Weight Loss Ventures, LLC, d/b/a Kiinilife (“Kiinilife”) operates a website (the “Website”) that connects patients to telehealth services relating to weight loss therapy (the “Services”). The Services are provided by licensed clinicians (the “Providers”) employed by or contracted with the independent medical groups with which we partner (the “Medical Groups”).
Telehealth involves the use of electronic communications to enable health care providers at different locations to share individual patient medical information for the purpose of improving patient care. Though telehealth services can be provided through various modalities, the Services occur primarily through submission of online questionnaires, telephone calls, and asynchronous communications. The purpose of this Informed Consent is to provide you with an overview of the expected benefits and possible risks of telehealth, and to obtain your consent to receiving medical services through telehealth.
Telehealth has many benefits, including:
- You do not have to leave the privacy of your home to receive a medical consultation or to pick up a prescription. This can save you time and money. It is easier and more efficient to access health care providers online when you need them, rather than waiting weeks and possibly months for an appointment.
- You can easily schedule follow-up consultations with your Provider from the convenience of your computer or phone.
There are possible risks to using telehealth, though, including:
- It may be more difficult for Providers to diagnose you without seeing you in person. For example, it may be more difficult for a Provider to perform a physical assessment, to check vitals, and/or to perform diagnostic tests.
- In some instances, your Provider may determine that the transmitted information is of inadequate quality, thus necessitating a rescheduled telehealth consult or a meeting with your local primary care provider.
- In some instances, a lack of access by your Provider to your complete medical records may result in adverse drug interactions, allergic reactions, or other judgment errors.
- There can be delays in evaluation and treatment in the event of a disruption in communication between you and your Provider if the online connection is interrupted for some reason, or if you or your Provider experience technical difficulties.
- While our Website includes security features to protect your information, there is a risk that unauthorized access to your information still can occur. In very rare instances, security protocols could fail, causing a breach of privacy of your personal medical information.
Providers are an addition to, and not a replacement for, your primary care provider and other health care providers on whom you may rely for medical services. The responsibility for your overall medical care should remain with your local primary care provider, if you have one, and we strongly encourage you to locate a primary care provider if you do not already have one.
If your Provider recommends use of a prescription drug as part of your recommended course of treatment, you may choose any pharmacy service to fill prescriptions ordered or requested by our Providers.
By accepting below or otherwise accessing the telehealth services, you confirm that:
- You have read, understand, and accept this Informed Consent.
- You understand the risks and benefits of the Services offered through the Website, and you have determined that telehealth is a good choice for you. You also understand that none of the benefits of the Services are guaranteed and that the treatment provided may not necessarily improve any of your medical conditions.
- It is your responsibility to provide accurate and complete medical information to your Provider, and you acknowledge and agree that your Provider will rely on such information in the delivery of the Services to you. The inaccuracy of any information you provide to your Provider may impact the efficacy of the Services. Further, your Provider may decide you need to seek treatment for your medical condition from a different provider, and that use of the Services is not sufficient or appropriate for your condition.
- You understand that your Provider will provide you with information related to your diagnosis, treatment, and ongoing care, and that the success of your treatment and care is dependent upon your review of this information. Therefore, you agree to review all such information your Provider provides to you.
- You understand that there is a risk of technical failures during the telehealth encounter that may be beyond our control. You agree to hold harmless Kiinilife, the Medical Groups, and Providers for any delays in evaluation or for information lost due to such technical failures.
- You understand there may be side effects from certain medications prescribed, and that your Provider will specifically address these risks when prescribing such medications.
- You understand that your health care information may be shared with other individuals for scheduling and billing purposes.
- You understand this is a telehealth-based service that is not equipped to handle medical or psychiatric emergencies. IF YOU HAVE AN EMERGENCY THAT NEEDS IMMEDIATE RESPONSE, YOU AGREE TO CALL 911 OR GO TO YOUR NEAREST EMERGENCY ROOM.
- You give your informed consent to telehealth as an acceptable form of delivering health care services to you, and that this consent will cover any and all Services provided to you through the Website.
- You may withdraw your informed consent at any time by discontinuing services through the Website and deactivating your account.
______ I HAVE READ THIS DOCUMENT CAREFULLY, UNDERSTAND THE RISKS AND BENEFITS OF THE TELEHEALTH CONSULTATION, AND HAVE HAD MY QUESTIONS REGARDING THE TELEHEALTH SERVICES EXPLAINED SUFFICIENTLY. I HEREBY CONSENT TO RECEIVING TELEHEALTH SERVICES AS DESCRIBED HEREIN.
