CONSENT TO TELEHEALTH/TELEMEDICINE

Last Updated: June 23, 2022

​

YOU UNDERSTAND THAT BY CHECKING THE BOX FOR THESE TERMS OF USE AND/OR ANY OTHER SUCH FORM OF THE SAME PRESENTED TO YOU FROM TIME TO TIME ON THE SITE YOU ARE AGREEING TO THESE TERMS OF USE AND THAT SUCH ON-GOING ACTIONS IN USING THE SITE CONSTITUTE A LEGAL SIGNATURE AND ON-GOING AGREEMENT TO THESE TERMS OF USE (IN WHATEVER FORM).

All capitalized terms used in this Consent to Telehealth/Telemedicine but not defined herein have the meanings assigned to them in the Terms of Use. For avoidance of any doubt, the terms “modMD“, “we“, “us“, or “our” refer to modMD, PC and the terms “you” and “yours” refer to the person using the Service.

Telehealth/Telemedicine involves the delivery of healthcare services using electronic communications, information technology or other means between a healthcare provider and a member who are not in the same physical location. Telehealth/Telemedicine may be used for diagnosis, treatment, follow-up and/or member education, and may include, but is not limited to:

• Electronic transmission of medical records, photo images, personal health information or other data between a member and a healthcare provider

• Interactions between a member and healthcare provider via audio, video and/or data communications

• Use of output data from medical devices, sound and video files.

 

The electronic systems used for the Service will incorporate network and software security protocols to protect the privacy and security of health information and imaging data, and will include measures to safeguard the data to ensure its integrity against intentional or unintentional corruption.
 

Possible Benefits of Telehealth/Telemedicine

• Can be easier and more efficient for you to access medical care and treatment.

• You can obtain medical care and treatment at times that are convenient for you.

• You can interact with providers without the necessity of an in-office appointment.

 

Possible Risks of Telehealth/Telemedicine

• Information transmitted to your provider(s) may not be sufficient to allow for appropriate medical decision making by the provider(s).

• The inability of your provider(s) to conduct certain tests or assess vital signs in-person may in some cases prevent the provider(s) from providing a diagnosis or treatment or from identifying the need for emergency medical care or treatment for you.

• Your provider may not able to provide medical treatment for your particular condition via telemedicine and you may be required to seek alternative care.

• Delays in medical evaluation/treatment could occur due to failures of the technology.

• Security protocols or safeguards could fail causing a breach of privacy.

• Given regulatory requirements in certain jurisdictions, your provider(s) treatment options, especially pertaining to certain prescriptions may be limited.

 

By accepting this Consent to Telehealth/Telemedicine, you acknowledge your understanding and agreement to the following:

• I have read this special Consent to Telehealth/Telemedicine carefully, and understand the risks and benefits of the use of telemedicine in the medical care and treatment provided to me through modMD’s platform by “Providers”.

• I give my informed consent to the use of telemedicine by providers affiliated with modMD.

• I understand that the delivery of healthcare services via Telehealth/Telemedicine is an evolving field and that the use of telemedicine in my medical care and treatment may include uses of technology not specifically described in this consent.

• I understand that while the use of Telehealth/Telemedicine may provide potential benefits to me, as with any medical care service no such benefits or specific results can be guaranteed. My condition may not be cured or improved, and in some cases, may get worse.

• I understand that “Providers” may determine in his or her sole discretion that my condition is not suitable for treatment using Telehealth/Telemedicine, and that I may need to seek medical care and treatment in-person or from an alternative source.

• I understand that the same confidentiality and privacy protections that apply to my other health care services also apply to these Telehealth/Telemedicine services.

• I understand that I have access to all of my health and wellness information pertaining to the Telehealth/Telemedicine services in accordance with applicable laws and regulations.

• I understand that I can withhold or withdraw this consent at any time by emailing modMD Men’s Health with such instruction. Otherwise, this consent will be considered renewed upon each new Telehealth/Telemedicine consultation with “Providers”.

• I agree and authorize my health care provider to share information regarding the Telehealth/Telemedicine exam with other individuals for treatment, payment and health care operations purposes.

• I agree and authorize my health care provider to release information regarding the Telehealth/Telemedicine exam to modMD.

 

By accepting this Agreement, you acknowledge and agree that modMD may send you messages, reports, and emails regarding your diagnosis and/or treatment. You further understand and agree that it is your sole responsibility to monitor and respond to these messages, reports, and emails and that ModMD will not be responsible in any way and you will not hold ModMD liable for any loss, injury, or claims of any kind resulting from your failure to read or respond to these messages or for your failure to comply with any treatment recommendations or instructions.

 

By accepting this Agreement, YOU EXPRESSLY AGREE TO  RELEASE, WAIVE, DISCHARGE, COVENANT NOT TO SUE, AND AGREE TO HOLD HARMLESS MODMD AND ITS HEALTHCARE STAFF (INCLUDING BUT NOT LIMITED TO THE PHYSICIANS AND OTHER PROFESSIONALS ADMINISTERING SERVICES), MEMBERS, SHAREHOLDERS, OFFICERS, AGENTS, CONTRACTORS, VOLUNTEERS, AND/OR EMPLOYEES, FROM ANY AND ALL LIABILITIES, CLAIMS, DEMANDS, INJURIES (INCLUDING, WITHOUT LIMITATION, PERSONAL INJURY, DEATH AND LOST WAGES, SALARY AND EMPLOYMENT), OR DAMAGES, INCLUDING, WITHOUT LIMITATION, COURT COSTS AND ATTORNEY’S FEES AND EXPENSES, THAT MAY BE SUSTAINED BY ME AS A RESULT OF THE TELEHEALTH/TELEMEDICINE SERVICES, INCLUDING MATTERS OF NEGLIGENCE AND STRICT LIABILITY.​

​

​