Informed Consent for Telehealth Services
Going to a doctor’s office for health care can take up a lot of your time and require travel. Also, sometimes the health care provider you need is far away. Oshi Health offers you a new way to connect with a health care provider. Instead of going to an office, you can get health care services through electronic communications – like using your phone, tablet or computer. We call this “telehealth”. In this form, we will call your telehealth care provider your “Treating Provider”.
Before you agree to interact with your Treating Provider on an Oshi Health telehealth platform, we want to make sure you understand how telehealth works, and the pros and cons. This consent form explains those things and provides other important information. Please read it carefully. If you understand everything it says, there is a place for you to sign at the end.
Your Treating Provider
You will have the opportunity to pick the Treating Provider that you want. Or, you can ask us to pick someone. Your Treating Provider’s license, experience and credentials are available to you and you can always ask questions if you need help. Your Treating Provider is part of a health care services company called Integrative GI Partners. Oshi Health is not a health care provider – Oshi Health helps you and your Treating Provider by providing the telehealth technology for visits and doing things like scheduling and billing.
You will not be in the same room as your Treating Provider. You might not even be in the same state. This means information is shared back and forth using technology. Your Treating Provider may use all of the following ways to connect with you, share information, and help you with a care plan.
Real-Time “Live” Visits
You may connect with your Treating Provider in “real time” through your phone, tablet, or computer. You may just hear each other’s voices, or see and hear each other on video.
You may send and receive messages to and from your Treating Provider. This may be text, e-mail, voicemail, online chatting, or even regular mail. The messages may include text, pictures, audio messages, or video messages.
“Store and Forward” Interactions
Your Treating Provider may ask other health care providers for advice. That means your Treating Provider may send your information to other health care providers – including providers who are not in your state.
Appointments & Monitoring
You can use the online system to schedule a time to meet with your Treating Provider. Also, if you have a device, like a heart monitor, that device can send information.
Your Treating Provider may help you manage your medications by sending a prescription, giving you a reminder, or offering information about your medicines.
Your Care Plan
You can access information about your care plan, including things like test results. Your Treating Provider can also give you educational information so you can learn more.
Information About You
The types of information you will share with your Treating Provider through telehealth is a lot like the information you give a doctor who you see in person. You may be asked to provide things like your: medical history, social history and habits, current medications, test results, imaging results (like x-rays), past medical records, descriptions of your problems and symptoms, or pictures of you. Your Treating Provider needs correct information about you in order to assess you, understand your concerns, consult with other providers, make recommendations for your care, and educate you about your health. You can log in and update your information any time. By signing at the end of this form, you agree that your Treating Provider and Oshi Health can get copies of your medical records from your other health care providers.
Your Care Plan
Your Treating Provider will help set up a care plan that focuses on you and explain the Treating Providers findings, diagnosis, treatment recommendations, pros and cons of treatment recommendations, and alternative treatments. Just like when you see a doctor in person, your Treating Provider cannot promise you that you will get better. But, your Treating Provider will meet the “standard of care” and follow the same laws that in-person health care providers follow. This means that your Treating Provider will do things in the same way an in-person provider would. If it is necessary for you to see someone in person or meet with a specialist, your Treating Provider will let you know. Sometimes this is called a “referral”. Your Treating Provider will use telehealth to help you ONLY when the Treating Provider thinks it is okay. If you need to see someone in-person, your Treating Provider will not agree to treat you through telehealth.
Just like when you see an in-person doctor, there is no guarantee that your treating Provider will send you a prescription. This will only happen if your Treating Provider thinks you need a prescription medication. You can decide to fill your prescription at any pharmacy you think is best for you.
You Still Need Your Primary Doctor
The biggest difference between in-person visits and telehealth is that there is no physical touching. Telehealth is terrific for certain questions and problems – but you still need a doctor that you can see in person. Your primary care physician is responsible for taking care of your overall health and well-being. Your Treating Providers will help supplement that care. If you do not have a primary care physician, we strongly encourage you to locate one near you. Your Treating Provider will let you know when you should see someone in person.
Your Privacy & Security
Your privacy is very important to us. Federal and state laws require health care providers to protect the privacy and the security of health information. Your Treating Provider will take steps to make sure that your identifiable health information is not seen by anyone who should not see it. The network and software system we use to store your personal health information meets the requirements of federal laws (like HIPAA) and state laws. Our system has a privacy and security plan to protect your privacy and prevent your information from being lost or corrupted. We will not use or disclose your information without asking you first, unless there is a state or federal law that allows us to do that. If you have any questions about how we protect your information, please contact us.
There are many ways that telehealth services are helpful to you and the health care providers who care about you. You can stay at home and still get the help you need. Even if you do not live near a specialist, you can still access care. You do not have to make an appointment just to share information, or get advice from your Treating Provider – you can quickly connect through telehealth. Also, it is much easier for health care providers to share information with each other – and with you.
People sometimes worry about computer networks being “hacked” and someone stealing their personal information. Or, information could get sent out to the wrong place, or get lost or corrupted. Your health information needs to be safe. We have a whole section about privacy and security above. If the internet is not working or there is an equipment problem, we may have trouble connecting and sharing information with you. This does not happen often, but we may need to reschedule your appointment or find another way to connect with you. This could cause a delay in your assessment or treatment.
Some people decide that they really like seeing a doctor in person. This is totally fine – it is really important to be comfortable with your health care provider. Let your Treating Provider know if you don’t want telehealth services. You can find a health care provider near you and we can send them your records.
Other people may be present during your visits with your Treating Provider to operate the telehealth equipment. If this happens, your Treating Provider will tell you. Your Treating Provider wants you to be comfortable sharing information, and it is not a good idea to leave out information because you do not like having another person around. If you would rather be alone with your treating Provider, it is totally okay – just let them know.
Your Medical Records
The telehealth services that you receive will be recorded in your telehealth medical record that we maintain in our system. You have the right to request a copy of your health records. All you need to do is ask. Your records will be prepared and sent to you as required by law. Sometimes there may be a small charge to cover the cost of preparing and shipping the records. Also, when you sign below, you agree that your Treating Provider and Oshi Health may use or send your medical records to others for scheduling and billing purposes. Additional information about your medical records is in our Notice of Privacy Practices.
Before you receive telehealth services, make sure your phone, tablet or computer is working well, and you are hooked up to a good, reliable internet connection. This is really important, especially for real time visits. If you have a friend who is good at these things, it might help to have them around for your first connection. If you are having technical troubles contact:
We want to help fix any problems you have with the telehealth system. Contact us right away if your technology is not working at 646-876-8455. We also want to know right away if you are having any problems with your Treating Provider. Contact us at email@example.com or 646-876-8455 if you have a complaint or want to pick a new Treating Provider. Also, every state has an agency that licenses health care providers. They want to know if a health care provider is not acting properly. You can usually file a complaint with that state agency online. If you need help filing a complaint you can contact us at the above number, or reach out to a local agency for support
Additional State Specific Information
Additional State-Specific Consents: The following consents apply to patients accessing Group’s website for the purposes of participating in a telehealth consultation as required by the states listed below:
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.
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.
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.
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.
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: I have been informed of the following notice: 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 here.
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.
** If you need help right away, please call 911 immediately **
Taking care of emergencies must be done in person. Our telehealth system cannot contact your local emergency services.
If you have any questions, please email us at firstname.lastname@example.org or call us at 646-876-8455.