You are asked to read and accept this consent before your assessment is submitted to a clinician. Accepting it does not obligate you to continue: you may withdraw consent at any time, as described in Section 13.
BY CLICKING “I AGREE,” CHECKING A BOX PRESENTED WITH THIS CONSENT, OR OTHERWISE AFFIRMATIVELY INDICATING YOUR ACCEPTANCE THROUGH THE PLATFORM, YOU CONFIRM THAT YOU HAVE READ AND UNDERSTOOD THIS CONSENT AND THAT YOU AGREE TO BE BOUND BY IT. IF YOU DO NOT AGREE, DO NOT REGISTER FOR AN ACCOUNT OR USE THE SERVICES. IF ANOTHER PERSON INDICATES ACCEPTANCE ON YOUR BEHALF, YOU CONFIRM THAT SUCH PERSON HAS YOUR AUTHORITY TO ACT AS YOUR AGENT FOR THAT PURPOSE. YOUR ELECTRONIC ACCEPTANCE CONSTITUTES YOUR SIGNATURE FOR PURPOSES OF APPLICABLE ELECTRONIC SIGNATURE LAWS, INCLUDING THE FEDERAL E-SIGN ACT AND STATE EQUIVALENTS.
DO NOT USE THE SERVICES IF YOU ARE EXPERIENCING A MEDICAL EMERGENCY. IF YOU BELIEVE YOU ARE EXPERIENCING AN EMERGENCY, CALL 911 OR GO TO THE NEAREST EMERGENCY ROOM. IF YOU ARE IN CRISIS OR THINKING ABOUT HARMING YOURSELF, CALL OR TEXT THE 988 SUICIDE AND CRISIS LIFELINE AT 988.
1. PURPOSE AND PARTIES
The purpose of this Telehealth Informed Consent (this “Consent”) is to give you information about how telehealth works, its expected benefits and possible risks, and to obtain your informed consent to receive medical care delivered by telehealth from licensed physicians, physician assistants, and nurse practitioners (“Providers”) through the online platform owned and operated by Soha Health, LLC (“Soha,” and such platform, together with related websites, applications, and services, the “Platform” or the “Services”). In this Consent, “you” and “your” refer to the individual patient using the Services.
Soha is a technology and management services company. Soha does not practice medicine or any other licensed profession, does not employ Providers, and does not provide medical care, medical advice, or clinical services of any kind. All clinical care available through the Platform is provided by independent Providers who are affiliated with independently owned professional medical entities (collectively, the “Medical Groups”). Your treatment relationship is with your Provider and the applicable Medical Group, not with Soha. Each Provider is licensed in the state in which you receive care, and you may review your Provider’s name, credentials, and licensure information through the Platform.
2. ELIGIBILITY; YOUR LOCATION
You must be at least eighteen (18) years old and legally able to enter into a binding contract to use the Services. When you register, you will be asked to provide your state of residence and to verify your identity, and you agree that the information you provide is accurate. You agree to use the Services only while you are physically located in a state in which the Services are offered and in which your Provider is licensed, and to promptly update your information through the Platform if your state of residence changes. We may ask you to confirm your physical location or identity at any time in order to comply with state licensure and telehealth laws, and the Services may be refused or unavailable in jurisdictions that are not currently served.
3. WHAT TELEHEALTH IS; HOW THE SERVICES WORK
Telehealth means the delivery of health care services using electronic information and communication technologies when you and your Provider are not in the same physical location. Telehealth may be used for evaluation, diagnosis, treatment, prescribing, follow-up, care coordination, and patient education. The technologies used may include: asynchronous (“store-and-forward”) transmission and review of the information you submit, such as your responses to medical intake questionnaires, your health history, photographs, and other records or data; secure messaging with your Provider and care team; synchronous (real-time) audio and/or video visits; and the electronic exchange of medical records, laboratory results, and other health information.
