Telehealth Consent

Consent To Telehealth

Youth-Fuel Inc (“Youth-Fuel”) provide websites through which you, may obtain an online visit with an independent, licensed health care professional in your area and as a result also may opt into mail order pharmacy services for medications prescribed to you as a result of your specific medical needs or diagnosis. (the “Services”).

In FL, MI, and SC these Services are known to constitute a form of telehealth, which involves the delivery of health care services using electronic communications between a health care provider and a patient who are not in the same physical location. Telehealth may be used for diagnosis, treatment, follow-up and/or patient education. “Telehealth” means the use of synchronous or asynchronous telecommunications technology by a telehealth provider to provide health care services, including, but not limited to, assessment, diagnosis, consultation, treatment, and monitoring of a patient; transfer of medical data; patient and professional health-related education; public health services; and health administration. The term does not include audio-only telephone calls, e-mail messages, or facsimile transmissions.

In addition, Telehealth services may include, but is not limited to:

• Electronic transmission of medical records, photo images, personal health information or other data between a patient and a Provider;

• Interactions between a patient and a Provider via audio, video and/or asynchronous data communications, such as secure messaging and email; and

• Use of data from remote monitoring devices, medical devices, and sound or video files.

• The websites, and information systems used in the Services incorporate network and software security protocols to protect the privacy, security, and integrity of your health information.

Potential Benefits of Telehealth

• Telehealth may allow you to more easily, efficiently, and with less expense, access medical care.

• Medical care and treatment may be scheduled at a more convenient time for you.

• A telehealth provider may use telehealth to perform a patient evaluation and if you qualify Telehealth Provider is not required to conduct a physical examination before using telehealth to provide health care services to you.

Potential Limitations of Telehealth

• Information transmitted to your Provider may not be sufficient to allow for appropriate medical decision making or your Provider may not be able to provide medical treatment for your condition via telehealth, and you may be required to seek alternative care or a physical examination.

• The inability of your Provider to conduct certain tests or assess vital signs in person may in some cases prevent the Provider from diagnosing or treating you or identifying that you need urgent medical care, and you may need to have a physical examination.

• If there are technological failures and lapses in service, your medical care could be delayed.

• By the very nature of electronic submission, technology and means of use a breach of your identified health information due to the failure of data security protocols and/or safeguards.

• Due to the regulatory and legal requirements in your jurisdiction and the nature of the Services treatment options, especially pertaining to certain prescriptions, may be limited.

By checking the “Agree” box you accept this Consent to Telehealth, and you acknowledge your understanding and agreement to the following:

• I understand that I cannot obtain emergency care through the Services.

• I understand, if emergency care is needed, I should call 9-1-1 and seek immediate medical treatment if I am experiencing a medical emergency.

• I give my informed consent to receive medical care and treatment by telehealth from Providers.

• I understand that the delivery of health care services via telehealth is an evolving field and that the use of telehealth in my medical care and treatment may include uses of technology not specifically described in this consent.

• I understand that a technical failure affecting the Services may result in the loss of my information and/or interrupt my online visit.

In addition to any disclaimers that I agreed to by accepting the Terms of Use, I agree to hold company harmless for any loss of information or delay in care resulting from a technical failure.

I understand that while the use of telehealth may provide benefits to me, as with any medical care service no such benefits or results can be, or are, guaranteed.

I understand that my condition may not be improved and/or cured, and in some cases, may get worse. I understand that I have a duty to answer questions about my health and medical history honestly and accurately, and to keep all my health care providers, including my Provider, up to date on any changes in my health, symptoms, treatments, or medications. I understand that withholding or providing inaccurate information about my health and medical history to obtain treatment may result in harm to me, including, in some cases, death.

I understand that I have access to all my health and wellness information pertaining to my telehealth consultation with my Provider in accordance with applicable laws and regulations applicable to my jurisdiction.

I understand that my Provider may determine in his or her sole discretion that my condition is not suitable for treatment using telehealth, and that I may need to seek medical care and treatment in person or from an alternative source. I understand that the Services enable coordination and communication with a Provider and do not replace my relationship with any existing health care provider. I understand that my information, including my identified health information, will be collected, used, shared, and protected as described in the Privacy Policy.

I understand that if applicable, my Provider, will share my telehealth record with my other health care providers only with my consent and at my request. I understand that I can have my telehealth record sent to my other health care providers by emailing my Provider and providing my consent along with my health care provider’s name, address, and phone number.

I understand that I can withhold or withdraw this consent at any time by emailing Youth-Fuel Incat Privacy@youth-fuel.com ​

Otherwise, this consent will be considered renewed upon each new telehealth consultation with a Provider.

I have carefully read this Consent to Telehealth and understand the risks and benefits of the use of telehealth in my medical care and treatment.

I agree and authorize Youth-Fuel Inc and my Providers to collect, use, and share my information, including my identified health information and other information regarding the telehealth exam, as described in Privacy Policy and for any other purposes permitted by law, including for treatment, payment, and health care operations purposes.

All capitalized terms used in this Consent to Telehealth but not defined herein have the meanings assigned to them in the Terms of Use and/or the Privacy Policy.