Informed Consent for Telehealth Services

Purpose

Telehealth involves the delivery and facilitation of health and health-related services, including medical care, via telecommunications and digital communication technologies, including but not limited to through websites, audio, video, and asynchronous data communications. The purpose of this consent form (“Consent”) is to provide you with information about Telehealth and to obtain your informed consent to the use of telehealth in the delivery of healthcare services to you by providers (as defined below) using the online platforms and systems owned and operated by Open Laboratories, Inc. and/or its subsidiaries (collectively, “Open Labs,” “we ”, “us”, or “our”). 

In this Consent, the terms “you” and “yours” refer to the person using the services, or in the case of a use of the Services by or on behalf of an individual minor between the ages of thirteen (13) and eighteen (18) or higher age of majority under applicable state law, “you” and “yours” refer to and include (i) the parent or legal guardian who provides consent to the use of the Services by such minor or uses the Services on behalf of such minor, and (ii) the minor for whom consent is being provided or on whose behalf the Services is being utilized.

Open Labs Telehealth Platforms and Services

Open Labs  (“Open Labs,” “Company” or “We”) provides certain websites through which patients can obtain certain Telehealth services from independent, licensed health care professionals (“Providers”) and mail order pharmacy/prescription fulfillment services for medications that may be prescribed to you and/or prepared by Providers (collectively, the “Services”).  The types of transmissions and communications that may occur via Open Labs’ Telehealth platforms include:

·      Administrative services such as information intake, scheduling, patient education, payment, and other operational services.

·      “Asynchronous” communications where a patient’s recorded health history (including but not limited to medical history records, medical intake forms, images, output data from medical devices, diagnostic and/or lab testing results)  is transmitted via electronic mechanism to a Provider who uses the information to evaluate the case or render a service outside of real-time or live interaction.

·      “Synchronous” communications where a patient and a Provider communicate in “real-time” via live video-conferencing, which is a two-way audiovisual link between a patient and a Provider.

·      A combination of “asynchronous” and “synchronous” communications between patient and Provider.

Our Telehealth platforms and systems incorporate network and software security protocols to protect the privacy and security of protected health information.

Open Labs has financial relationship with the Providers. You are free to obtain your medical examination from another healthcare provider that is not associated with Open Labs. Open Labs will use its physician network and/or affiliated pharmacy to fulfill your order directly to your door. You are free to obtain your prescription from any pharmacy of your choice by contacting our support team. You must pay the full amount of the costs associated with use of the Services, including any prescription you may receive, and you will not attempt to submit a claim to Medicare, any other federal payor, or any state or private insurer.

Open Labs and the Providers DO NOT address medical emergencies via Telehealth or otherwise.  In case of an emergency, you should seek immediate medical attention by calling 911.

Potential Benefits and Risks Associated with Telehealth 

There are potential benefits and risks associated with Telehealth. 

Some of the potential benefits of Telehealth include but are not limited to:

·      Improved access to care by enabling you to remain in your home while the provider consults at distant/other sites.

·      Telehealth can make access to medical care easier, more efficient, and less expensive.

·      You can obtain medical care or other services and treatment by Provider(s) at times that are convenient for you.

Some of the potential risks of Telehealth include but are not limited to:

·      Delays in care, evaluation, or treatment could occur due to failures of equipment and technologies.

·      Information transmitted via Telehealth may not be sufficient to allow for appropriate medical decision making or your Provider may not be able to provide medical treatment for your condition, and you may be required to seek alternative care.

·      A lack of access to complete medical records may result in adverse drug interactions or allergic reactions or other judgment errors.

·      In rare events, a Provider may determine that the transmitted information is of inadequate quality, thus necessitating a rescheduled telehealth consult or a meeting with your local primary care doctor.

·      The inability of your Provider to conduct certain tests or assess vital signs in person may in some cases prevent the Provider from diagnosing or treating you or identifying that you need urgent medical care.

·      Data security protocols or safeguards could fail and cause a breach of your identified health information.

·      Due to the nature of the Services and regulatory requirements in certain jurisdictions, your treatment options, especially pertaining to certain prescriptions, may be limited.

Alternative methods of care may be available to you, such as in-person services, and you may choose an alternative at any time. Always discuss alternative options with your Provider.

If you need to receive follow-up care, assistance in the event of an adverse reaction to the treatment, or in the event of an inability to communicate as a result of a technological or equipment failure, please contact Open Labs at patients@openlaboratories.co.

Consent 

BY CLICKING ON THE BOX TITLED “I AGREE AND CONSENT,” YOU ACKNOWLEDGE YOU ACCEPT THIS CONSENT AND ALL OF THE TERMS HEREIN, AND THAT YOU AGREE TO THE FOLLOWING TERMS AND PROVISIONS:

1.    I have read this Consent carefully and understand the risks and benefits of the use of telehealth in my medical care and treatment.

2.  I give my informed consent to receive medical care and treatment from Providers affiliated with Open Labs via telehealth and Open Labs’ telehealth platforms and modalities.

3.   I understand that federal and state law requires health care providers to protect the privacy and the security of health information.  I understand that the provider will take steps to make sure that my health information is not seen by anyone who should not see it. I understand that telehealth may involve electronic communication of my personal medical information to other health practitioners who may be located in other areas, including out of state.

4.  I understand that I have the right to withhold or withdraw my consent to the use of telehealth in the course of my care at any time, without affecting my right to future care or treatment. I understand that I may suspend or terminate use of the telehealth services at any time for any reason or for no reason.

5.  I understand that alternatives to telehealth consultation, such as in-person services are available to me, and in choosing to participate in a telehealth consultation, I understand that some parts of the services involving tests may be conducted by individuals at my location, or at a testing facility, at the direction of the provider.

6.   I understand that while the use of telehealth 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.

7.   I understand that I will not be prescribed any narcotics for pain, nor is there any guarantee that I will be given a prescription at all.

8.  I understand that if I participate in a consultation, that I have the right to request a copy of my medical records which will be provided to me at reasonable cost of preparation, shipping, and delivery.

9.   I understand that the delivery of health care services via telehealth is an evolving field and that the use of telehealth in my medical care and treatment may include uses of technology not specifically described in this consent.

10.                 I understand that I have a duty to answer questions about my health and medical history honestly and accurately, and to keep all of my health care providers, including my Provider, up-to-date on any changes in my health, symptoms, treatments, or medications.

11. I understand that withholding or providing inaccurate information about my health and medical history in order to obtain treatment may result in harm to me, including, in some cases, death.

12.                 I understand that my Provider may determine in his or her sole discretion that my condition is not suitable for treatment using telehealth, and that I may need to seek medical care and treatment in person or from an alternative source.

13.                 I understand that the Services enable coordination and communication with a Provider and do not replace my relationship with any existing health care provider.

14.                 I understand that I cannot obtain emergency care through the Services, and I should call 9-1-1 and seek immediate medical treatment if I am experiencing a medical emergency.

15.                 I understand that my information, including my identified health information, will be collected, used, shared, and protected as described in the Privacy Policy.

16.                  I understand that Open Labs and my Provider may share my telehealth record with my other health care providers only with my consent and at my request. I understand that I can have my telehealth record sent to my other health care providers by emailing Open Labs at patients@openlaboratories.co and providing my consent along with my health care provider’s name, address, and phone number.

17.                  I understand that a technical failure affecting the Services may result in the loss of my information and/or interrupt my online visit. In addition to any disclaimers that I agreed to by accepting the Terms of Use, I agree to hold Open Labs harmless for any loss of information or delay in care resulting from a technical failure.

18.                 I understand that I can withhold or withdraw this consent at any time by emailing Open Labs at patients@openlaboratories.co with such instruction. Otherwise, this consent will be considered renewed upon each new telehealth consultation with a Provider.

19.                  I agree and authorize Open Labs and my Providers to collect, use, and share my information, including my identified health information and other information regarding the telehealth exam, as described in Open Lab’s Privacy Policy and for any other purposes permitted by law, including for treatment, payment, and health care operations purposes.

20.               I agree to indemnify and hold harmless Open Labs and its employees, agents, directors, members, managers, shareholders, officers, representatives, assigns, parents, predecessors, and successors, as well as the Providers, from and against any and all loss or damage, including indirect, incidental, special, consequential, or exemplary damages, expenses, liabilities, claims, or demands, of any kind, resulting from or related to any failure of technology or equipment in connection with the provision of Telehealth, whether or not such loss, damage, expense, liability, claim, or demand arises from or relates to Open Labs or the Provider’s negligence or other conduct.

All capitalized terms used in this Consent but not defined herein have the meanings set forth in Open Labs’ Terms of Use. 

Last Revised: October 14, 2021