Depending on your state and your clinical circumstances, your initial evaluation may be conducted asynchronously, meaning your Provider reviews the medical information you submit and communicates with you by secure messaging without a scheduled phone or video visit. A phone or video visit will be used where required by applicable law, where your Provider determines one is clinically appropriate, or where you request one. Alternatives to telehealth, including in-person care, are available to you, and you may choose an in-person alternative at any time. You are encouraged to discuss the available alternatives with your Provider.
4. ANTICIPATED BENEFITS
Possible benefits of telehealth include: easier and more convenient access to medical evaluation and treatment, including from your home; the ability to obtain care at times that work for your schedule and without travel or in-office appointments; more efficient evaluation and management of your care; and access to clinicians with expertise relevant to your condition, including hormone and menopause care, who may not be available in your geographic area.
5. POTENTIAL RISKS
Telehealth also involves potential risks. These include, without limitation, the following: the information transmitted (for example, questionnaire responses or image quality) may be insufficient to allow your Provider to make an appropriate clinical decision, which may require additional information, a rescheduled encounter, or an in-person visit with a local provider; technical problems, outages, or failures of equipment, software, or connectivity could delay your evaluation or treatment, interrupt communications, or in rare cases result in inaccurate or lost records or transmissions; because your Provider cannot perform a hands-on physical examination or take vital signs in person, some conditions, findings, or the need for urgent or emergency care may not be identified; your Provider may not have access to your complete medical records, which could increase the risk of adverse drug interactions, allergic reactions, or other errors in clinical judgment; despite reasonable security safeguards, electronic systems and communications could fail or be breached, resulting in unauthorized access to your personal or health information; and laws and regulations in some states may limit the diagnoses that can be made or the treatments and prescriptions that can be provided by telehealth. Your condition may not improve, and in some cases could worsen, in connection with any treatment, whether delivered by telehealth or in person.
6. NO GUARANTEES; PROVIDER JUDGMENT; PRESCRIPTION POLICIES
No guarantees have been made to you regarding the results of any evaluation, treatment, or service. Your Provider will exercise independent professional judgment to determine whether telehealth is appropriate for your condition and whether any particular treatment or prescription is appropriate for you. You may be treated by a physician, or by a nurse practitioner or physician assistant practicing in accordance with applicable state law, and by using the Services you agree to receive care from these categories of clinicians. Your Provider may determine, in his or her sole discretion, that your condition is not appropriate for treatment through the Platform and may direct you to in-person care, a specialist, or emergency services. Not every condition can be diagnosed or treated by telehealth, and the Services are not a substitute for a primary care physician, routine preventive care, or ongoing management of unrelated acute or chronic conditions. A prescription is never guaranteed; whether to prescribe any medication is solely your Provider’s decision. Providers do not prescribe controlled substances through the Platform.
7. EMERGENCIES; RESPONSE TIMES; FOLLOW-UP CARE
Telehealth is not an appropriate method of care for emergencies. If you require immediate or urgent care, call 911, go to the nearest emergency room, or seek care from a provider equipped to deliver urgent or emergency services. Providers may not respond immediately to messages submitted through the Platform, and the secure messaging feature should be used only for non-urgent communications. If a technical failure prevents you from reaching your Provider through the Platform, contact us at support@joinsoha.com. Your Provider will give you instructions for follow-up care as appropriate, and you agree to follow those instructions and to seek in-person or emergency care when directed or when your symptoms change or worsen.
8. YOUR RESPONSIBILITIES
Safe and effective telehealth care depends on the information you provide. You agree to provide truthful, accurate, and complete information to Soha and your Providers, including your full medical history, current medications and supplements, allergies, prior adverse reactions, and information about care you are receiving or have received from other health care providers, and to update that information promptly if it changes. You agree to keep your contact information current, to participate in recommended follow-up, to report side effects or new symptoms to your Provider, and to inform your primary care physician and other treating providers of the care you receive through the Platform. You are responsible for sharing your records with, and initiating follow-up care from, your other health care providers.
