Last updated: 4/25/2023
Informed Consent To Participate In U.S. Telehealth Consultation & Telemedicine Services
Introduction:
Telehealth services refer to the provision of healthcare services remotely using telecommunications technology. This may include virtual consultations, online therapy, or other forms of telemedicine. Telehealth services can provide greater convenience, accessibility, and flexibility for patients, but it is important to understand the potential risks and limitations of these services.
If you are experiencing an emergency, or if you have severe symptoms or reactions, or if you need urgent medical help: please do not use any telehealth services and instead please go to your nearest emergency room or call 911.
Purpose:
The purpose of this form is to obtain your consent for an U.S. licensed M.D. physician, a licensed D.O. physician, a nurse practitioner under the direction of a M.D. physician, or a physician assistant under the direction of a M.D. physician, (collectively referenced as “Providers” or “Provider”), to provide you with telehealth consultation and telemedicine services using Cure.expert’s or Cure.expert affiliated company’s technology platform and online websites (“Service”). The term “you” and “your” refers to the person using the Service on Cure.expert’s or Cure.expert affiliated company’s technology platform and online websites, and include your legal guardian if you are a minor less than the age of eighteen. The terms “we”, “us” and “our” refer to Cure.expert and Cure.expert’s affiliates, employees, contractors, physicians, medical care providers, partners, subsidiaries, and management service organizations (including Kergi Corp.).
Nature of Telehealth Services:
Telehealth services involve the use of online messaging, online questionaires, emails, videoconferencing, phone calls, video calls, or other electronic communications technology to interact with you, consult with your healthcare provider and/or review your medical information for the purpose of diagnosis, treatment, follow-up and/or education. During your telemedicine consultation, details of your medical history and personal health information may be discussed with other health professionals through the use of interactive video, audio, and/or telecommunications technology. Additionally, if applicable, a physical examination of you may take place and video, audio, and/or photo recordings may be taken or uploaded to Cure.expert websites. Telehealth services may include virtual consultations, remote diagnosis and treatment, online therapy, or other forms of telemedicine. These telehealthservices may be conducted in real-time or asynchronously, and may involve the use of different platforms such as online questionaires, online forms, online chat, phone calls, video calls, or messaging applications.
Benefits:
The benefits of telemedicine include having greater convenience and accessibility to medical specialists and additional medical information and education without having to travel outside of your local health care community. This can be particularly useful for individuals who are unable to attend in-person appointments due to geographic, physical, time, budget, or other constraints. Telehealth services can also be more cost-effective and can help reduce the spread of infectious diseases by minimizing in-person contact.
Risks:
A potential risk of telemedicine is that because of your specific medical condition, or due to technical problems, a face-to-face consultation still may be necessary after the telemedicine appointment. Other risks include: in rare circumstances, security protocols could fail causing a breach of patient privacy or the unauthorized disclosure of personal health information; or technical difficulties such as poor video or audio quality, interruptions in service, bugs in the software on our websites, or corruption or loss of data, causing your health information to be lost or causing your Provider to misdiagnose or provide incorrect treatments or advice; or limitations in the ability of your Provider to perform certain types of examinations or tests remotely or to notice certain vital signs, causing your Provider to misdiagnose or to provide the incorrect treatments or to fail to alert you to seek emergency services; or your Provider’s ability to provide complete, correct, or effective services to you may be restricted; or you may need to seek the care of an in-person physician or emergency services despite having a telehealth consultation; or you may be delayed in seeking the medical evaluation and treatment of an in-person physician or emergency services because of your telehealth consultation; or your Provider may deny you a prescription or drug for your medical problem causing a delays in your medical evaluation and treatment; or your Provider may be limited in providing you with more treatment options; or your Provider, not having access to your health records at other institutions, may misdiagnose or provide you with incorrect treatments or advice, or give you treatments which may cause an allergic reaction or adverse reactions with other drugs you are taking; or your Provider may be limited by federal or state or local regulations to provide you with more treatment options; if your Provider provides you with at-home testing kits made by third parties not affiliated with us, we cannot guarantee the accuracy or reliability of such third-party kits, and such third-party kits may give inaccurate or inconclusive results leading to a misdiagnosis or incorrect treatments or advice.
