Telehealth Consent & Open Payments notice

LAST MODIFIED October 30th, 2024

INFORMED CONSENT REGARDING USE OF TELEHEALTH

Last updated: October 30, 2024

By clicking “I Agree,” checking a related box to signify your acceptance, or using any other acceptance protocol presented through the Service, you acknowledge that you have read, accepted, and agreed to be bound by this consent. If you do not agree to this consent, it is imperative that you do not create an account or use the Service. Furthermore, you grant agency authority to any party who clicks on the “I Agree” button or otherwise indicates acceptance of this consent on your behalf.

IF YOU ARE EXPERIENCING A LIFE-THREATENING SITUATION SUCH AS CONTEMPLATING SUICIDE, CALL 911 OR THE 988 SUICIDE & CRISIS LIFELINE AT 988.

Purpose of Consent Form
The purpose of this consent form (“Consent”) is to provide you with comprehensive information about telehealth and to obtain your informed consent for the use of telehealth in the delivery of healthcare and/or mental health services by physicians, physician assistants, or nurse practitioners (“Providers”) utilizing the online platforms owned and operated by Viking Man Inc. dba SkyRx and/or its subsidiaries (the “Service”). In this Consent, the terms “you” and “yours” refer to the individual using the Service.

Use of Telehealth
Telehealth encompasses the delivery of healthcare services utilizing electronic communications, information technology, or other methods to connect healthcare providers and patients who are not physically present in the same location. Telehealth can be employed for a variety of purposes, including diagnosis, treatment, follow-up care, and patient education. This may involve several components, such as the electronic transmission of medical records, photo images, personal health information, and other pertinent data between a patient and a provider. Interactions may occur through audio, video, or data communications, including messaging or email. Additionally, telehealth may utilize output data from medical devices, as well as sound and video files.

It is important to note that while telehealth offers many advantages, alternative methods of care, such as in-person services, are also available. You have the right to choose an alternative method at any time, and it is advisable to discuss these options with your Provider to determine the most appropriate course of action for your healthcare needs.

Anticipated Benefits of Telehealth
The use of telehealth offers several potential benefits that can enhance your healthcare experience. Firstly, it facilitates easier and more efficient access to medical care or other services and treatments for the conditions managed by your Provider(s). This means you can receive timely care without the barriers often associated with in-person visits, such as travel time or scheduling conflicts. Secondly, telehealth allows you to obtain medical care at times that are convenient for you, offering greater flexibility in managing your health needs. Lastly, it enables you to interact with your Provider(s) without the necessity of attending an in-office appointment, which can save you time and reduce exposure to potential health risks.

Potential Risks of Telehealth
While the use of telehealth in the delivery of care offers numerous potential benefits, it is important to be aware of the associated risks. These risks may include limitations in the quality, accuracy, or effectiveness of the services you receive from your Provider. Additionally, the technology used in the Service may contain bugs or errors that could affect functionality, produce erroneous results, or render parts or all of the technology inoperable. Such failures could lead to incorrect records, data corruption, or loss of information, which can significantly impact the delivery of care. Moreover, the inability of your Provider to conduct certain tests or assess vital signs in person may hinder their ability to provide a proper diagnosis or treatment, potentially delaying the identification of emergency medical needs. Your Provider(s) may not be able to provide treatment for your particular condition, necessitating the need for you to seek alternative healthcare or emergency services. Additionally, delays in medical evaluation or treatment could arise due to the unavailability of your Provider(s) or due to deficiencies or failures in the technology or electronic equipment used during your consultation. There is also the possibility that the electronic systems or security protocols employed may fail, leading to a breach of privacy regarding your medical or personal information. Data communicated electronically, such as through email, may be more vulnerable to unintended disclosure of protected health information to third parties. Furthermore, due to regulatory requirements in certain jurisdictions, your Provider(s) may face limitations in diagnosing or offering treatment options, particularly concerning specific prescriptions. Lastly, a lack of access to all of your medical records could result in adverse drug interactions, allergic reactions, or other judgment errors, potentially impacting your health outcomes.

