Truemed Telehealth Consent

Telehealth is a mode of delivering health care services via communication technologies to facilitate diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care.

You are reviewing and acknowledging this Telehealth Consent because you are seeking healthcare services (the “Services”) facilitated by True Medicine, Inc. (“Truemed”) and provided by Truemed’s partner telehealth services providers (the “Medical Groups”) through Truemed’s online applications and websites (the “Platform”). A list of Truemed’s partner Medical Groups is listed below, and through this Telehealth Consent you are consenting to the Medical Groups’ provision of telehealth services; Truemed is a third-party beneficiary of this Telehealth Consent. If you receive telehealth services from OpenLoop Healthcare Partners, PC and its affiliated entities and providers (“OpenLoop”), by agreeing to this Telehealth Consent you are also consenting to OpenLoop’s telehealth consent form, which you can find here.

This Telehealth Consent supplements but does not modify or supersede Truemed's Terms of Use, Privacy Policy, or Consumer Health Data Privacy Policy, or any other terms of service, privacy policy, or notice of privacy practices of other Medical Groups or healthcare providers offering services via the Platform.

By beginning Truemed’s medical questionnaire available through the platform, you indicate that you have reviewed this Telehealth Consent or had it explained to you, that you understand the risks and limitations of using telehealth technologies, that you have been given the opportunity to ask questions and that such questions have been answered to your satisfaction, and that you consent to receiving the Services from licensed health care providers employed by or contracted by the Medical Groups (“Providers”) who are located at sites remote from you.

• I understand that Medical Groups offer telehealth encounters, which are conducted through asynchronous technology and my Provider will not be present in the room with me.

• To protect the confidentiality of my health information, I agree to undertake my telehealth encounter in a private location using secure technology (i.e., not using shares computers). I understand that my Provider will similarly be in a private location.

• I understand there are potential risks to the use of telehealth technology, including but not limited to, interruptions, delays, unauthorized access, and or other technical difficulties. I understand that either my Provider or I can discontinue the telehealth appointment if the technical connections are not adequate for my visit. I AGREE TO HOLD HARMLESS TRUEMED AND ITS MEDICAL GROUPS, TOGETHER WITH THEIR 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 that in some cases, my Provider might be a nurse practitioner, physician assistant, or other appropriately licensed clinician, and not a physician.

• I understand that I could seek an in-office visit rather than obtain care from a Provider, and I am choosing to participate in a telehealth encounter with a Provider. I further understand that my Provider may not have access to a complete copy of my medical records and will not have the ability to perform an in-person examination, which could result in negative health outcomes from the recommended treatment (e.g., adverse drug interactions or allergic reactions). I further understand that while using telehealth technologies may benefit me, no such benefits or specific results are guaranteed and my condition may not improve.

• I agree that any information I provide as part of any telehealth visit is accurate, true, and complete.

• I understand that my Provider may determine that a telehealth encounter is not appropriate for me due to my particular health concern or for other reasons related to my health status.

• I understand that participating in a telehealth encounter is not a guarantee that I will be given a letter of medical necessity, and that the decision as to whether a letter of medical necessity is appropriate for my condition and the product(s) or service(s) I am seeking will be made in the professional judgment of my Provider.

• I understand that I am responsible for payment of any amounts due and owing resulting from my telehealth encounter.

• I understand that Providers do not address medical emergencies via the Platform. I understand that the responsibility of my Provider may be to direct me to emergency medical services, such as an emergency room.

• I (we) the parent(s) or legal guardian of a minor, do hereby authorize consent to any medical order, laboratory order, medical diagnosis, or treatment and that I (we) have legal authority to consent to such treatment or order.

• I agree that Root Cause Functional Medicine, PLLC, OpenLoop Health, Inc., and their respective affiliates are third party beneficiaries of this Telehealth Consent and have the right to enforce it against me.

• I understand and agree that I give permission to Providers to use and disclose my personal information, including protected health information and information within my medical record.

• To the extent that Truemed uses or discloses any protected health information, such use or disclosure is for the purpose of telehealth treatment, operations, or payment purposes.

• Alaska: I understand that my primary care provider may obtain a copy of my records of my telehealth encounter.

• California: The Open Payments database is a federal tool used to search payments made by drug and device companies to physician and teaching hospitals. It can be found at https://openpaymentsdata.cms.gov.

• Treatment Records: I understand that If I live in one of the following states, my primary care provider or other treating physician may obtain a copy of my telehealth treatment records with my consent, and the applicable Medical Group may, upon request, securely send a copy of my telehealth treatment records to my primary care provider or other treating physician. If I need help sending my telehealth treatment records to my primary care provider I can contact Truemed at privacy@truemed.com and provide information necessary for the Medical Group to securely send my records.

  • Connecticut: I understand that my primary care provider may obtain a copy of my records of my telehealth encounter.

  • Kansas: I understand that if I have a primary care provider or other treating physician, the person providing telemedicine services must send a report to such primary care or other treating physician of the treatment and services rendered to me during the telemedicine encounter within three days of me providing consent to the person providing telemedicine services to send such report.

  • New Hampshire: I understand that my primary care provider or treating provider may obtain a copy of my records of my telehealth encounter.

  • New Jersey: I understand I have the right to request a copy of my medical information, and I understand my medical information may be forwarded directly to my primary care provider or health care provider of record, or upon my request, to other health care providers.

  • Ohio: I understand that my primary care provider may obtain a copy of my records of my telehealth encounter.

  • South Carolina: I understand that my medical records may be distributed only with my consent and in accordance with applicable laws and regulations to other treating health care practitioners.

  • Texas: I understand that with my consent my medical records may be sent to my primary care physician within 72 hours after receiving Services.

• California: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board's website here, or the physician assistant board's website here.

• Georgia: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board's website, here.

• Idaho: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board's website, here.

• Indiana: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board's website, here.

• Iowa: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board's website, here.

• Kentucky: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board's website, here.

• Maine: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board's website, here.

• New York: I have been informed that to get information regarding your rights and how to report professional misconduct, I should visit here.

• Oklahoma: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board's website, here; or, the Oklahoma Board of Osteopathic Examiners' website, here.

• Oregon: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board's website, here.

• Rhode Island: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board's website, here.

• Texas:

  • NOTICE CONCERNING COMPLAINTS - Complaints about physicians, as well as other licensees and registrants of the Texas Medical Board, including physician assistants, acupuncturists, and surgical assistants may be reported for investigation at the following address: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018, Assistance in filing a complaint is available by calling the following telephone number: 1-800-201-9353, For more information, please visit our website at www.tmb.state.tx.us.

  • AVISO SOBRE LAS QUEJAS - Las quejas sobre médicos, asi como sobre otros profesionales acreditados e inscritos del Consejo Médico de Tejas, incluyendo asistentes de médicos, practicantes de acupuntura y asistentes de cirugia, se pueden presentar en la siguiente dirección para ser investigadas: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018, Si necesita ayuda para presentar una queja, llame al: 1-800-201-9353, Para obtener más información, visite nuestro sitio web en www.tmb.state.tx.us.

• Vermont: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board's website, here; or, the Vermont Board of Osteopathic Examiners' website, here.

• Wyoming: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board's website, here.