Specific risks when taking erectile dysfunction drugs:
You understand and accept that risks of taking erectile dysfunction drugs such as tadalafil (Cialis) or sildenafil (Viagra) may include severe side effects and/or declines in your blood pressure ranging from mild to severe and life-threatening, especially if you are also taking conflicting drugs such as 1. nitrates, which include nitroglycerin (Nitrostat, Nitrolingual, Nitro-Dur, Nitroquick, Minitran, Rectiv, GoNitro), isosorbide dinitrate (Isordil, ISDN, Dilatrate-SR, Isochron, Sorbitrate, Isotrate), isosorbide mononitrate (Imdur, ISMO, Monoket), sodium nitroprusside (Nipride, Nitropress), 2. alpha blockers, which include Prazosin (Minipress, Prazopress), Terazosin (Hytrin, Zayasel), Doxazosin (Cardura, Doxadura, Larbex, Raporsin, and Slocin), Tamsulosin (Flomax, Contiflo, Harnalidge, Contiflo, Faramsil, Flomaxtra, Pamsvax, and Tabphyn), Alfuzosin (Uroxatral, Xatral), 3. calcium channel blockers, which include Amlodipine (Norvasc), Diltiazem (Cardizem, Cartia, Diltzac, Taztia, Tiazac), Felodipine (Plendil), Isradipine (DynaCirc), Nicardipine (Cardene), Nifedipine (Procardia, Adalat), Nisoldipine (Sular), Verapamil (Calan, Isoptin, Verelan), 4. beta blockers, which include Acebutolol (Sectral), Atenolol (Tenormin), Bisoprolol (Zebeta), Carvedilol (Coreg), Esmolol (Brevibloc), Labetalol (Normodyne, Trandate), Metoprolol (Lopressor, Toprol-XL), Nadolol (Corgard), Nebivolol (Bystolic), Penbutolol (Levatol), Pindolol, Propranolol (Inderal LA, InnoPran XL), 5. ACE inhibitors, which include Benazepril (Lotensin), Captopril (Capoten), Enalapril (Vasotec), Fosinopril (Monopril), Lisinopril (Prinivil, Zestril), Moexipril (Univasc), Perindopril (Aceon), Quinapril (Accupril), Ramipril (Altace), Trandolapril (Mavik), 6. angiotensin II receptor blockers (ARB), which include Losartan (Cozaar), Valsartan (Diovan), Irbesartan (Avapro), Candesartan (Atacand), Olmesartan (Benicar), Telmisartan (Micardis), Eprosartan (Teveten), or Enalapril (Vasotec), 7. guanylate cyclase stimulators, which include riociguat (Adempas, Riociguat Bayer), 8. protease inhibitors, which include Atazanavir (Reyataz), Darunavir (Prezista), Fosamprenavir (Lexiva), Indinavir (Crixivan), Lopinavir/ritonavir (Kaletra), Nelfinavir (Viracept), Saquinavir (Invirase, Fortovase), Tipranavir (Aptivus), Atazanavir/cobicistat (Evotaz), Darunavir/cobicistat (Prezcobix), Lopinavir/ritonavir (Aluvia), Ritonavir (Norvir), Glecaprevir/pibrentasvir (Mavyret), Grazoprevir/elbasvir (Zepatier), Paritaprevir/ritonavir/ombitasvir/dasabuvir (Viekira Pak, Viekira XR), Simeprevir (Olysio), Voxilaprevir (Vosevi), 9. macrolide antibiotics, which include Azithromycin (Zithromax, Z-Pak), Clarithromycin (Biaxin, Biaxin XL), Erythromycin (E-Mycin, Eryc, Ery-Tab, PCE), Fidaxomicin (Dificid), or Telithromycin (Ketek), 10. antifungal medications, which include Ketoconazole (Nizoral), Itraconazole (Sporanox), Fluconazole (Diflucan), 11. seizure drugs, which include carbamazepine, phenytoin, phenobarbital, and valproate, 12. bendroflumethiazide, which include Aprinox, Neo-Naclex. You acknowledge that you have been specifically warned not to take erectile dysfunction drugs (such as tadalafil or sildenafil) together with the conflicting drugs listed in this section. You understand and accept the risks, benefits, alternatives, side effects, and complications of taking erectile dysfunction drugs (such as tadalafil and sildenafil). You have read and understood all the drug information (which includes drug risks, benefits, alternatives, side effects, and complications) at http://cure.expert/sildenafil and at http://cure.expert/tadalafil.
