Telehealth Consent Policy

These Terms of Use (“Terms”) govern use of the TeleMed2U, Inc. (“we,” “us,” or “our”) website and any other website or online service operated by TeleMed2U, Inc. and Cloud Health Medical Group, P.A., Cloud Health Medical Group of California, P.C., Cloud Health Medical Group of New Jersey, P.A., and Cloud Health Medical Group of Kansas, P.C. (collectively, “Cloud Health Medical”) that links to these Terms (collectively, the “Services”).

Please review these Terms carefully before using the Services. We may change these Terms or modify features of the Services at any time. By using the Services, you accept these Terms; by continuing to use the Services after changes are posted, you accept those changes.

The Services respect and uphold patient confidentiality for protected health information (“PHI”) as required by HIPAA. Subject to HIPAA, express patient consent will be obtained before patient-identifiable information is shared with a third party for purposes other than treatment, payment, or healthcare operations.

By clicking “AGREE,” you authorize providers to release your contact information to Telemedicine Group DE, L.L.C. dba TeleMed2U and Cloud Health Medical solely so they may provide information about additional clinical services or general wellness. You may opt out by contacting Privacy@TeleMed2U.comMedrecs@telemed2u.com.

While using the Services, you may be asked whether you want to share PHI collected by third-party platforms with TeleMed2U and Cloud Health Medical. By clicking “AGREE,” you authorize TeleMed2U and Cloud Health Medical to collect, and providers to use, that PHI.

We provide the following information on behalf of participating providers.

Telemedicine uses audio, video, or other electronic communication to allow healthcare providers remote from patients to provide consultation, therapy, or treatment. A provider may use video-conferencing technology for a telehealth session. With consent, a session may be recorded for quality review, operations, training, research, and safety. Information may be used for diagnosis, therapy, follow-up, or education and may include live two-way audio, video, and other materials. I confirm that I have read this form, or had it explained to me, and understand the following:

Telemedicine Benefits

• Improved access to healthcare providers from a patient’s home or office
• Improved efficiency for access to medical evaluation and management

Telemedicine Risks

• Technical problems, including video, sound, or connectivity issues, may require rescheduling, referral to an in-person appointment, use of another TeleMed2U- or Cloud Health Medical-approved video service, or other arrangements to continue the visit.
• Limited ability to respond to emergencies during the visit
• Although safeguards are used, security protocols could fail and cause a breach of privacy involving personal medical information.
• I or my provider may determine that the video-conferencing equipment or connection is inadequate and stop the telemedicine visit, switch to another approved service, or make other arrangements to continue.
• The possibility that conditions identifiable in person may not be identified during telehealth

Acknowledgements

• A video consultation is not the same as an in-person visit because I am not in the same room as my provider. Telemedicine may electronically communicate my personal medical information to practitioners in other areas, including outside my state. I will be informed and asked for consent before other TeleMed2U or Cloud Health Medical staff or trainees actively assist my provider during the visit.
• I may ask my provider questions about telehealth benefits and risks and have them answered to my satisfaction before services. The risks, benefits, and alternatives have been explained in a language I understand.
• The laws protecting privacy and confidentiality of medical information apply to telemedicine, and I have reviewed the HIPAA Notice.
• Benefits cannot be guaranteed.
• Information may be shared for treatment, payment, and healthcare operations.
• Health-plan payment policies for telehealth may differ from in-person policies. I am responsible for applicable out-of-pocket costs, including copayments and coinsurance.
• During a telehealth visit, I must be physically located in a state where my provider is licensed or the visit must be rescheduled. If I am in a state different from the one previously provided, I will notify the provider’s office before the visit so eligibility can be confirmed.
• I may refuse telehealth at any time. The refusal will be documented in my medical record and will not affect my right to future care or treatment or cause loss or withdrawal of benefits to which I am otherwise entitled.

Access, Network, and Plan Provisions

You may receive services from providers in person or through telehealth, if available. Contact your primary care provider, treating specialist, facility, or other health professional to determine availability. Telehealth and in-person services are subject to applicable timeliness and geographic-access standards. Coverage, cost-sharing obligations, and balance-billing protections depend on your plan, including whether it offers out-of-network benefits, has no or limited out-of-network benefits, or is a Medicare Supplement plan.

Medical Records and Primary Care Provider Sharing

You have the right to access your medical records. Records of care received from third-party corporate telehealth providers will be shared with your primary care provider (“PCP”). Your record will be made accessible through an electronic patient-record system or provided by another method unless you opt out. Costs for services received through a third-party corporate telehealth provider are available at in-network cost-sharing rates, and out-of-pocket costs will accrue toward any applicable deductible or out-of-pocket maximum.

If you do not want a third-party telehealth provider to share information about your care with your PCP, call the number on the back of your medical insurance card or contact medrecs@telemed2u.com to opt out.

• I have rights relating to access, sharing, and restrictions involving my health information.
• My healthcare information may be shared when a valid court order requires medical records, to report suspected abuse, neglect, or domestic violence, or to prevent or reduce a serious threat to anyone’s health or safety.
• I may choose services from a medical group or provider with in-person clinics instead of telehealth.
• I may withhold or withdraw telehealth consent at any time without affecting future care, treatment, or entitled benefits.
• Federal and state law require protection of health-information privacy and security. Telehealth reports become part of my medical record, and TeleMed2U and Cloud Health Medical will protect them under applicable law.
• Telehealth may electronically communicate my personal health information to practitioners in other areas, including outside my state.
• There is no guarantee I will be treated by a Cloud Health Medical provider. A provider may deny care for potential misuse or when services are not medically or ethically appropriate in the provider’s professional judgment.

Additional General Telehealth Disclosures

I understand that telehealth may involve transmission of personal health information across state lines; that all resulting medical reports become part of my record; and that applicable federal and state confidentiality protections apply. I may choose an available in-person provider instead, withhold or withdraw telehealth consent without affecting future care, and ask questions about alternatives. A provider may decline services when misuse is suspected or care is not medically or ethically appropriate.

Patient Consent to the Use of Telemedicine

I have read and understand the information above and understand the risks and benefits of the Services. By accepting these Terms, I consent to telehealth as an acceptable form of delivering healthcare services to me, and this consent covers any and all of my sessions using telehealth.