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FastDoc Informed consent

Telehealth involves the use of electronic communications to enable healthcare providers at different locations to share individual patient medical information for the purpose of improving patient care. Telehealth services also include remote monitoring, tele-pharmacy, prescription refills, appointment scheduling, regional health information sharing, and non-clinical services, such as education programs, administration, and public health. Medical providers may include primary care practitioners, specialists, and/or subspecialists. The information may be used for diagnosis, therapy, follow-up and/or education, and may include any combination of the following: (1) patient medical records; (2) medical images; (3) live two-way audio and video; (4) interactive audio; and (5) output data from medical devices and sound and video files.

Electronic systems used will incorporate network and software security protocols to protect the confidentiality of patient identification and imaging data and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption.

Primary responsibility for your medical care should remain with your local primary care doctor, if you have one, as does your medical record.

Expected Benefits:

Improved access to medical care by enabling you to remain in your local healthcare site (i.e. home) while the provider consults and obtains test results at distant/other sites.

More efficient medical evaluation and management.

Obtaining expertise of a specialist.

Possible Risks:

Delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment and technologies.

In rare events, the provider may determine that the transmitted information is of inadequate quality, thus necessitating a rescheduled telehealth consult or a face-to-face meeting with your local primary care doctor.

In very rare events, security protocols could fail, causing a breach of privacy of personal medical information.

In rare events, a lack of access to complete medical records may result in adverse drug interactions or allergic reactions or other judgment errors.

By checking the box associated with “Informed Consent”, you acknowledge that you understand and agree with the following:

