Informed Consent for Future Health Management. LLC:
You are purchasing a telemedicine visit from Future Health Management LLC Services. Telemedicine is the use of electronic communication between Medical Professionals (“Providers” or “Clinicians”) and patients for the diagnosis and treatment of patients who are in various locations away from the provider. Telemedicine is commonly used for diagnosis, treatment and prescribing of medication. When you are using the Services, you will be seen by a licensed professional in your state. You will therefore enter a doctor-patient relationship with a physician or psychologist of Future Health Management LLC. Please note that Future Health Management. LLC does not provide the services. Rather, it simply provides the administrative, payment and other business operational activities for the Future Health Management. LLC providers in support of the Services that you are using.
The potential benefits of using telemedicine, which you agree to, are improved and quicker access to medical care due to reduced travel and visit time, an efficient medical evaluation and management as well as the ability to access care from any location (assuming data or Wi-Fi access).
The potential risks of using telemedicine, which you agree to, include delays in medical evaluation and treatment due to technological delays, gaps and failures including disconnected video calls, loss of information due to technical or other electronic difficulties and in some cases, a lack of access to complete medical information which may result in allergic or adverse drug reactions or judgment errors.
As reminders for your visit, you will receive the following:
- A confirmation email with a confirmation code as soon as you book your visit.
- A reminder email 15 minutes prior to your visit reminding you to log into the portal for your telehealth visit
- A text message reminder 15 minutes prior to your visit reminding you to log into the portal for your telehealth visit
- You will provide a complete and accurate medical history and will update your medical health records at least twice a year with Future Health Management.LLC.
- You will use electronic equipment such as an iPhone, smartphone, tablet or laptop that has the necessary internet access for the telehealth visit. You also agree to arrange for a location with sufficient lighting and privacy that is free from noise and distractions so that the telemedicine visit can proceed.
- You cannot use Future Health Management.LLC Services to obtain prescriptions for DEA controlled substances, non-therapeutic drugs and certain drugs that have the potential for abuse
- You are not guaranteed a treatment or “cure”; nor are you guaranteed a prescription during your visit. The Future Health Managemental Clinician reserves the right to deny care if he/she suspects misuse of the Services or if in the professional judgment of the Clinician, the Service is not medically or ethically appropriate.
- You understand and state your preference to have your physician, and other staff at GeeVida Health communicate with you by email or standard SMS messaging regarding various aspects of your medical care, which may include, but shall not be limited to, test results, prescriptions, appointments, and billing. Due to the nature of third party email and standard SMS messaging, they may be considered insecure and not confidential methods of communication. This may allow for such risk that email and SMS messaging correspondence containing confidential medical information to be intercepted and read by third party unintended recipients.
- If the provider believes that another form of service (such as an in-person, traditional consultation visit) is appropriate, he/she may discontinue telemedicine services and schedule an in-person consultation or refer me to a provider in my area who can provide such services
- You are not using Future Health Management. LLC for emergencies or life-threatening conditions. If you think you are experiencing a medical emergency or another life-threatening situation, please call 911 or go to the nearest emergency room.
- You are required to pay all visit fees at the time you schedule an appointment.
Your use of the Services is completely voluntary. You reserve the right to withdraw your consent to the services at any time by ending the session. If you choose to end the session, your right to future telemedicine services, your medical history and future relationship with Future Health Management. LLC will NOT be adversely affected.