Consent to Telehealth
Version 1.0: Last Modified on October 11, 2018.
Make sure you read all the important information below because we cover:
- That our medical team consists of doctors and nurse practitioners.
- How most states require you to do a video consultation with one of our doctors or nurse practitioners.
- When our duty of care begins.
- The benefits and risks of using our service.
- The importance of reading all the information we provide.
- The importance of answering all questions fully and truthfully.
- The risks of accepting our treatment plan.
- The risks to electronic health information.
Only use our service if you have read this information and subsequently made an informed decision that our service is right for you. If you have any questions, please send us a message at firstname.lastname@example.org.
We have one medical group. The medical group does business as “PainTheory”. Telehealth services are only offered in the State of Colorado and are provided by PainTheory Medical Group, registered in Colorado.
Our medical team is made up of doctors and nurse practitioners. Whenever we use the term “Doctor” we mean both our doctors and nurse practitioners.
Not For Emergencies
I understand that I should never use PainTheory in a medical or psychiatric emergency. I understand that in an emergency, I should dial 911 or go to an emergency department.
When Our Duty of Care Begins
I understand that the doctor will take responsibility for my care only after I have answered all the required health questions and made payment (if applicable), and the doctor has subsequently reviewed my request for treatment and the health questions that I have completed, reviewed all my information, and then subsequently determined that I am a good candidate for the telehealth services. I understand that the duty of care does not begin at the point of me answering questions or making payment or starting a chat/text visit but at the point at which the doctor accepts the duty of care.
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 the request form on the PainTheory Website) or sending a text message to the doctor does not in and of itself create a duty of care or create a doctor-patient relationship.
I understand that there may be a delay until the next business day before a doctor reviews my request for treatment and any messages I send.
I understand that the only content on the Website that constitutes professional medical advice is the personalized messages the doctor sends me (once I have completed the health questions and made payment (if applicable), and the doctor has subsequently taken responsibility for my care). No other content on the Website constitutes professional medical advice. Specifically, the information provided in our health questions about whom we can and cannot treat does not constitute professional medical advice.
I understand that all other content on the Website does not constitute professional medical advice and is instead for information purposes only. Never disregard professional medical advice or delay in seeking it because of something you have read on our Website.
Benefits And Risks of Using Our Service
I understand that by using the service I am seeking great care that is convenient and affordable.
I understand that important differences exist between PainTheory’s model of care and traditional healthcare. Specifically, by using PainTheory I accept a far greater responsibility to read and understand information throughout the Website about the limitations of PainTheory’s model of care, the risks of seeking care this way, and the risks and benefits of a proposed treatment plan.
I understand that to read important information I may need to click on both links and various titles to expand the information that is visible below, and that without clicking on links and titles I will not be able to read important information that enables me to give my informed consent to treatment.
I understand that by using PainTheory I accept the responsibility to provide full and truthful answers to all questions.
I understand that the doctor is unable independently to verify the information I provide and that the doctor will make a professional judgment based on the information I provide.
I understand that the Doctor will not diagnose me during my telehealth visit. I won’t receive any other medical services that go beyond the doctor educating me on my symptoms, potential diagnoses, potential treatment options, and suggestions for the best types of specialist doctor to consider after my telehealth visit. Due to the virtual nature of PainTheory telehealth services and the limited amount of information I am able to provide the PainTheory doctor, I understand that it is unreasonable to expect the doctor to be able to diagnose my condition. To receive a diagnosis, I understand that I will need to schedule a visit with a doctor who can complete a physical examination, and review historical medical records, labs, and medical imaging. I need to seek other sources of care for formal diagnosis and other medical needs.
I understand that by using the service for a telemedical consultation, I won’t have an in-person consultation and physical exam that might identify a medical condition that needs further investigation or immediate treatment.
I understand that by using the service I won’t necessarily speak or message with a doctor or nurse in real time. The only exception to this is patients who will have a video visit with a doctor.
I understand that I must check my cell phone for messages because this is the way that the doctor will communicate important information to me. I understand that if I do not check my cell phone for messages regularly, then my care may be delayed.
I understand that if I have any questions relating to my care that are not urgent, I can message the doctor via text. I understand that the doctor may not review and respond to my messages until the next business day.
Importance Of Reading All The Information We Provide
I understand that PainTheory will provide information in the Website to help me make an informed decision about whether to accept a proposed treatment plan.
I understand the importance of reading the information the doctor provides about adverse events, including the signs and symptoms of serious side effects and common side effects from taking medicine, as this will ensure that I seek appropriate medical attention in a timely manner.
Importance Of Answering All Questions Fully and Truthfully
I understand that by using PainTheory I seek to enter into a relationship where the doctor relies exclusively upon information that I provide to decide whether or not treatment is safe and appropriate.
I understand that the doctor has no way of verifying the information and photos that I provide and that the doctor will consider information to be accurate, true and complete, including my age, gender and all my answers to health questions.
I understand that if I provide information that is not true and complete, then I will be at greater risk of adverse events from any treatment that the doctor prescribes and I may go forward with a treatment that is not necessary, appropriate, or safe.
I understand that even if I provide information that is true and complete, I am still at risk of adverse events from any treatment or course of action the doctor recommends.
I understand that by using PainTheory I am giving my explicit consent for the doctor to access medication history, where it is available. I understand that, if appropriate, the doctor may take this information into account when suggesting a treatment plan but this does not change how important it is that I provide full, true and complete information during the PainTheory visit.
Risks Of Accepting Our Treatment Plan
I understand that all the medicines that the doctor may recommend, including over-the-counter medicines and “behind-the-counter” medicines, can cause serious side effects and adverse events that include severe allergic reaction, permanent disability, and death.
I understand that it is my responsibility to make an informed decision whether to accept a treatment plan that the doctor proposes after weighing the risks and benefits discussed, alternative treatment options and the risks and benefits of such alternatives, and the option of not seeking any treatment.
I understand the importance of reading the manufacturer’s leaflet that comes with medicine, including over-the-counter or behind-the-counter medicine, before I take medicine because this leaflet includes important information about risks and warnings.
I understand that adverse events can be caused by a number of things, including an allergic reaction, side effects, or interactions between a medicine that the doctor recommends and any medical conditions I may have, other prescription medicines or other things (e.g., supplements, herbs, over-the-counter medicines, or recreational drugs) I am taking, and lifestyle choices such as smoking tobacco products or drinking alcohol.
Spine, Joint, and Other Musculoskeletal Pain
I understand that adverse events from taking medications to treat spine, joint, and other musculoskeletal pain include but are not limited to an allergic reaction, permanent disability, and death.
I understand that by using PainTheory to determine the treatment options and type of doctor to visit, he or she may speculate as to potential causes or diagnoses of the pain, but will not formally diagnose the source of my pain. The true cause of my problem and proper treatment options must be determined by scheduling a visit with a doctor who can complete a physical examination, and review historical medical records, labs, and medical imaging.
I understand that by using PainTheory to educate me on my symptoms, potential diagnoses of my pain, potential treatment options, and suggestions for the best types of specialist doctor to consider after my telehealth consultation, the doctor won’t be able to do a complete and thorough exam of my body or review other necessary tests, images, medical history, or data. Because PainTheory doctors cannot complete a thorough examination, there is a risk that they may not identify a medical condition that needs further investigation or immediate treatment.
I understand that even if PainTheory doctors correctly recommend a treatment plan, it may subsequently be necessary for me to seek additional care with a doctor in person if the treatment is not effective or the doctors consider my pain issue to be too complicated to manage online.
Risks To Electronic Health Information
Electronic mail (email) and text messaging are forms of communication that may be utilized between you and PainTheory doctors. We want to make sure you know that unencrypted email and text communications are not secure communications and your protected health information could be intercepted by an unauthorized individual after it is sent. If you decide to use PainTheory telehealth services, you acknowledge and accept that you will be communicating via an insecure communication method.
Email and text communications may become a part of your patient medical record and be accessible to clinical support staff as needed for our operations. Incoming email and text communications will be reviewed and answered as soon as possible. EMAIL COMMUNICATION SHOULD NEVER BE USED IN THE CASE OF AN EMERGENCY OR FOR URGENT REQUESTS FOR INFORMATION. We are not able to encrypt text messages.