  1. I hereby consent to receiving FastDoc’s services via telehealth technologies. I understand that FastDoc and its consulting providers offer telehealth services, but that these services do not replace the relationship between me and my primary care doctor. I also understand it is up to the FastDoc provider to determine whether or not my needs are appropriate for a telehealth encounter.
  2. I have been given an opportunity to select a consulting provider from the FastDoc prior to the consult, including a review of the consulting provider’s credentials.
  3. I understand that federal and state law requires health care providers to protect the privacy and the security of health information. I understand that FastDoc will take steps to make sure that my health information is not seen by anyone who should not see it. I understand that telehealth may involve electronic communication of my personal medical information to other medical practitioners who may be located in other areas, including out of state.
  4. I understand there is a risk of technical failures during the telehealth encounter beyond the control of FastDoc. I agree to hold harmless FastDoc for delays in evaluation or for information lost due to such technical failures.
  5. I understand that I have the right to withhold or withdraw my consent to the use of telehealth in the course of my care at any time, without affecting my right to future care or treatment. I understand that I may suspend or terminate access to the service at any time for any reason or for no reason. I understand that if I am experiencing a medical emergency, that I will be directed to dial 9-1-1 immediately and that the FASTDOC LLC health service specialists are not able to connect me directly to any local emergency services.
  6. I understand the alternatives to telehealth consultation, such as in-person services are available to me, and in choosing to participate in a telehealth consultation, I understand that some parts of the services involving physical tests may be conducted by individuals at my location, or at a testing facility, at the direction of the FastDoc consulting healthcare provider (e.g. labs or bloodwork).
  7. I understand that the audio portion of my medical visit (including audio from visits that include video) is recorded for purposes which may include treatment, quality improvement, improvement of health status, customer and patient experience, customer and patient engagement and/or behavior modification, peer review, payment, efficiency, cost effectiveness and/or other purposes relating to operations and provision of telehealth services and I specifically consent to the recording of my medical visit. I understand that behavioral health visits are not recorded.
  8. I understand that I may expect the anticipated benefits from the use of telehealth in my care, but that no results can be guaranteed or assured.
  9. I understand that my healthcare information may be shared with other individuals for scheduling and billing purposes. Persons may be present during the consultation other than the FastDoc provider in order to operate the telehealth technologies. I further understand that I will be informed of their presence in the consultation and thus will have the right to request the following: (1) omit specific details of my medical history/examination that are personally sensitive to me; (2) ask non-medical personnel to leave the telehealth examination; and/or (3) terminate the consultation at any time.
  10. I understand that I will not be prescribed any Drug Enforcement Agency controlled substances nor is there any guarantee that I will be given a prescription at all.
  11. I understand that if I participate in a consultation, that I have the right to request a copy of my medical records which will be provided to me at reasonable cost of preparation, shipping and delivery.
  12. I understand that in the event of any problem with the website or related services, I agree that my sole remedy is to cease using the website or terminate access to the service. Under no circumstances will FASTDOC LLC or any FASTDOC LLC subsidiary or affiliate be liable in any way for the use of the telehealth services, including but not limited to, any errors or omissions in content or infringement by any content on the website of any intellectual property rights or other rights of third parties, or for any losses or damages of any kind arising directly or indirectly out of the use of, inability to use, or the results of use of the website, and any website linked to the website, or the materials or information contained on any or all such websites. I agree that I will not hold FASTDOC LLC, its subsidiaries or affiliates liable for any punitive, exemplary, consequential, incidental, indirect or special damages (including, without limitation, any personal injury, lost profits, business interruption, loss of programs or other data on my computer or otherwise) arising from or in connection with your use of the website whether under a theory of breach of contract, negligence, strict liability, malpractice or otherwise, even if we or they have been advised of the possibility of such damages.
  13. I understand that FASTDOC LLC makes no representation that materials on this website are appropriate or available for use in any other location. I understand that if I access these services from a location outside of the United States, that I do so at my own risk and initiative and that I am ultimately responsible for compliance with any laws or regulations associated with my use.
  14. Additional State-Specific Consents: The following consents apply to users accessing the FASTDOC LLC website for the purposes of participating in a telehealth consultation as required by the states listed below:
    1. Arizona: Guardian consents to verify his/her identity prior to performing a mental health screening or mental health treatment on a minor. AZ ST § 36-2272.
    2. Connecticut: I understand that my primary care provider may obtain a copy of my records of any telehealth interaction. CT Public Act No. 15-88 (2015).
    3. Iowa: I understand that as necessitated by the availability of resources in the community where services are delivered, telehealth may be used in delivering and coordinating interventions with appropriate providers for autism support, subject to the licensure of the participating provider. Iowa Code Ann. § 225D.2.
    4. Kentucky: I understand that I have the right to be informed of any party who will be present at the site during the telehealth consult and I have the right to exclude anyone from being present. I also understand that I have the right to object to the videotaping of the telehealth consultation. KY Admin. Regs. Tit. 907, 3:170.
    5. Maryland: I understand that I cannot request telehealth services to be conducted via correspondence only. Code of MD Reg. 10.41.06.04.
    6. Nebraska: I understand that I have the right to be informed of any party who will be present at the site during the telehealth consult and I have the right to exclude anyone from being present. I understand that any dissemination of identifiable images or information from a consult requires my express permission. I understand that I have the right to request an in-person consult immediately after the telehealth consult and I will be informed if such consult is not available. NE Revised Stat. 71-8505; NE Admin. Code Tit. 471, Ch. 1.
    7. Nevada: I understand that the transmission of any confidential medical information while engaged in telemedicine is subject to all applicable federal and state laws with respect to the protection of and access to confidential medical information. NV Rev. Stat. Ann. § 633.0165.
    8. Pennsylvania: I understand that I may be asked to confirm my consent to behavioral health or tele-psych services.
    9. Tennessee: I understand that I may request an in-person assessment before receiving a telehealth assessment.
    10. Vermont: I understand that I have the right to receive a consult with a distant-site provider and will receive one upon request immediately or within a reasonable time after the results of the initial consult. I understand that receiving tele-dermatology or tele-ophthalmology services via FASTDOC LLC does not preclude me from receiving real-time telemedicine or face-to-face services with the distant provider at a future date. VT Stat. Ann. § 9361.

Disclaimer

FastDoc is not an insurance product or a prescription fulfillment warehouse.

FastDoc does not replace the existing primary care physician relationship.

Medical services rendered by your physician are subject to their professional judgment.

FastDoc operates subject to state regulation and may not be available in certain states.

FastDoc does not guarantee that a prescription will be written.

FastDoc physicians do not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse.

FastDoc physicians reserve the right to deny care for potential misuse of services.

FastDoc phone consultations are available 24/7/365, while video consultations are available during the hours of 7 am to 9 pm, 7 days a week or by scheduled availability.

FastDoc and the FastDoc logo are registered trademarks of FastDoc, Inc. and may not be used without written permission.

Nondiscrimination Notice

Content coming soon

ADA Policy

FastDoc LLC. is committed to the accessibility of its electronic and information technologies for individuals with disabilities by meeting the requirements of Section 508 of the Rehabilitation Act. Section 508 requires that individuals with disabilities have access to and use of information and data that is comparable to those who are not individuals with disabilities, unless an undue burden would be imposed on us. More information of Section 508 can be found at American Disability Act Standards.

