Telehealth Consent & Open Payments Notice
Last updated: November 14, 2024

INFORMED CONSENT REGARDING USE OF TELEHEALTH

BY CLICKING “I AGREE,” CHECKING A RELATED BOX TO SIGNIFY YOUR ACCEPTANCE, USING ANY OTHER ACCEPTANCE PROTOCOL PRESENTED THROUGH THE SERVICE OR OTHERWISE AFFIRMATIVELY ACCEPTING THIS CONSENT, YOU ACKNOWLEDGE THAT YOU HAVE READ, ACCEPTED, AND AGREED TO BE BOUND BY THIS CONSENT. IF YOU DO NOT AGREE TO THIS CONSENT, DO NOT CREATE AN ACCOUNT OR USE THE SERVICE. YOU HEREBY GRANT AGENCY AUTHORITY TO ANY PARTY WHO CLICKS ON THE “I AGREE” BUTTON OR OTHERWISE INDICATES ACCEPTANCE TO THIS CONSENT ON YOUR BEHALF.

IF YOU ARE EXPERIENCING A LIFE-THREATENING SITUATION SUCH AS CONTEMPLATING SUICIDE, CALL 911 OR THE 988 SUICIDE & CRISIS LIFELINE AT 988.

Purpose

The purpose of this consent form ("Consent") is to provide you with information about telehealth and to obtain your informed consent to the use of telehealth in the delivery of healthcare and/or mental health services to you by physicians, physician assistants, nurse practitioners, and/or mental health professionals ("Providers") using the online platforms owned and operated by NueYue ("Service").

In this Consent, the terms "you" and "yours" refer to the person using the Service, or in the case of a use of the Service by or on behalf of an individual minor between the ages of thirteen (13) and eighteen (18) or higher age of majority under applicable state law, "you" and "yours" refer to and include (i) the parent or legal guardian who provides consent to the use of the Service by such minor or uses the Service on behalf of such minor, and (ii) the minor for whom consent is being provided or on whose behalf the Service is being utilized.

Use of Telehealth

Telehealth involves the delivery of healthcare and/or mental health services using electronic communications, information technology, or other means between a healthcare or mental health provider and a patient who are not in the same physical location.

Through NueYue’s platform, telehealth may be used for diagnosis, treatment, follow-up and/or patient education, and may include, but is not limited to:

  • Electronic transmission of medical records

  • Photo images, personal health information, or other data between you and your provider

  • Real-time interactions with your provider via audio and video communications

  • Secure messaging and email communications

  • Review and sharing of medical device data, sound files, and video files

  • Remote monitoring and assessment of health conditions

Alternative methods of care may be available to you, such as in-person services, and you have the right to choose an alternative method of care at any time.

Anticipated Benefits

The use of NueYue’s telehealth services may offer you several possible benefits, including:

  • Easier access to medical care and treatment for conditions managed by your Provider(s)

  • Ability to receive care from the comfort and privacy of your chosen location

  • Reduced need for travel and exposure to potential illnesses

  • Continuous access to your healthcare team through secure messaging

  • Increased comfort and confidence for mental health patients, with improved access to support

Potential Risks

While NueYue’s telehealth services offer many advantages, there are potential risks, such as:

  • Limited ability to conduct physical exams or certain tests

  • Technical issues including software bugs, data transmission errors, or downtime

  • Privacy risks inherent to electronic communications

  • Possible regulatory restrictions (e.g., prescriptions, controlled substances)

  • Emotional difficulty during therapy sessions due to the virtual format

  • Reliance on accurate self-reporting of symptoms by the patient

LIFE THREATENING AND OTHER EMERGENCY SITUATIONS; FOLLOW-UP CARE

If you are experiencing a life-threatening situation, call 911 or the 988 Suicide and Crisis Lifeline at 988.

For urgent care, seek in-person emergency services. Providers may not respond promptly to communications submitted through the Service.

Data Privacy & Protection

The electronic systems used in the Service will incorporate security protocols to protect your information. Protected health information will not be disclosed to third parties without your consent, except as authorized by law or outlined in your Provider’s Notice of Privacy Practices.

Laboratory Products & Services

Certain services provided through NueYue’s platform may require at-home diagnostic tests from third-party labs. These tests, like all medical tests, have limitations and may yield inaccurate results. Your Provider may recommend follow-up testing or in-person evaluation.

Open Payments Notice

For informational purposes, see the federal Open Payments database (Physician Payments Sunshine Act) at:
https://openpaymentsdata.cms.gov

Contacting Us

If you have any questions about this Consent, please contact us at:

privacy@nueyue.com

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© NueYue 2024

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