Alternatives:
The alternative to telemedicine consultation is a face-to-face visit with a physician.
Confidentiality and Privacy:
All U.S. laws concerning patient access to medical records and copies of medical records apply to telemedicine. All telehealth services provided are held to the same standards of privacy and confidentiality as in-person visits. We will use secure platforms that meet HIPAA standards to ensure your personal health information is protected. Dissemination of any patient identifiable images or information from the telemedicine consultation to researchers shall not occur without your consent. All existing confidentiality protections under federal and California law apply to information used or disclosed during your telemedicine consultation. We will not share any personal information that could identify you or include protected health information with any third party without your consent, except in situations where it is allowed for consultation, diagnosis, treatment, billing, prescription drug order fulfillment, or to provide you with our Service, or to run our healthcare operations, or as described in our Privacy Policy. You understand and acknowledge that from time to time we may need to contact you via email that may need to include some of your protected health information. You understand and agree that the devices and software that you personally use to access electronic communications with us (including via emails or directly via a browser on our websites) may or may not be secure, and you agree that it is your sole responsibility to make sure that such personal devices and software are secure so that none of your protected health information contained in the electronic communications may inadvertently be disclosed to anyone other than yourself.
Rights:
You may withhold or withdraw your consent to a telehealth consultation at any time before or during the consult without affecting your right to future care or treatment, or risking the loss or withdrawal of any program benefits to which you would otherwise be entitled. If you withhold consent to a telehealth consultation, the telehealth consultation will not take place. We do not currently accept Medi-Cal. However, if we decide to accept Medi-Cal in the future, and if at that future time you are using Medi-Cal to pay for your service and if you receive teleophthalmology or teledermatology by store and forward, then at that future time you have the right to an interactive communication (whether synchronously or asynchronously) with your medical care provider which may occur at the time of your consultation or within 30 days after you receive the results of the consultation.
Limitations:
Telehealth services may have limitations, including the inability to provide a in-person physical exam, limited access to testing, and difficulty providing certain types of treatment or counseling.
Emergency Situations:
Telehealth services may not be appropriate for emergency situations that require immediate medical attention. If you are experiencing a medical emergency, please contact your local emergency services.
Your Full Acknowledgement, Full Consent, and Full Agreement:
By clicking an “Agree to Informed Consent” or “I Understand and Agree to Informed Consent” or “I agree to all Terms, Conditions, & Policies” or “I understand and agree to all Terms, Conditions, & Policies” buttons on our websites, or by clicking a checkbox for “I agree to Informed Consent” or “I agree to all Terms, Conditions, & Policies” or “I Understand and Agree to Informed Consent” or “I understand and agree to all Terms, Conditions, & Policies” words on our websites, you acknowledge that you are an U.S. person and that you have fully read and fully understood this Telehealth Informed Consent and have been fully informed about the nature and risks and benefits and limitations of telehealth, and you fully accept, fully agree, and fully consent to the telehealth consultation and telemedicine services you will receive. Furthermore, you fully consent and agree to the following: You understand and agree that medical care providers that may provide you with telehealth consultation and telemedicine services using Cure.expert’s or Cure.expert affiliated company’s technology platform and online websites may be a licensed M.D. physician, a licensed D.O. physician, a nurse practitioner under the direction of a M.D. physician, or a physician assistant under the direction of a M.D. physician, or any other medical provider licensed in your state to provide telehealth services. You understand and agree that technical difficulties such as poor video or audio quality, interruptions in service, bugs in the software on our websites, or corruption or loss of data during transmission, may cause your health information to be lost or causing your Provider to misdiagnose or provide incorrect treatments or advice. You hereby release and hold harmless Cure.expert and all members of your medical care team from any loss of data or information due to technical failures associated with the telehealth/telemedicine service. You understand and agree that if your Provider provides you with at-home testing kits made by third parties not affiliated