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1. A burning sensation when urinating
2.Urine that appears red or bright pink
3. Runny nose
4. Chest tightness
5. Swollen face or body
6. Watering eyes
CONNECT WITH A HEALTHCARE PROFESSIONAL NOW BY FILLING OUT THIS FORM.
This Informed Consent for telehealth & wellness contains important information.
Please read it carefully with your acceptance and use of the service, it will represent an agreement between you and your Third Party Service Provider.
Benefits/Risks of Telehealth and wellness
- Telehealth and wellness refers to providing health and wellness services remotely via video or telephone, typically for the benefits of continuity of care and convenience. Telehealth and wellness, however, requires technical competence. Here are some risks and differences between in-person health and wellness consultations and telehealth and wellness:
- Risks to confidentiality.
- Because telehealth and wellness sessions take place outside of the Third Party Service Provider's private office, there is potential for other people to overhear sessions. Keel Digital Solutions and all of its subsidiaries, on behalf of your Third Party Service Provider will take reasonable steps to ensure your privacy as it relates to our service. You should do the same, making sure to be in an area where other people cannot overhear the session.
- Issues related to technology.
- There are many ways that disruptions can arise with technology, such as it stopping working during a session or other people potentially getting access to our conversation.
- Crisis management/intervention. Telehealth and wellness is not typically used for times of crisis and can be harder to manage than in-person.
- Efficacy. Most research shows that telehealth and wellness services can be as effective as in-person health and wellness services, but you should know that there is debate about whether or not something is lost by not being in the same room, such as a Third Party Service Provider's ability to fully read non-verbal information.
- Risks to confidentiality.
Location During Sessions
- All clients must be in an appropriate and private setting for telehealth and wellness sessions. By signing this, you agree that no sessions will be conducted while you are out-of-state or province from where your provider resides. This restriction is due to licensure restrictions unless otherwise stipulated.
- Telehealth and wellness sessions allow your Third Party Service Provider to diagnose, consult, treat and educate using interactive audio, video or data communication regarding your treatment. I hereby consent to participating in telehealth and wellness sessions via telephone or the internet. I am also aware that sessions may be recorded for training purposes or to facilitate collaborative care and give your consent. A supervisor, from time to time, of equal or greater competence may join sessions from behind a “digital one-way mirror” to ensure high-level, responsible care. I understand that a Third Party Service Provider can include a supervisor as well.
- You are aware that your Third Party Service Provider and their provider Keel Digital Solutions and all of its subsidiaries have taken precautions to avoid loss of confidentiality during electronic transmission of confidential information. The extent of confidentiality and its exceptions, as outlined in any Informed Consent document that you have been given by your Third Party Service Provider(s) still apply. However, the nature of electronic communications technologies is such that Keel Digital Solutions and all of its subsidiaries must warn you that although we have taken the necessary precautions and steps to protect your data, we cannot guarantee that all communications will be kept confidential or that other people may not gain access to your communications. You should also take reasonable steps to ensure the security of your communications (for example, only using secure networks for telehealth and wellness sessions and having passwords to protect the device you use for your sessions).
Data Ownership within Keel Digital Solutions and all of its subsidiaries platforms
- The Get A-Head platform is a PaaS (platform as a service) solution where Get A-Head operates the platform as a Service for the Third Party Service Provider who is a Get A-Head customer. With this in mind, all customer data is owned by the Third Party Service Provider. Get A-Head is a data custodian of this customer data, and we protect this data on behalf of our Third Party Service Provider.
- You have a right to confidentiality with telehealth and wellness sessions under the same laws that protect the confidentiality of your medical information for in-person sessions. Any information disclosed by you during the course of your service, therefore, is generally confidential. There are, by law, exceptions to confidentiality, including mandatory reporting of child, elder, and dependent adult abuse and any threats of violence you may make towards a reasonably identifiable person. You also understand that if you are in such a mental or emotional condition to be a danger to yourself or others, your Third Party Service Provider(s) has the right to break confidentiality to prevent the threatened danger. Further, you understand that the dissemination of any personally identifiable images or information from the telehealth and wellness interaction to any other entities other than your Third Party Service Provider(s) shall not occur without your written consent.
- If you are having an emergency and there is a technical problem, call 911, or go to your nearest emergency room. If the session is interrupted under non-emergency circumstances, your provider will attempt to recontact you via the platform where we were disrupted. If you do not receive a call back within a couple of minutes, then reach out to your provider through the platform or contact [email protected]
- You hereby consent that you understand your Third Party Service Provider(s) will maintain a medical record of your session and any derivative data, analytics or summaries in the same way they maintain records of in-person sessions. This includes demographic information, specific interactions, and progress notes. You hereby consent that although sessions may be recorded from time-to-time, that because it will be strictly used for health and wellness/clinical training, and is not a part of your medical records and that you give up right to access that recording as it can pose a potential threat to you and your Third Party Service Provider(s) if made public. You understand these recordings are securely kept in a HIPAA/PIPEDA/PHIPA compliant environment depending on your location and are disposed of in a reasonable period of time as determined by your Third Party Service Provider.
- This agreement is intended as a supplement to the general informed consent used at the outset of service and does not amend any of the terms of a previous agreement or agreement with your Third Party Service Provider. You understand that you can withdraw your consent to telehealth and wellness communications by providing written notification to your Third Party Service Provider. Clicking the box below indicates that you have read this Agreement and agree to its terms.
- You agree that Keel Digital Solutions and any of its wholly owned subsidiaries (eg Tulip Health) may, from time to time, send you new product and feature announcements, marketing materials and/or promotional offers via email. You may opt-out of such communication by contacting customer service.
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