Life-Threatening and Other Emergency Situations; Follow-Up Care
If you are experiencing a life-threatening situation, such as contemplating suicide, it is critical to seek immediate help by calling 911 or contacting the 988 Suicide and Crisis Lifeline at 988. Your safety and well-being are of utmost importance, and professional assistance is essential in such circumstances.

In the event of any emergency, including medical emergencies, you should also call 911. It is important to recognize that telehealth services may not be appropriate for all situations, particularly those requiring immediate or urgent care. If you find yourself in need of urgent medical attention, you must seek care at an emergency room facility or contact another provider equipped to deliver urgent or emergent care.

Please note that Providers may not respond promptly to communications submitted through the Service, particularly in emergency situations. For non-emergency communications, if you do not require immediate or urgent care, you can use the secure message service within the Service to connect with your Providers. However, if a technical failure prevents you from communicating with your Providers through the Service, you should contact the following number for assistance: Phone: 1-855-759-7979 (available Monday through Friday from 8 AM to 3 PM MT).

Data Privacy and Protection
The electronic systems utilized in the Service incorporate robust network and software security protocols designed to protect the privacy and security of your information. These systems include measures aimed at safeguarding data against both intentional and unintentional corruption. Personal information that identifies you or contains protected health information will not be disclosed to any third party without your explicit consent, except as authorized by law. This includes disclosures necessary for purposes such as consultation, treatment, payment and billing, certain administrative functions, and mandated reporting to relevant authorities in instances such as danger to yourself or others, or the mandatory reporting of child, elder, or vulnerable adult abuse. These practices are also outlined in your Provider's Notice of Privacy Practices.

Additionally, the use of the Service may involve email communications that include your protected health information. It is important to understand that while we strive to maintain the confidentiality and security of your information, SkyRx cannot guarantee the security or privacy of the services you use to receive communications, including your email service provider.

Laboratory Products and Services
Certain healthcare services offered through the Service may require you to complete an at-home diagnostic test. These tests are provided by third-party laboratories, and it is important to understand that neither SkyRx nor your Provider(s) can guarantee the accuracy or reliability of these tests. Laboratory tests can yield false negatives, false positives, or inconclusive results, which may adversely affect your Provider’s ability to diagnose or treat your medical conditions accurately. Furthermore, any failures or defects in these tests could similarly hinder your Provider’s capacity to provide appropriate medical care.

Open Payments Notice

For informational purposes, we provide a link to the federal Centers for Medicare and Medicaid Services Open Payments web page. The federal Physician Payments Sunshine Act mandates that detailed information about payments and other valuable transfers exceeding ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals must be publicly disclosed. The Open Payments database serves as a federal tool to search for payments made by drug and device companies to physicians and teaching hospitals. You can access the database at [https://openpaymentsdata.cms.gov]

Your Acknowledgments
By clicking “I Agree,” checking a related box to signify your acceptance, using any other acceptance protocol presented through the Service, or otherwise affirmatively accepting this consent, you are providing your explicit agreement and consent regarding the terms set forth below. This acknowledgment signifies your understanding and acceptance of the policies and practices outlined in the Privacy Policy and any related documents with respect to the folowing:

