Medical Consent

AgeMD LLC
Telehealth Medical Consent
(DBA: AgeMD™)
Last updated: June 01, 2024

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I. Introduction

You are reviewing and acknowledging this Telehealth Informed Consent because you seek Healthcare Services utilizing telehealth technologies by Telegenixx Inc. facilitated through AgeMD LLC. website, iOS mobile app, web mobile app, or other telehealth technologies collectively the “AgeMD / Telegenixx Platform.” This Telehealth Informed Consent does not modify or supersede any Terms of Use, Privacy Policy, or the Providers, rather, it supplements these terms and documents.

By creating an account, starting a consult, clicking “I consent to telehealth,” checking a related box to signify your acceptance, or using any other acceptance protocol presented through the AgeMD / Telegenixx Platform, you indicate that you have reviewed the risks as described herein of receiving services utilizing telehealth technologies and consent to receive the services. A record of this Telehealth Informed Consent is maintained in the files and records of the applicable Provider delivering your services, and your ongoing participation in services by Telegenixx Inc. using telehealth technologies serves as an ongoing acknowledgment of your acceptance of this Telehealth Informed Consent and updates at such time the representations you provide herein.

Telegenixx Inc. refers to a network of medical professional organizations affiliated with AgeMD, LLC. and its employed and contracted health providers (the “Providers”).

II. What is Telehealth?

Telehealth involves delivering health and wellness services using electronic communications, information technology, or other means between a licensed, certified, or registered healthcare professional at one location and a patient in another location about a clinical matter. Telehealth may be used for diagnosis, treatment, follow-up, and/or patient education. These telehealth services may involve various modalities, including asynchronous interactions, real-time (synchronous) video and audio encounters, and interactive audio with store and forward. This “Telehealth Informed Consent” informs the patient (“patient,” “you,” or “your”) concerning the treatment methods, risks, and limitations of utilizing telehealth to meet your health and wellness needs.

III. What are the Possible Benefits of Telehealth?

The benefits of telehealth include easier and more efficient access to health and wellness services. You can obtain health and wellness services at times that are convenient for you without an in-office appointment, including follow-up care related to your treatment. If you need follow-up care, please contact us through the AgeMD / Telegenixx platform or the AgeMD call center at 1-855-624-3631, Mon-Sun 8:00 am EST - 8:00 p.m EST.

IV. What are the Possible Risks of Telehealth?

Information transmitted to your health professional may not be sufficient to allow for appropriate health or wellness services to meet your particular needs. Some clinical needs may not be appropriate for a telehealth visit, and your Provider will make that determination. The technology necessary to interact with your health professional may fail and delay your services. If a technical failure prevents you from communicating with your Providers, you should call the following number: 1-855-624-3631, Mon-Sun 8:00 am EST - 8:00 p.m EST.

In rare events, a lack of access to complete medical records and/or the quality of transmitted data could result in adverse drug interactions, allergic reactions, and/or other clinical judgment errors. You may stop or decline any ongoing Healthcare Services provided by Telegenixx Inc. using telehealth technologies anytime. However, you acknowledge that applicable fees may apply if a medical consultation has occurred before the request to cancel services, and Telegenixx Inc. has no obligation for your ongoing care or selection of separate healthcare services in such circumstances.

I understand that certain diagnostic testing services, including laboratory products and services offered through the AgeMD / Telegenixx Platform to support the Healthcare Services of Providers, may contain defects, including ones that may limit functionality or produce erroneous results, any or all of which could limit or otherwise impact the quality, accuracy and/or effectiveness of the medical care or other services that I receive from my Provider(s).

THIRD-PARTY LABORATORY PRODUCTS AND SERVICES To facilitate certain Healthcare Services, Providers may require that you complete diagnostic test(s). Third-party laboratories provide these diagnostic tests, and neither AgeMD, Telegenixx, nor Provider(s) can guarantee the accuracy or reliability of these tests. These laboratory tests can provide false negative, false positive, or inconclusive results that could impact your Provider(s) ability to diagnose or treat your medical conditions correctly. A failure or defect of these tests could also impact your Provider(s) ability to diagnose or treat your medical conditions correctly. .

V. Patient Acknowledgments

By accepting this Telehealth Informed Consent, you acknowledge you understand and consent to the following:

1. You have reviewed this Telehealth Informed Consent carefully and understand the risks, limitations, and benefits of utilizing telehealth.

2. You understand that the electronic nature of telehealth services poses a greater risk to the privacy of my health information.

3. Sometimes, my Provider may be a nurse practitioner or physician assistant, not a physician.

4. Persons other than my provider may be present during the telehealth visit to operate the telehealth technologies and/or provide language translation assistance if requested. If another person is present during the telehealth visit, I will be informed of the individual’s presence and his or her role.

5. I understand that the information I provide as part of any telehealth offering is considered accurate, true, and complete.

6. I understand that in certain instances, and in compliance with applicable law, my Provider may determine that providing my Healthcare Services asynchronously via store-and-forward technology is appropriate. In such instances, my Provider and I will communicate electronically through the AgeMD / Telegenixx Platform and not via telephone or video. I agree that if my provider makes that determination, I would like to receive Healthcare Services in this manner.

7. I understand that there is no guarantee that I will be given a prescription and that the decision of whether a prescription is appropriate will be made in the professional judgment of my Provider. I understand that while the use of telehealth may provide benefits to me, no such benefits or specific results can be guaranteed, and my condition may not improve.

8. I understand there is a risk of technical failures during the telehealth encounter beyond the control of AgeMD, Telegenixx, and my Provider(s). I AGREE TO HOLD HARMLESS AGEMD AND TELEGENIXX AND ITS EMPLOYEES, CONTRACTORS, AGENTS, DIRECTORS, MEMBERS, MANAGERS, SHAREHOLDERS, OFFICERS, REPRESENTATIVES, ASSIGNS, PREDECESSORS, AND SUCCESSORS, INCLUDING ADONIS HEALTH AND ITS EMPLOYEES, CONTRACTORS, AGENTS, DIRECTORS, MEMBERS, MANAGERS, SHAREHOLDERS, OFFICERS, REPRESENTATIVES, ASSIGNS, PARENTS, PREDECESSORS, AND SUCCESSORS FOR DELAYS IN EVALUATION OR FOR INFORMATION LOST DUE TO SUCH TECHNICAL FAILURES.

9. I understand that certain diagnostic testing services, including laboratory products and services offered through the AgeMD / Telegenixx Platform to support the Healthcare Services of Providers, may contain defects, including ones that may limit functionality or produce erroneous results, any or all of which could limit or otherwise impact the quality, accuracy and/or effectiveness of the medical care or other services that I receive from my Provider(s).

10. I understand the AgeMD / Telegenixx Platform makes a specific set of services available, and I may need to seek other resources for my other health needs. There is no guarantee that I will be approved for treatment by a Provider. My Provider reserves the right to deny care for any reason if, in the professional judgment of my Provider, the provision of the services, including when provided via telehealth, is not medically or ethically appropriate. I understand that the Providers, and not AgeMD or Telegenixx, are responsible for the quality and appropriateness of the care they render to me. They make all decisions regarding clinical care at their independent discretion without the influence of AgeMD or Telegenixx. I agree to only seek relief against the Provider for any liabilities pertaining to medical or clinical issues arising as a direct result of medical or clinical services accessed through AgeMD.

11. I understand that by using the AgeMD / Telegenixx Platform, I am only sometimes speaking or messaging with my Provider in real-time, and there may be a delay before my messages or information are reviewed. I understand that I must check the Adonis Health Platform for messages because this is how my Provider will communicate important information to me. I understand my services may be delayed if I do not regularly check the AgeMD / Telegenixx Platform.

12. I have the opportunity to discuss the use of telehealth, including Healthcare Services, with my Provider(s), including the benefits and risks of such use and the alternatives to telehealth. I have the right to withdraw my consent to the use of telehealth during my care without prejudice to any future care or treatment and without risking the loss or withdrawal of any health benefits to which I am entitled. Still, I understand that the Providers who provide Healthcare Services via the AgeMD / Telegenixx Platform do not offer in-person treatment.

13. I understand that I have access to my medical record pertaining to the Healthcare Services of Providers utilizing the Adonis Platform in accordance with applicable laws and regulations and that my primary care provider, or other treating provider, may obtain copies of my health and wellness information with my consent.

14. I understand that while the AgeMD / Telegenixx Platform may provide access to a pharmacy or diagnostic lab services coordinated with Healthcare Services, I can request any pharmacy or lab of my preference.

15. I agree that Telegenixx is a third-party beneficiary of the Telehealth Patient Consent and has the right to enforce it against you.

VI. Additional State-Specific Disclosures

The following disclosures apply to users accessing the AgeMD / Telegenixx Platform to participate in a telehealth visit as required by the states listed below:

Iowa
I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website here: https://medicalboard.iowa.gov/consumers/filing-complaint.

Kentucky
I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website here: https://kbml.ky.gov/grievances/Pages/default.aspx.

Maine
I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website here: https://www.maine.gov/md/complaint/file-complaint.

New York
I have been informed that to get information regarding your rights and how to report professional misconduct, I should visit here: https://www.health.ny.gov/professionals/doctors/conduct.

Oregon
I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website here: https://www.oregon.gov/omb/investigations/pages/how-to-file-a-complaint.aspx.

Rhode Island
I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, https://health.ri.gov/complaints/.

Texas
I have been informed of the following notice:

NOTICE CONCERNING COMPLAINTS- Complaints about physicians, as well as other licensees and registrants of the Texas Medical Board, including physician assistants, acupuncturists, and surgical assistants, may be reported for investigation at the following address: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018, Assistance in filing a complaint is available by calling the following telephone number: 1-800-201-9353, For more information, please visit our website at www.tmb.state.tx.us.

AVISO SOBRE LAS QUEJAS- Las quejas sobre médicos, asi como sobre otros profesionales acreditados e inscritos del Consejo Médico de Tejas, incluyendo asistentes de médicos, practicantes de acupuntura y asistentes de cirugia, se pueden presentar en la siguiente dirección para ser investigadas: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018, Si necesita ayuda para presentar una queja, llame al: 1-800-201-9353, Para obtener más información, visite nuestro sitio web en www.tmb.state.tx.us

Vermont
I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website here: http://www.healthvermont.gov/health-professionals-systems/board-medical-practice/file-complaint; or Board of Osteopathic Examiners can be found at: https://sos.vermont.gov/opr/complaints-conduct-discipline/

Wyoming
I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website here: http://wyomedboard.wyo.gov/consumers/file-a-complaint.