9. PRIVACY AND SECURITY OF YOUR HEALTH INFORMATION
The Platform uses network and software security measures designed to protect the privacy and security of your information and to safeguard data against corruption or loss. Your individually identifiable health information will be used and disclosed only as permitted or required by applicable law, including for purposes of treatment, payment, and health care operations, and as described in the applicable Medical Group’s Notice of Privacy Practices and in the Soha Privacy Policy. Your health information will not otherwise be disclosed to third parties without your authorization, except where disclosure is permitted or required by law (for example, mandatory reporting obligations). You acknowledge that the Services involve the electronic transmission of your personal and health information, including by email, text message, and Platform messaging, and that Soha cannot guarantee the security of communication channels operated by third parties, such as your email or wireless service provider.
10. CONSENT TO ELECTRONIC COMMUNICATIONS
You authorize Soha and the Medical Groups (and their respective service providers acting on their behalf) to contact you by phone call, voicemail, text message, email, and Platform messaging at the contact information you provide, and you acknowledge that these communications may include your health information, such as treatment recommendations, care instructions, refill and appointment reminders, test or evaluation status, and billing matters. You understand that text messages and emails may be unencrypted, that they carry a risk of being read by unauthorized persons, and that neither Soha nor the Medical Groups is responsible for unauthorized access that occurs in the course of transmission by third-party carriers or email services. You may manage marketing communication preferences as described in the Soha Privacy Policy; communications related to your treatment may continue as needed for your care.
11. FINANCIAL RELATIONSHIPS; YOUR FREEDOM OF CHOICE
Soha has entered into commercial arrangements with third parties that support the Services, including with the independent clinical network and Medical Groups whose Providers deliver care through the Platform, to which Soha provides technology and administrative support services, and with one or more licensed pharmacies that may dispense and ship medications prescribed by your Provider. Soha may have a financial relationship with the entities that employ or contract with your Providers. You are free to obtain a medical evaluation from any health care provider of your choice, including providers not associated with Soha, and you are free to have any prescription filled at the pharmacy of your choice. By default, prescriptions will be routed to a partner pharmacy for fulfillment and home delivery, and prescriptions may be filled by, and transferred between, partner pharmacies on your behalf. If you would like a prescription sent or transferred to a different pharmacy, contact support@joinsoha.com; Soha will make reasonable efforts to assist you and will facilitate your request where required by applicable law. Questions about these relationships may be directed to the same address.
12. PAYMENT; NO INSURANCE; NO FEDERAL HEALTH CARE PROGRAM CLAIMS
The Services are offered on a direct, cash-pay basis. The Providers and Medical Groups do not participate in, and are not enrolled with, commercial health insurance plans or federal or state health care programs, including Medicare and Medicaid, and services provided through the Platform are not provided on an in-network basis with any payor. By using the Services, you are choosing to purchase them outside of any insurance plan or government health care program, and you agree that you are solely responsible for all fees for the Services and any prescriptions you receive. You agree that you will not submit, and will not permit anyone to submit on your behalf, any claim for the Services to Medicare, Medicaid, any other federal or state health care program, or any commercial insurer. Your fees do not cover ancillary or third-party services, including laboratory testing, imaging, hospital, emergency room, or urgent care services, or visits to providers to whom you are referred, and you are responsible for the costs of any such services. The Services may be eligible for reimbursement through a flexible spending account (FSA) or health savings account (HSA), subject to the terms of your plan, and you are responsible for confirming eligibility with your plan administrator.
13. YOUR RIGHT TO WITHHOLD OR WITHDRAW CONSENT
Your participation in telehealth is voluntary. You may withhold or withdraw your consent to the use of telehealth at any time, without affecting your right to future care or treatment and without risking the loss or withdrawal of any health benefit to which you are otherwise entitled. Because the Providers available through the Platform deliver care exclusively by telehealth, withdrawing your consent means that Services can no longer be provided to you through the Platform, and you will be responsible for arranging care elsewhere. A withdrawal of consent is effective upon receipt of your written notice and applies prospectively only; it does not affect actions taken in reliance on this Consent before the notice was received. Unless and until you withdraw it, this Consent remains in effect and is renewed upon each telehealth encounter with a Provider.
14. NO RECORDING
Neither you nor your Provider may record, photograph, or capture any telehealth encounter or communication without the prior written consent of the other party and, in the case of recordings by you, of the applicable Medical Group.
