By clicking the “AGREE” button you acknowledge that you are consenting to receiving care via the Service. The scope of care will be at the sole discretion of the healthcare provider who is treating you, with no guarantee of diagnosis, treatment, or prescription. The healthcare provider will determine whether or not the condition being diagnosed and/or treated is appropriate for a telehealth encounter via the Service. The Service respects and upholds patient confidentiality with respect to protected health information as outlined by the Health Insurance Portability and Accountability Act (“HIPAA”), and, subject to HIPAA regulations, will obtain express patient consent prior to sharing any patient-identifiable information to a third party for purposes other than treatment, payment or health care operations. In addition, by clicking the “AGREE” button you are authorizing Inhealth Medical Services, Inc to release your contact information to American Well solely in order for American Well to provide you with marketing materials promoting the Service. You may opt out of receiving such marketing materials by contacting us at email@example.com. Finally, when using the Service you may be asked if you would like to share certain PHI collected by Apple’s HealthKit with American Well. By clicking on “SYNC” you are authorizing American Well to collect and Inhealth Medical Services, Inc providers to utilize such PHI.
We are providing this information on behalf of Inhealth Medical Services, Inc:
Telemedicine involves the use of electronic communications to enable health care providers at sites remote from patients to provide consultative services. Providers may include, but is not limited to primary care practitioners, specialists, subspecialists, registered dieticians, nutritionists, and health educators. The information may be used for diagnosis, therapy, follow-up and/or education, and may include live two-way audio and video and other materials (e.g. medical records, data from medical devices).
The communications systems used will incorporate network and software security protocols to protect the confidentiality of patient information and will include reasonable measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption.
An encounter summary will be provided to the patient at the end of each encounter which may be kept for the patient’s records and may be shared with the patient’s local primary care or other provider, as appropriate.
Anticipated Benefits of Telemedicine:
Possible Risks of Telemedicine:
As with any medical procedure, there are potential risks associated with the use of telemedicine.
Inhealth Medical Services, Inc believes that the likelihood of these risks materializing is very low. These risks may include, without limitation, the following:
I understand that this authorization to bill my credit card or debit card (including any other American Well accepted payment mechanism) will remain in effect until I cancel it in writing, and I agree to notify American Well in writing of any changes in my account information. In the case of an ACH Transaction being rejected for Non-Sufficient Funds (NSF), I understand that American Well may at its discretion attempt to process the charge again at any time within 30 days. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this credit card/bank account and will not dispute these scheduled transactions with my bank or credit card company; so long as the transactions correspond to the co-payment required by my health plan.