As part of the development process and ongoing website maintenance, FastDoc team tests the site using assistive technologies, including screen readers, screen magnifiers, speech recognition software and text-only browsers. FastDoc LLC. uses tools, such as the W3C HTML. Validator, WAVE by WebAIM and the Color Contrast Analyzer, to ensure the best experience possible for all visitors.

Should you have any feedback or concerns related to the accessibility of this webpage and resources contained within it, please contact us via email at compliance@fastdoc.com. If applicable, please include the web address, brief description of the issue encountered and your contact information.

WASHINGTON CONSUMER HEALTH DATA PRIVACY NOTICE

This Washington Consumer Health Data Privacy Notice applies to “consumer health data” collected from Washington state residents and those whose consumer health data is collected through the FastDoc, LLC. (“FastDoc,” “we,” “us,” or “our”) or affiliated website on which it is posted, as well as those whose consumer health data is collected in the State of Washington. This notice applies to Washington residents and those whose consumer health data is collected in Washington. Consumer health data means personal information that is linked or reasonably linkable to a consumer and that identifies the consumer's past, present, or future physical or mental health status, under the Washington State My Health My Data Act (MHMDA). See also our other privacy notices that provide disclosures about personal information that is not consumer health data subject to MHMDA.

This notice does not apply where an exception or exemption applies such as with respect to protected health information under the Health Insurance Portability and Accountability Act (“HIPAA”) and data that is subject to the Gramm-Leach-Bliley Act (“GLBA”). When we are a covered entity, we provide separate HIPAA and GLBA privacy notices to certain customers and consumers as required under applicable laws and regulations. Most consumer health data we process is regulated under HIPAA or GLBA or is processed for a necessary function.

Consumer Health Data Collected

The personal information, including consumer health data, we collect varies based on your relationship with us. For example, if you visit our website we may collect personal information through tracking technologies essential to running our website. Or, if you visit our physical premises in Washington, we may collect video surveillance or other information that could incidentally include consumer health data.

We may collect the following categories of consumer health data:

  • Individual health conditions, treatment, diseases, or diagnosis;
  • Social, psychological, behavioral, and medical interventions;
  • Health-related surgeries or procedures;
  • Use or purchase of prescribed medication;
  • Bodily functions, vital signs, symptoms, or measurements of other types of consumer health data;
  • Diagnosis or diagnostic testing, treatment, or medication;
  • Gender-affirming care information;
  • Reproductive or sexual health information;
  • Biometric data;
  • Genetic data;
  • Precise location information that could reasonably indicate a consumer's attempt to acquire or receive health services or supplies;
  • Data that identifies a consumer seeking health care services; and
  • Other information that may be processed to derive or infer data related to the above or other consumer health data.

The categories of consumer health data above may include the following personal information, when collected in connection with your past, present, or future physical or mental health status:

  • Identifiers such as name, contact information, online identifiers, and government-issued ID numbers;
  • Characteristics of Protected Classifications under state or federal law such as age and medical conditions;
  • Commercial Information such as transaction information and purchase history;
  • Internet or Network Activity Information such as browsing history, interactions with our website, Internet Protocol (IP) address, Media Access Control (MAC) address; operating system and version; Internet browser type and version;
  • Geolocation Data such as device location; and
  • Audio, Electronic, Visual and Similar Information such as call and video recordings;

We process any de-identified consumer health data only in a de-identified fashion and will not attempt to re-identify such data.

Why We Collect and Use Consumer Health Data

To the extent we collect your Consumer Health Data as described above, we may use it for the following purposes:

  • Services and Support. To provide and operate our Services, communicate with you about your use of the Services, provide you with information about our Services, including information about health care, health related services, resources and benefits that will help you manage your health; sending administrative information to you, such as changes to our terms, conditions, and policies; provide troubleshooting and technical support, respond to your inquiries, fulfill your orders and requests, process your payments and claims, communicate with you about the Services, complete transactions, provide quotes; and to provide our insurance products or services requested by consumers;
  • Analytics and Improvement. To better understand how you access and use the Services, and for other internal research and analytical purposes, such as to evaluate and improve our Services and business operations and for internal quality control and training purposes;
  • Research and Surveys. To administer surveys and questionnaires, such as for customer engagement purposes;
  • Infrastructure. To maintain our facilities and infrastructure and undertake quality and safety assurance measures;
  • Authentication. To authenticate or confirm your identity;
  • Security and Protection of Rights. To protect the Services and our business operations; to protect our rights or those of our stakeholders; to prevent and detect fraud, unauthorized activities and access, and other misuse; conduct risk and security control and monitoring; where we believe necessary, to investigate, prevent or take action regarding illegal activities, suspected fraud, situations involving potential threats to the safety or legal rights of any person or third party, or violations of our Terms of Use as well as any additional terms specific to the site;
  • Compliance andLegal Process. To comply with the law and our legal obligations, to respond to legal process and related to legal proceedings;
  • General Business and Operational Support. To consider and implement mergers, acquisitions, reorganizations, bankruptcies, and other business transactions such as financing's, and related to the administration of our general business, accounting, auditing, compliance, record keeping, and legal functions; and
  • Business Transfers. To consider and implement mergers, acquisitions, reorganizations, and other business transactions, and where necessary to the administration of our general business, accounting, record keeping, and legal functions.
  • De Identification. We may also aggregate or de-identify data by removing identifying details so it no longer identifies an individual. If we de-identify the data, we will not attempt to re-identify it.
  • Categories of Sources

We generally collect personal information, including consumer health data, from the following categories of sources:

  • Directly from you and automatically;
  • Our affiliates; and
  • Our vendors
  • Our Sharing of Consumer Health Data

The categories of third parties and other recipients with whom we may share consumer health data as necessary to provide our products and services requested by consumers are:

How to Exercise Your Rights

MHMDA grants certain rights including a right of access and deletion, subject to certain exceptions.

If you would like to exercise your rights under the MHMDA, you may make a request by contacting us at privacy@fastdoc.com,by mail at: 1178 Broadway New York, NY 10001, : Privacy Office. Please indicate that you are making a request pursuant to your “Washington Privacy Rights” and provide us with the following information: (1) first and last name; (2) email address; (3) physical address; and (4) date of birth. We will take steps to verify your request by matching the information provided by you with the information we have in our records.

If your request to exercise a right under the MHMDA is denied, you may appeal the denial. A method for submitting an appeal will be contained in our response. If your appeal is unsuccessful, you can raise a concern or lodge a complaint with the Washington State Attorney General at www.atg.wa.gov/file-complaint.

Notice Effective Date: March 31, 2024

HIPAA-Compliant Consent for Video and Audio Recordings in Electronic Health Records

Purpose of the Consent

This consent form is designed to inform you about the use of video and audio recordings as part of your Electronic Health Records (EHR). These recordings will be used for clinical documentation, healthcare operations, and/or educational purposes, as outlined below. Your privacy and confidentiality are of utmost importance to us, and we comply with the Health Insurance Portability and Accountability Act (HIPAA) to protect your personal health information (PHI).

Types of Recordings:

  • Video Recordings: Capture visual information about your medical condition and treatment.
  • Audio Recordings: Capture spoken interactions between you and your healthcare provider.

Uses of Recordings:

  1. Clinical Documentation: Recordings may be used to document your medical condition, treatment, and interactions with healthcare providers to improve the accuracy of your EHR.
  2. Healthcare Operations: Recordings may be used for purposes related to the management of your care, including quality assurance, training, and compliance with legal and regulatory requirements.
  3. Educational Purposes: With your additional consent, recordings may be used for educational purposes, such as training healthcare professionals.

Privacy and Confidentiality

Your recordings are considered PHI and will be stored securely within our EHR system. Only authorized personnel who require access to your recordings to perform their job functions will be able to view or listen to them. We implement appropriate administrative, technical, and physical safeguards to protect the confidentiality and security of your recordings.

Right to Revoke Consent

You have the right to revoke your consent to the use of video and audio recordings at any time by notifying us in writing. However, any recordings made prior to the revocation of consent may still be used as described in this form.

Voluntary Participation

Your participation is voluntary, and your decision to consent or not will not affect the quality of care you receive. You will not be penalized or denied healthcare services if you choose not to consent to video or audio recordings.

Contact Information

If you have any questions or concerns about this consent form or your rights under HIPAA, please contact our Privacy Officer at:

Cliff Capdevielle

cliff@fastdoc.com

FastDoc LLC

1178 Broadway New York, NY 10001