BRIGHTSIDE HEALTH CONSENT TO TELEHEALTH
Last updated: February 1, 2018
Before using the Service, it’s important to make sure you understand how using the Brightside Health app, including native and web-based apps ('the App') to obtain care differs from visiting a more traditional doctor's office. In particular, make sure you understand the risks associated with taking antidepressant medication. If you have any questions, please send us a message at firstname.lastname@example.org.
NOT FOR EMERGENCIES
I understand that I should never use the App in an emergency. I understand that in an emergency, I should dial 911 or go to an emergency department.
I understand that 24 hour help is available through the Crisis Text Line at 741-741 or the Suicide Prevention Lifeline at 800-273-TALK.
I understand that telehealth involves the delivery of healthcare services using electronic communications, information technology or other means between a healthcare provider and a patient who are not in the same physical location.
I understand that this means that the doctor is unable to conduct certain tests or assess vital signs in-person may in some cases prevent the provider(s) from providing a diagnosis or treatment or from identifying the need for emergency medical care or treatment for me.
I understand that while the use of telemedicine may provide potential benefits to me, as with any medical care service no such benefits or specific results can be guaranteed. My condition may not be cured or improved, and in some cases, may get worse.
I give my informed consent to the use of telehealth by providers affiliated with Brightside Health.
I understand that the doctor has the right to refuse to take responsibility for my care if the doctor makes a professional judgment that I am not a good candidate for this service. I understand that making a request for treatment (by completing a visit and making payment) does not in and of itself create a duty of care or create a doctor-patient relationship.
I understand that the doctor will take responsibility for my care only after the doctor has reviewed my request for treatment, reviewed all my information, and then subsequently determined that I am a good candidate for the telehealth services.
I understand that there may be a delay until the next business day, and at times longer, before a doctor reviews my request for treatment and any messages I send.
I understand that I need to be responsive to ongoing requests for information from me, including but not limited to completion of ongoing assessments about my symptoms and side effects during my treatment, in order to remain under the care of this doctor. If I am not responsive to these requests for information, I understand that I cannot be considered to be under the care of the prescribing doctor.
DEPRESSION TREATMENT ONLY
I understand that by using the App and associated third party services I'll receive care for Depression only. I understand that by using the App and associated third party services I won't receive any other medical services that go beyond Depression. I need to seek other sources for my other medical needs.
GREATER RELIANCE ON INFORMATION I PROVIDE
I understand that by using the App and associated third party services I seek to enter into a relationship where the doctor relies exclusively upon information that I provide to decide whether or not antidepressant medications are safe.
I understand that the doctor has no way of verifying the information I provide and that the doctor will consider the information I provide to be accurate, true, and complete.
I understand that using telehealth means that the information transmitted to the doctor may not be sufficient to allow for appropriate medical decision making by the provider.
UNDERSTANDING THE RISKS ASSOCIATED WITH YOUR MEDICINE
I understand that through the App I can request a prescription for different types of antidepressant medication, each of which has different risks of adverse events and different side effects.
I understand that all the information I provide when requesting a prescription for antidepressant medication is important in the doctor's determination as to whether I'm a good candidate for a particular medication and for the service in general. I agree to provide true and complete information and understand that if I provide information that isn't true and complete, then I'll be at greater risk of adverse events from taking antidepressant medication.
I understand that adverse events can be caused by a number of things, including other health conditions I may have, an allergic reaction, side effects, or interactions between antidepressant medication and other medications, nutritional supplements, or other things I'm taking.
I understand that adverse events from taking antidepressant medication include but aren't limited to increased risk of suicide, Serotonin Syndrome, gastrointestinal bleeding, mania, birth defects, angle closure glaucoma, hyponatremia, and heart, liver, or kidney issues.
NO COMMUNICATION WITH A DOCTOR IN REAL TIME
I understand that by using the App I won't speak or message with a doctor or nurse in real time.
I understand that I must check my email for messages and the App for updates because this is the way that Brightside Health will communicate important information to me. I understand that if I don't check the App regularly, then my care may be delayed.
I understand that if I have any questions relating to my care that aren't urgent, I can message Brightside Health at email@example.com. I understand that Brightside Health may not review my messages until the next business day or possibly later.
IMPORTANCE OF READING INFORMATION BRIGHTSIDE HEALTH PROVIDES
I understand that by using the App I will receive personalized content on the most appropriate treatment methods available to me and that I am using this information to make my own decisions about which treatment(s) I would like to pursue. I understand that it is important that I read the information provided within the App and via links to third-party websites for information about my Depression treatment choices.
I understand that it is critical that I read and understand all information provided about any antidepressant medication prescribed to me. I understand that information about the risks of antidepressant medication is found within the Frequently Asked Questions and the information Brightside Health provides when I am prescribed a specific medication. I also understand that I should discuss the medication with my pharmacist before I begin taking it.
RISK TO ELECTRONIC HEALTH INFORMATION
I understand that the electronic nature of the App means that there's a greater risk to the privacy of my health information compared to visiting a traditional doctor's office. I understand that although Brightside Health implements a wide range of administrative, physical, and technical safeguards to protect my health information, Brightside Health cannot guarantee the privacy and confidentiality of my health information.
I agree and authorize my healthcare provider to share information regarding the telemedicine exam with other individuals for treatment, payment and health care operations purposes.
I agree and authorize my healthcare provider to release information regarding the telemedicine exam to Brightside Health and its affiliates.
I agree to this Consent to Telehealth and acknowledge that using the Site constitutes an on-going agreement to this Consent to Telehealth.