team from any loss of data or information due to technical failures associated with Telehealth services and My Allergy App.
I understand and agree that health information gathered by My Allergy App and My Allergy Score may be the only source of health information used by medical professionals during the course of my evaluation and treatment at the time of my Telehealth, and that such professionals may not have access to my full medical record.
My healthcare information may be shared with others for scheduling or billing purposes.
In an emergency situation, I understand that the responsibility of my Telehealth healthcare provider may be to direct me to emergency medical services, such as an emergency room.
I have the right to withhold or withdraw consent to the use of Telehealth services at any time and revert back to traditional in-person clinic services. I understand that if I withdraw my consent for Telehealth, it will not affect any future services or care benefits to which I am entitled.
By acknowledging my consent below (or through any “I agree” button or prompt), by using the My Allergy App, or providing my data to generate a My Allergy Score, I understand and agree to the following: