YOU ACKNOWLEDGE AND UNDERSTAND THAT BY CHECKING THE “AGREE” BOX FOR THIS CONSENT TO
TELEHEALTH AND/OR ANY OTHER SUCH FORM OF AGREEMENT PRESENTED TO YOU FROM TIME TO TIME ON
THE SITE YOU ARE AGREEING TO THIS CONSENT TO TELEHEALTH AND RELATED TERMS AND CONDITIONS OF USE
(“TERMS”), AND THAT SUCH ONGOING ACTIONS IN USING THE SITE CONSTITUTE A LEGAL SIGNATURE AND
ONGOING AGREEMENT TO THIS CONSENT TO TELEHEALTH AND THE TERMS, IN WHATEVER FORM.
Telemedicine involves the delivery of healthcare services using electronic communications, information technology
or other means between a healthcare provider and a member who are not in the same physical location.
Telemedicine may be used for diagnosis, treatment, follow-up and/or member education, and may include, but is
not limited to:
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Electronic transmission of medical records, photo images, personal health information or other data
between a member and a healthcare provider;
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Interactions between a member and healthcare provider via audio, video and/or data communications;
and
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Use of output data from medical devices, sound and video files.
The electronic systems used Nimbus Healthcare Corporation and its affiliated entities (“Nimbus”) will incorporate
network and software security protocols to protect the privacy and security of health information and imaging
data, and will include measures to safeguard the data to ensure its integrity against intentional or unintentional
corruption.
Possible Risks of Telemedicine
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Information transmitted to your provider(s) may not be sufficient to allow for appropriate medical
decision making by the provider(s).
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The inability of your provider(s) to conduct certain tests or assess vital signs in-person may in some cases
prevent the provider(s) from providing a diagnosis or treatment or from identifying the need for
emergency medical care or treatment for you.
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Your provider may not able to provide medical treatment for your particular condition via telemedicine
and you may be required to seek alternative care.
- Delays in medical evaluation/treatment could occur due to failures of the technology.
- Security protocols or safeguards could fail causing a breach of privacy.
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Given regulatory requirements in certain jurisdictions, your provider(s) treatment options, especially
pertaining to certain prescriptions may be limited.
By accepting this Consent to Telehealth, you acknowledge your understanding and agreement to the following:
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I have read this Consent to Telehealth carefully, and understand the risks and benefits of the use of
telemedicine in the medical care and treatment provided to me through the Nimbus platform by
healthcare providers.
- I give my informed consent to the use of telemedicine by healthcare providers affiliated with Nimbus.
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I understand that the delivery of healthcare services via telemedicine is an evolving field and that the use
of telemedicine in my medical care and treatment may include uses of technology not specifically
described in this consent.
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I understand that while the use of telemedicine may provide potential benefits to me, as with any medical
care service no such benefits or specific results can be guaranteed. My condition may not be cured or
improved, and in some cases, may get worse.
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I understand that a healthcare provider may determine in his or her sole discretion that my condition is
not suitable for treatment using telemedicine, and that I may need to seek medical care and treatment in-
person or from an alternative source.
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I understand that the same confidentiality and privacy protections that apply to my other healthcare
services also apply to these telemedicine services.
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I understand that I have access to all of my health and wellness information pertaining to the
telemedicine services in accordance with applicable laws and regulations.
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I understand that I can withhold or withdraw this consent at any time by emailing Nimbus with such
instruction. Otherwise, this consent will be considered renewed upon each new telemedicine consultation
with a healthcare provider.
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I agree and authorize my healthcare provider to share information regarding the telemedicine
examination with other individuals for treatment, payment and healthcare operations purposes.
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I agree and authorize my healthcare provider to release information regarding the telemedicine
examination to Nimbus and its affiliated entities.