15. OPEN PAYMENTS NOTICE
For informational purposes: the federal Physician Payments Sunshine Act requires that detailed information about payments and other transfers of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public. The Centers for Medicare & Medicaid Services maintains the Open Payments database, a federal tool that may be used to search such payments, at https://openpaymentsdata.cms.gov.
16. QUESTIONS AND COMPLAINTS; MEDICAL BOARD NOTICES
If you have a concern about a Provider, you may contact the medical board of the state in which you received care. Contact information for state medical boards is available through the Federation of State Medical Boards at https://www.fsmb.org/contact-a-state-medical-board/.
Notice to California Patients. Physicians and surgeons are licensed and regulated by the Medical Board of California. To check a license or to file a complaint, visit www.mbc.ca.gov or call (800) 633-2322.
17. YOUR ACKNOWLEDGMENTS
By accepting this Consent, you acknowledge and agree that:
- Medical services provided to you through the Platform will be delivered by telehealth, and your treating clinician may be a physician, nurse practitioner, or physician assistant as permitted by applicable law.
- You have been informed of the nature of telehealth, its anticipated benefits, its potential risks, and the alternatives to telehealth, including in-person care, and you have had the opportunity to ask questions and have them answered to your satisfaction.
- No specific results, outcomes, or benefits have been promised or guaranteed to you, your condition may not improve and could worsen, and not every condition can be diagnosed or treated through the Platform.
- Your Provider will determine, in his or her professional judgment, whether telehealth is appropriate for your condition, whether any treatment or prescription is appropriate, and whether you should be directed to in-person, specialist, or emergency care, and by continuing to use the Services you agree to receive care on that basis.
- Technology used to deliver the Services may experience errors, outages, or failures that could affect the quality, accuracy, timeliness, or availability of the Services.
- It is your responsibility to provide truthful, accurate, and complete medical information and to keep it current, and the quality and safety of your care depends on the accuracy of the information you provide.
- The Services involve electronic transmission of your personal and health information, and you consent to the communications described in this Consent.
- You have been informed of Soha’s commercial and financial relationships described above, of your freedom to seek care from any provider of your choice, and of your freedom to use any pharmacy of your choice.
- You are paying for the Services on a cash basis, and you will not submit any claim for the Services to any federal or state health care program or commercial insurer.
- Technical failures may result in the loss of information or delays in your care despite reasonable safeguards, and, in addition to any disclaimers in the Soha Terms and Conditions, you agree to hold Soha, the Medical Groups, and your Providers harmless for loss of information or delays in care resulting from technical failures.
- You may withdraw your consent to telehealth at any time as described in Section 13.
- Additional state-law notices and consents may apply to you based on your location, including those set out in the State-Specific Disclosures below, which are incorporated into this Consent.
18. STATE-SPECIFIC DISCLOSURES
The state in which you reside or are located when you receive Services may require additional notices or consents. The following disclosures apply to you if you receive Services in the applicable state:
All States. In every state, and as required by the telehealth informed consent laws of the state in which you are located: you consent to receiving health care services by telehealth; you have been informed of the nature of telehealth, its benefits, its risks and limitations, and the alternatives available to you, including in-person care; you may refuse or withdraw your consent to telehealth at any time without affecting your right to future care or treatment and without the loss or withdrawal of any benefit to which you are entitled; the identity, credentials, and licensure of your Provider are available to you and will be verified, and your identity and location will be verified; your Provider will determine whether your condition is appropriate for telehealth; all confidentiality protections applicable under federal and state law apply to your telehealth services; the records of your telehealth encounter are part of your medical record, and you have the right to access them and to have them transmitted to your primary care provider or another provider of your choice upon request; you have been informed of the security measures used with the Services and of the remaining risks to privacy, and that information may be lost or delayed due to technical failures; and you have been given instructions for follow-up care and for obtaining emergency care.
Alaska: Your primary care provider may obtain a copy of the records of your telehealth encounter. (Alaska Stat. § 08.64.364.) To file a formal complaint about a provider, visit https://www.commerce.alaska.gov/web/cbpl/ComplaintFAQs.aspx.