with us, we cannot guarantee the accuracy or reliability of such third-party kits, and such third-party kits may give inaccurate or inconclusive results leading to a misdiagnosis or incorrect treatments or advice. You understand and agree that the utilization of telehealth or other technology cannot assure any definite advantages or particular outcomes or good benefits, including diagnosis or treatment provided by your Provider. You understand and agree that there is a possibility that your medical condition may not be healed or ameliorated, and in certain circumstances, it might deteriorate. You understand and agree that in rare circumstances, security protocols could fail causing a breach of patient privacy or the unauthorized disclosure of personal health information. You understand and agree that limitations in the ability of your Provider to perform certain types of examinations or tests remotely or to notice certain vital signs through telehealth may cause your Provider to misdiagnose or to provide the incorrect treatments or to fail to alert you to seek emergency services. You understand and agree that your Provider’s ability to provide complete, correct, or effective medical care services to you may be restricted through telehealth technology. You understand and agree that you may not be able to seek help for all your medical problems as some medical problems cannot be diagnosed or treated by telehealth. You understand and agree that you may need to seek the care of an in-person physician or emergency services despite having a telehealth consultation. You understand and agree that you may be delayed in seeking the medical evaluation and treatment of an in-person physician or emergency services because of your telehealth consultation. You understand and agree that your Provider will evaluate your medical condition and, at his or her own sole discretion, may conclude that it is medically suitable or unsuitable to diagnose and/or treat your condition using telehealth, and if your Provider deems your case unsuitable for telehealth through Cure.expert, then you will need to obtain another consultation with another medical care provider not affiliated or associated with Cure.expert. You understand and agree that your Provider may deny you a prescription or drug for your medical problem causing a delays in your medical evaluation and treatment. You understand and agree that your Provider may be limited in providing you with more treatment options. You understand and agree that your Provider, not having access to your health records at other institutions, may misdiagnose or provide you with incorrect treatments or advice, or give you treatments which may cause an allergic reaction or adverse reactions with other drugs that you may be taking. You understand and agree that your Provider may be limited by federal or state or local regulations to provide you with more treatment options. You understand and agree that you have the freedom and the choice to receive your medical consultation and examination from a healthcare provider not affiliated with Cure.expert. You understand and agree that Cure.expert has a financial relationship with Cure.expert’s management service organization Kergi Corp. You acknowledge that you have had an opportunity to ask questions about all the information in this Informed Consent via email to service@cure.expert, and you acknowledge that all of your questions have been answered before you start your telehealth consultation with us. If a consultation includes free medications mailed from us but you do not want such free medications and instead want to pay your designated pharmacy to provide you with such medications, you understand and agree that you must email us with your user name and order ID immediately after you place your order, at: service@cure.expert. If you are not able to email us imediately, you agree not to place an order for a telehealth consultation with us in the first place. You understand and agree that all transactions with Cure.expert is on a cash basis only through electronic payments from you to us. You understand and agree that Cure.expert is not a Medicare or Medi-Cal or Mediaid or federal or state enrolled healthcare provider, and you agree to be solely responsible for the full cost of any services or products provided by Cure.expert. You agree that you will not file any insurance claims to any insurance company or to Medicare or to Medi-Cal or to Mediaid or to the Veteran Affairs or to any federal or state agency, and you agree not to ask Cure.expert to help to file any claims, and you agree that Cure.expert is not obligated or liable to you for filing any claims on your behalf with any insurance company or with any federal or state agency. You understand and agree that through the continual use of our Service, you acknowledge and accept your Provider’s medical evaluation of your medical problem and consent to obtain a diagnosis and/or treatment through telehealth technology. You understand and agree that if you access our websites through other persons, then you grant power of attorney and agency powers to such other persons to give full consent and agreement to this Informed Consent on your behalf.