Healthcare services provided through the Service will be delivered via telehealth. It is important to note that in some cases, your treating Provider may be a nurse practitioner or physician assistant rather than a physician. By using the Service, you acknowledge and agree to receive treatment from non-physician providers, where applicable. Additionally, certain technology, including the Service, may still be in beta testing and development phases, meaning that it may not yet represent a final or fully developed product. As a result, the technology used to deliver care may contain bugs or errors, which could affect functionality, produce erroneous results, or render part or all of the technology unavailable or inoperable. These issues may lead to incorrect records, data corruption, or loss of information, all of which could potentially impact the quality, accuracy, and effectiveness of the medical care or other services you receive from your Provider(s). Certain diagnostic testing services, including laboratory products and services available through the Service, may contain defects that could limit functionality or yield erroneous results. These issues have the potential to affect the quality, accuracy, and effectiveness of the medical care or other services you receive from your Provider(s). As telehealth is an evolving field, the technology used in your medical care may involve methods that differ from those explicitly described in this Consent. It is crucial to understand that while telehealth offers numerous benefits, no specific outcomes or laboratory testing results can be guaranteed. Your condition may not improve, and in some instances, it could worsen. Additionally, there are inherent limitations to receiving medical care or treatment via telehealth, and not every condition may be suitable for diagnosis and treatment through this medium. There are potential risks to the use of telehealth and other technology, including but not limited to the risks described in this Consent. You have the opportunity to discuss the use of telehealth, including the Service, with your Provider(s), including the benefits and risks of such use and the alternatives to the use of telehealth. You understand that there will be no recording of any online treatment sessions by your Provider(s) or you. Your Provider(s) will assess your medical condition and, in their sole discretion, may determine it is medically appropriate to diagnose and/or treat your condition via telehealth and whether you maintain sufficient knowledge and skills in the use of technology appropriate to diagnosing and/or treating your condition via telehealth. By continuing to use the Service, you concur with your Provider’s medical assessment and agree to receive a diagnosis and/or treatment via telehealth technology. You have the right to withdraw your consent to the use of telehealth in the course of your care, without prejudice to any future care or treatment and without risking the loss or withdrawal of any health benefits to which your entitled, but you understand that the Providers who utilize the Service do not offer in-person treatment. Any withdrawal of your consent will be effective upon receipt of written notice to your Providers, except that such withdrawal will not have any effect on any action taken by SkyRx or your Provider(s) in reliance on this Consent before it received your written notice of withdrawal. Any withdrawal of your consent will not affect any other provision of this Consent, and you will continue to be bound by this Consent. By using the Service, you acknowledge that it involves electronic communication of your personal medical information related to the provision of telehealth services, including communications via email. It is your responsibility to provide SkyRx and your Provider(s) with truthful, accurate, and complete information regarding your health. This includes sharing all relevant details about care you have received or are currently receiving from other healthcare and mental health providers, as well as providing emergency contact information for your local healthcare or mental health providers. You understand that your Provider(s) will evaluate your medical condition and, at their discretion, may determine whether it is appropriate to diagnose and/or treat your condition using telehealth technology, including the Service. By continuing to use the Service, you agree with your Provider’s medical assessment and consent to receive diagnosis and/or treatment via telehealth technology. However, it is also essential to recognize that your Provider(s) may conclude that your condition is not suitable for telehealth diagnosis or treatment, necessitating a referral to a specialist or other healthcare provider for in-person care. SkyRx maintains commercial relationships with several entities, including Pharmxpress Limited Liability Company dba Pharmxpress Pharmacy, Hwareh.com, Inc. dba Health Warehouse, BPI Labs, LLC, and Precision Compounding Pharmacy & Wellness Inc. Additionally, SkyRx has a financial relationship with the entity that employs or contracts with your Provider. Importantly, you have the freedom to obtain your medical examination and prescriptions from any healthcare provider that is not affiliated with SkyRx. SkyRx utilizes its pharmacy partners to fulfill your orders and deliver medications directly to your door. However, you also have the option to obtain your prescription from any pharmacy of your choice by contacting our support team. Prescriptions may be filled by and transferred between any of our pharmacy partners on your behalf. It is important to note that you are responsible for paying the full costs associated with using the Service, including any prescriptions you may receive. Additionally, you will not attempt to submit a claim to Medicare, any other federal payor, or any state or private insurer for these costs.

If you have a concern about a medical professional, it is crucial to take the appropriate steps to address the issue effectively. You may contact the Medical Board in your state to voice your concerns or seek guidance. For applicable contact information, you can refer to the list available on the Medical Board's website. For California clients, it is important to note that physicians and midwives are licensed and regulated by the Medical Board of California. If you need to confirm a license or file a complaint, you can visit their website at www.mbc.ca.gov or call (800) 633-2322. Additionally, the California Board of Behavioral Sciences handles complaints regarding services provided within the scope of practice of marriage and family therapists, licensed educational psychologists, clinical social workers, and professional counselors. You can contact the Board of Behavioral Sciences at [http://www.bbs.ca.gov](http://www.bbs.ca.gov) or by calling (916) 574-7830.