Telehealth Medical Consent

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DIAL 1-800-273-TALK

DIAL OR TEXT 988

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I. Introduction

You are reviewing and acknowledging this Telehealth Informed Consent because you are seeking Healthcare Services utilizing telehealth technologies by the Colchis Medical Group facilitated through the Adonis Health, Inc. website, iOS mobile app, web mobile app or other telehealth technologies collectively the “Adonis Platform.” This Telehealth Informed Consent does not modify or supersede any Terms of Use, Privacy Policy, or Notice of Privacy Practices of Adonis Health or the Providers, rather it supplements these terms and documents.

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 Adonis 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, and your on-going participation in services by the Colchis Medical Group using telehealth technologies serves as an on-going acknowledgement of your acceptance of this Telehealth Informed Consent and updates at such time the representations you provide herein.

Colchis Medical Group refers to a network of medical professional organizations affiliated with Adonis Health, Inc. and its employed and contracted health providers (the “Providers”).

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. If you need follow-up care, please contact us through the Adonis Health Platform or the Adonis Health call center at

1-909-787-2342,  Mon – Sun 4:00 am PST – 5:00 p.m PST

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. If a technical failure prevents you from communicating with your Providers, you should call the following number:

Phone: 1-800-(909) 787-2342 Mon – Sun 4:00 am PST – 5:00 pm PST

 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 provided by Colchis Medical Group 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 and Colchis Medical Group 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 Adonis 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 Adonis Health, Colchis Medical Group, 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.

 

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