Arizona: All medical records resulting from a telemedicine encounter are part of your medical record. (A.R.S. § 12-2291.)
Colorado: You may refuse telehealth services at any time without affecting your right to future care or treatment and without the loss or withdrawal of any treatment; all applicable confidentiality protections apply to the services; and you have access to all medical information resulting from the services as provided by law. To file a formal complaint about a provider, visit https://dpo.colorado.gov/FileComplaint.
Connecticut: Your primary care provider may obtain a copy of the records of your telehealth encounter, and you may revoke your consent to telehealth at any time. (Conn. Gen. Stat. § 19a-906.)
District of Columbia: You have been informed of alternate forms of communication with a physician for urgent matters. (D.C. Mun. Regs. tit. 17, § 4618.10.)
Georgia: You have been given clear, appropriate, and accurate instructions for follow-up in the event you need emergency care related to your treatment. (Ga. Comp. R. & Regs. 360-3-.07(7).)
Idaho: You acknowledge: verification of your identity and of your Provider and your Provider’s credentials; your agreement that your Provider will determine whether the condition being diagnosed or treated is appropriate for telehealth services; that you have received information on the security measures taken with the use of telehealth technologies, such as encryption of data, password-protected screen savers and data files, and other reliable authentication techniques, as well as the potential risks to privacy notwithstanding those measures; and that information may be lost due to technical failures. (Idaho Code § 54-5708 and Idaho Board of Medicine guidance.) To file a formal complaint about a provider, visit https://dopl.idaho.gov/filing-a-complaint/.
Illinois: To file a formal complaint about a provider, visit the Illinois Division of Professional Regulation at https://idfpr.illinois.gov/admin/dpr/complaint.html.
Indiana: To file a formal complaint about a provider, visit https://inoag.my.salesforce-sites.com/ConsumerComplaintForm.
Iowa: To file a formal complaint about a provider, visit https://dial.iowa.gov/about-dial/boards-0/medicine.
Kansas: If you have a primary care provider or other treating physician, the telemedicine provider must, within three business days, send a report of the treatment and services rendered to you during the telemedicine encounter to that physician. (Kan. Stat. Ann. § 40-2,212(d)(2)(A).) The complaint process is described at http://www.ksbha.org/complaints.shtml.
Kentucky: To file a formal complaint about a provider, visit https://kbml.ky.gov/grievances/Pages/default.aspx.
Louisiana: You understand the role of any other health care providers who may be present during a consultation in addition to the telehealth provider. (46 La. Admin. Code Pt. XLV, § 7511.)
Maine: To file a formal complaint about a provider, visit https://www.maine.gov/md/complaint/file-complaint.
Maryland: Telehealth services may not be provided based solely on an online questionnaire. To file a formal complaint about a provider, visit https://www.mbp.state.md.us/forms/complaint.pdf.
Nebraska: All existing confidentiality protections apply to your telehealth consultation, and you have access to all medical information resulting from it as provided by law. No patient-identifiable images or information from the consultation may be disseminated to researchers or other entities without your written consent. You have the right to request an in-person consultation immediately after the telehealth consultation, and you will be informed if such a consultation is not available. (Neb. Rev. Stat. § 71-8505; 471 Neb. Admin. Code § 1-006.05.) To file a formal complaint, visit https://dhhs.ne.gov/Pages/Complaints.aspx.
New Hampshire: The telehealth provider may forward your medical records to your primary care or treating provider. (N.H. Rev. Stat. § 329:1-d.)
New Jersey: You have the right to request a copy of your medical information, and your medical information may be forwarded directly to your primary care provider or health care provider of record or, at your request, to other health care providers. (N.J. Rev. Stat. § 45:1-62.)
Ohio: The telehealth provider may forward your medical records to your primary care or treating provider. (Ohio Admin. Code 4731-11-09(C).)
Oklahoma: To file a formal complaint about a provider, visit http://www.okmedicalboard.org/complaint. The Board of Osteopathic Examiners may be reached through https://www.ok.gov/osboe/faqs.html.
