Consent to Telehealth

Thank you for choosing Easylose and Beluga Health, P.A. ("Beluga")! You are viewing this form because you have elected to engage in asynchronous telemedicine visits with a Beluga healthcare practitioner via Easylose. Your practitioner is a board-certified physician licensed in your state.

By clicking "I Agree," you acknowledge that you have read and understood the terms presented below, including the risks and benefits of asynchronous telemedicine. By accepting these Terms of Use, you hereby give your informed consent to participate in asynchronous telemedicine under these terms.

What is Telemedicine?
Telemedicine is the delivery of healthcare services, including examination, consultation, diagnosis, and treatment, through electronic communication technologies when you (the patient) are located in a different location than your healthcare practitioner. Beluga allows you to receive treatment from a healthcare practitioner without having to travel to another location or schedule a separate appointment, helping you avoid long wait times that you might otherwise experience at an in-person visit.What is Asynchronous Telemedicine?Asynchronous telemedicine is a method of delivering telemedicine that allows participants to submit and collect data at different times, often referred to as “store-and-forward” communication. An example is sending photos, videos, or other communications via email or text message for a telemedicine encounter. Asynchronous telemedicine differs from synchronous telemedicine, which generally involves real-time visits through phone calls or video conferencing. Asynchronous telemedicine aids in diagnoses and consultations when live communication or face-to-face contact is not possible or necessary.Beluga’s platform ("Platform") facilitates asynchronous telemedicine through:Text-based interactions via SMS and MMSSecure data collection through asynchronous store-and-forward patient questionnairesWhat are the Possible Risks to Using Asynchronous Telemedicine?While Beluga believes that the risks associated with asynchronous telemedicine are low, the following risks may occur:


‍Delays in Medical Evaluation:
Consultation or treatment delays may arise due to equipment failures, poor data quality, Internet outages, or other service interruptions. Should these occur, you may reschedule your visit with the healthcare practitioner.

‍Security Protocol Failures: Breaches of personal medical information may occur if security protocols fail.

‍Incomplete Medical Records: Since Beluga does not have access to your complete medical records, if you fail to disclose your full medical history, including diagnoses, medications, and allergies, there may be adverse treatments, drug interactions, allergic reactions, or other negative outcomes.

‍Non-Emergency Service: Asynchronous telemedicine is not an emergency service. Your personal data will not be monitored 24/7. If you experience a medical emergency, call 911 immediately.

‍Note: The care you receive will be at the sole discretion of the treating healthcare practitioner. There is no guarantee of diagnosis, treatment, or prescription. The practitioner will determine if your condition is appropriate for asynchronous telemedicine care.Your Rights and Acknowledgments:

‍Privacy Rights: You retain the same privacy rights through asynchronous telemedicine as you would during an in-person visit. No identifiable images or information will be shared with researchers or other entities without your written consent. For more information, please read the Beluga Privacy Policy.

‍Cross-Border Communication: Asynchronous telemedicine may involve the electronic transmission of your personal medical information to healthcare practitioners located outside your state.

‍No Guarantee of Results: While you may expect certain benefits from using asynchronous telemedicine, there are no guaranteed outcomes.

‍Access to Medical Records: All information submitted through Beluga's platform, including text messages, becomes part of your medical record and will be accessible to you by contacting admin@belugahealth.com.

‍Practitioner Identification: Your healthcare practitioner’s initial text message to you will include their name and credentials. This will also be part of your medical record.

‍Right to Withdraw Consent: You may withdraw your consent and delete your patient profile at any time by contacting admin@belugahealth.com.

‍Healthcare Information Sharing: Your healthcare information may be shared with other individuals as allowed by the Beluga Privacy Policy and in accordance with state or federal regulations.

‍Circumstances for Data Sharing:A valid court order for medical recordsReporting of suspected abuse, neglect, or domestic violencePreventing or reducing serious threats to anyone's health or safetyCall/Email/Text Messaging Consent:You expressly consent to allow Beluga or its healthcare practitioners to contact you via phone, email, or text (SMS/MMS) regarding your personal data, appointments, or related matters using the contact information you provided. Calls or texts may be made using an auto-dialer or pre-recorded voice, even if your number is on a do-not-call list. Standard phone carrier rates may apply.This consent is not a condition of purchase, and you may revoke it at any time by emailing admin@belugahealth.com.