Before you give your informed consent to request and receive telehealth services, please be aware of how obtaining health services remotely from our physicians and other licensed health care professionals (together, the “Providers”) through an online telehealth platform developed and maintained by K Health, Inc., (the “Platform”) differs from in-person care. Some of the risks associated with receiving telehealth services are described in this Informed Consent. There may be other risks to telehealth services that are not currently known.
Our Providers are affiliated with one or more of the following K Health professional entities: Knowledge Health Medical Services, P.C. (NY), Knowledge Health Medical Services, P.C. (NJ), and Preventive Medicine Associates, P.C. (CA) (collectively, “K Health Professional Entities”). If you are connecting with a Provider in NJ or CA, you will be served by our NJ or CA professional entity, respectively. All other locations will be served by Knowledge Health Medical Services, P.C. (NY). In this Informed Consent, the terms “K Health,” “we”, “us”, or “our” refers to the K Health Professional Entities and K Health, Inc. The terms “you” and “yours” refer to the patient using the Platform to request telehealth services from Providers affiliated with the K Health Professional Entities. Please read each item carefully.
You understand that you should never use the Platform in a medical emergency. You understand that in a medical emergency you should dial 911 or visit an emergency room. Our services are not designed for acute treatment of severe behavioral health systems. In the event you are experiencing emotional distress, please contact the National Suicide Prevention Hotline: Crisis Text Line at 1-800-273-8255, text 988, or text “Home” to 741-741, to obtain immediate assistance.
You understand that K Health provides, through its Providers clinical care services through a web-based Platform as part of an overall primary care practice and that it is not a full-service medical practice. K Health’s Services may also include certain mental health therapy services provided by mental health professionals. Our primary care practice and our mental health therapy services are herein referred to together as the “Services”. You understand that your use of such Services is voluntary and you can seek in-person treatment at any time. You further understand that the Platform may involve asynchronous and synchronous communications and the electronic transmission of medical information and other data between you and your Provider.
In using the Services on the Platform, you understand that you will be provided with your treating Provider’s name and credentials. If you are receiving treatment from an advanced practice professional (e.g. a nurse practitioner) and would like to speak to a physician, you may request to speak to a physician, although you understand that there could be a delay in service. You understand that state medical licensure laws require that you be seen by a Provider who is licensed to practice in the state where you are located at the time of the Service.
You understand that by using the Platform to receive Services, you will not have an in-person physical examination from the K Health Professional Entities that might identify a potentially serious medical condition, and that the absence of an in-person physical examination may affect the Provider’s ability to diagnose any potential condition, disease, or injury. You also understand and agree that the health information you provide through the Platform may be the only source of health information used by Providers during the course of your evaluation and treatment through the Platform, and that such Providers may not have access to any other health information held by your previous medical providers (e.g., allergies, drug reactions, etc.) or be able to otherwise confirm the health information you inform them about. You understand and agree that any diagnosis you receive is limited, and, in some cases, provisional and that the Services are not intended, in all cases, to replace a full medical evaluation or an in-person visit with a health care Provider. Your Provider may not be able to diagnose or treat you if you require an in-person physical exam or any other test that requires a follow-up visit.
Any care that you receive is based on your symptoms and information you provide. You certify that the information, including your geographic location, you provide to the Platform for the Services is true, accurate, and complete. You understand that if you knowingly provide false, misleading, or incomplete information to a Provider, it may have a negative effect on your treatment and your health.
You understand that you need to be responsive to ongoing requests for information from your care team, including but not limited to completion of ongoing assessments about your symptoms and side effects during your treatment, and to consent to access to prior medical information, including your prescription history, in order to remain under the care of your care team. If you are not responsive to these requests for information, you understand that you cannot be considered to be under the care of the prescribing provider or care team. You understand that a variety of alternative methods of medical care may be available to you, and that you may decide to stop using the Services and choose one or more of these alternative modes of care at any time.
Payment and Insurance
If you are enrolled in our Membership Plan(s) (as defined by the Terms of Service), you understand that K Health is not an insurance company and any Membership Plan offered by K Health does not meet any individual health mandate that may be required by federal law. You further agree and acknowledge that: (i) if you are uninsured you may still be subject to tax penalties under the Patient Protection and Affordable Care Act for failing to obtain insurance; and (ii) that our Membership Plans have exclusions as further described in our Terms of Service. If you are a Medicare or Medicaid enrollee or insured by other health insurance plans, you may be entitled to receive similar digital healthcare services from a provider enrolled in Medicare or your state’s Medicaid program or other arrangements, as applicable, at little or no cost to you. Please review our Terms of Service for additional terms related to Insurance.
Nature of Electronic Services
You further understand that the electronic nature of the Service means that there is a greater risk to the privacy of your electronic health information relative to receiving in-person care. You understand that information transmitted may not be sufficient (e.g. poor resolution of images) to allow for appropriate medical or health-care decision making by the Provider. You understand that if you are experiencing technical difficulties through the Platform, you may email [email protected].
Consent to Share Information
Further, for so long as you continue to receive Services on the Platform, you authorize K Health and its Providers to access your prescription history from pharmacies that have filled your prescriptions and aggregators of such information to allow for the Providers to use this information for your treatment purposes.
You understand that under applicable state laws, Providers may be required to report suspicions of child abuse, neglect, statutory rape, domestic violence, and sexual assault. K Health does not become involved in those decisions. In addition, if your Provider believes that you may be a danger to yourself or others, then your Provider may need to share information with your emergency contact or send care to you by calling 911, other emergency services or initiating a welfare check. You hereby release and hold harmless K Health and Providers for Provider’s good faith compliance with state mandatory reporting laws.
California Open Payments Notice
For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided below. The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public. The Open Payments database is a federal tool used to search payments made by drug and device companies to physicians and teaching hospitals. It can be found at https://openpaymentsdata.cms.gov.
You hereby consent to the use of telehealth to examine, consult, diagnose, or treat you.
You further acknowledge and agree that:
- You are at least eighteen (18) years of age;
- You are located in the state you identified during registration at the time of your visit(s);
- You have read and understood the information above, including the benefits, risks and limitations of using the Platform for Services;
- Our Providers may determine that our clinical services are not appropriate for some or all of your treatment needs and may elect not to provide Services to you through the Platform; and
- This Informed Consent will become a part of your medical record.
- If you are providing consent to treat a minor under the age of 18, you hereby swear and declare that you are the parent or legal guardian of the minor listed below and that there are no court orders preventing you from granting this Consent to provide Services to the minor.
- K Health makes every effort to comply with applicable state laws and regulations with respect to its telehealth platform. You understand that this Informed Consent is intended to incorporate these additional state protections
Additional Informed Consent Related to Mental Health Therapy Services
To the extent K Health offers and you receive mental health therapy services from us, you acknowledge that the K Health Professional Entities and your Provider may use and disclose your mental health information as described in the Notice of Privacy Practices. You acknowledge and authorize these entities to use and disclose your mental health information to: (1) other Providers for your treatment; and (2) to K Health, Inc. and its service providers, for payment and health care operations purposes, as described in the Notice of Privacy Practices. You understand and acknowledge that K Health will continue to use and disclose your mental health information for these purposes so long as you continue to receive mental health services on the Platform. K Health will keep a copy of your mental health records, as required by applicable law. You understand that you have a right to receive a copy of this consent and you can email [email protected] to request a copy of this informed consent.