Oregon: To file a formal complaint about a provider, visit https://www.oregon.gov/omb/OMBForms1/complaint-form.pdf.
Rhode Island: If you use email or text-based technology to communicate with your provider, you understand the types of transmissions that are permitted and the circumstances in which alternate forms of communication or an office visit should be used. You have discussed security measures, such as encryption of data, password-protected screen savers and data files, and other reliable authentication techniques, as well as the potential privacy risks that remain notwithstanding those measures. Failure to comply with this agreement may result in the provider terminating the telehealth relationship. (Rhode Island Medical Board Guidelines.)
South Carolina: Your medical records may be distributed, in accordance with applicable law and regulation, to other treating health care practitioners. (S.C. Code Ann. § 40-47-37.)
South Dakota: You have received disclosures regarding the delivery models and treatment methods or limitations applicable to your care, and you have discussed with the telehealth provider your diagnosis and its evidentiary basis and the risks and benefits of the available treatment options. (S.D. Codified Laws § 34-52-3.)
Utah: You understand: any additional fees charged for telehealth services, if any, and how payment is to be made for them if charged separately from fees for related face-to-face services; to whom your health information may be disclosed and for what purpose, including any consent governing release of patient-identifiable information to a third party; your rights with respect to your health information; and the appropriate uses and limitations of the Platform, including in emergency situations. You understand the telehealth services meet industry security and privacy standards and comply with the laws referenced in Utah Code § 26-60-102. You have been warned of potential privacy risks notwithstanding the security measures used and that information may be lost due to technical failures, and you agree to hold the provider harmless for such loss. You have been provided the location of the company’s website and its contact information. You were able to select your provider of choice, to the extent possible, and your pharmacy of choice. You are able to: access, supplement, and amend the personal health information you have provided; contact your provider for subsequent care; obtain, upon request, an electronic or hard copy of your medical record documenting the telemedicine services, including this informed consent; and request that your medical record documenting the telemedicine services be transferred to another provider. (Utah Admin. Code r. 156-1-603.)
Vermont: You have the right to receive a consultation with a distant-site provider and will receive one upon request immediately or within a reasonable time after the results of your initial consultation. To file a formal complaint about a provider, visit https://www.healthvermont.gov/health-professionals-systems/board-medical-practice/file-complaint; the Board of Osteopathic Physicians may be reached through https://sos.vermont.gov/osteopathic-physicians/.
Virginia: You acknowledge that you have received details regarding the security measures used with these telemedicine services, such as encryption of data, password-protected screen savers and data files, and other reliable authentication techniques, as well as the potential privacy risks that remain notwithstanding those measures. You agree to hold Soha, the Medical Groups, and your Provider harmless for information lost due to technical failures, and you expressly consent to the forwarding of patient-identifiable information to a third party as described in this Consent. (Virginia Board of Medicine Guidance Document 85-12.)
Texas: Your medical records may be sent to your primary care physician. (Tex. Occ. Code § 111.005.) You have been provided the following notice required by the Texas Medical Board:
NOTICE CONCERNING COMPLAINTS – Complaints about physicians, as well as other licensees and registrants of the Texas Medical Board, including physician assistants, acupuncturists, and surgical assistants, may be reported for investigation at the following address: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018. Assistance in filing a complaint is available by calling the following telephone number: 1-800-201-9353. For more information, please visit our website at www.tmb.state.tx.us.
AVISO SOBRE LAS QUEJAS – Las quejas sobre médicos, así como sobre otros profesionales acreditados e inscritos del Consejo Médico de Tejas, incluyendo asistentes de médicos, practicantes de acupuntura y asistentes de cirugía, se pueden presentar en la siguiente dirección para ser investigadas: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018. Si necesita ayuda para presentar una queja, llame al: 1-800-201-9353. Para obtener más información, visite nuestro sitio web en www.tmb.state.tx.us.
19. CONTACT
If you have questions about this Consent, contact us at legal@joinsoha.com.
Questions about this document? Email legal@joinsoha.com.
See also our Important Safety Information.