Telehealth Consent

Bella Sky MedSpa may directly provide Services to you or a Covered Family Member using virtual technology when the Bella Sky MedSpa Clinician and you are not in the same physical location, and/or deliver health care services virtually, including via digital or automated tools, including without limitation tools for obesity- and weight loss-related diagnosis or treatment (the “Telehealth Services”).

Telehealth may be used for diagnosis, treatment, care, follow-up and/or patient education, and may include, without limitation, the following:  (i) electronic transmission of patient medical records, and/or other patient data or information; (ii) synchronous (i.e., “real time”) and asynchronous (i.e., non-”real time”) interactions via audio, video, text, and/or data or other electronic communications; and (iii) automated, electronic or digital tools or services for diagnosis, care, treatment and/or communication pertaining to healthcare matters; and output, transmission or exchange of data from devices, sound and video files. You also acknowledge that such virtual encounters may involve care by a variety of types of Bella Sky MedSpa Clinicians, including but not limited to physicians, nurse practitioners, physician assistants, and registered dietitians in accordance with applicable laws and regulations.

You understand that virtual encounters required to receive Telehealth Services via phone, email, video, or otherwise, could involve certain limitations and risk, including those detailed below, and you hereby consent to the use of automated tools for diagnosis, care, treatment or communication pertaining to healthcare matter and agree to the following terms with respect to use of the Telehealth Services:

 ·       You understand that there may be possible risks and limitations of the Telehealth Services, including that it may be possible that your condition cannot be treated via the Telehealth Services, or that information transmitted through the Site may not be sufficient or of too poor image quality, or there may be insufficient information or data to allow for appropriate medical decision making. For example, certain medical conditions may require an in-person procedure or a healthcare provider other than your Bella Sky MedSpa Clinician, or your Bella Sky MedSpa Clinician may determine that your diagnosis and/or treatment requires an in-person office visit or are otherwise not appropriately addressed through use of the Services, such as for certain laboratory services, or alternative healthcare or emergency services. Accordingly, you may be required to seek additional in-person medical care. If your health or medical problem or condition persists after use of the Telehealth Services, you will immediately contact your Services provider and seek appropriate additional in-person medical care or emergency care, as appropriate.

·       You understand that in rare circumstances, security protocols could fail, causing a breach of privacy that allows unauthorized persons access to your PHI.

·       You agree NOT to use the Site using an unsecured public Wi-Fi or other unsecure electronic communication.

·       You agree NOT to record any audio or visual communication transmitted via the Site, including Telehealth Services, without the express consent of all communicating parties.

·       You understand that you are responsible for providing accurate information through the Site, including demographics and location information, medical histories, medication use, current adverse conditions, financial information, and keeping all such information current.

 You agree to follow all recommendations, protocols and other instructions you receive concerning the use of the Site and from Bella Sky MedSpa concerning the Telehealth Services.