Asynchronous Telemedicine Informed Consent

Thank you for choosing Salvo Health! You are viewing this form because you have elected to engage in asynchronous telemedicine visits with a Salvo Health healthcare practitioner. Your practitioner name and credentials will be shared with you upon assignment and again at your first telehealth visit. If you did not receive this information please contact legal@salvohealth.com.

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By clicking “I Agree,” I ACKNOWLEDGE I HAVE READ AND UNDERSTAND THE TERMS PRESENTED BELOW, AND UNDERSTAND THE RISKS AND BENEFITS OF ASYNCHRONOUS TELEMEDICINE AND THE COMMUNICATION METHODS LISTED BELOW, AND BY ACCEPTING THESE TERMS OF USE I HEREBY GIVE MY INFORMED CONSENT TO PARTICIPATE IN ASYNCHRONOUS TELEMEDICINE AND ALLOW SALVO HEALTH TO CONTACT ME VIA THE COMMUNICATION METHODS LISTED BELOW 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. Salvo Health allows you to receive treatment from a healthcare practitioner without having to travel to another location or schedule a separate appointment and helps you avoid long wait times that you might otherwise experience at an in-person visit.

What is Asynchronous Telemedicine?

Asynchronous telemedicine is one way to deliver telemedicine. Asynchronous communication is often referred to as “store-and-forward” communication, where participants submit and collect data at different times. An example of asynchronous communication is a telemedicine encounter with a healthcare practitioner that involves sending photos, video, or other communications via email or text message. “Asynchronous” means “not occurring at the same time” and is different from “synchronous” telemedicine, which generally includes visits conducted in real-time between patients and healthcare practitioners through audio or video means (e.g., live phone calls or video-conferencing). Healthcare practitioners may use asynchronous telemedicine to aid in diagnoses and medical consultations when live communication or face-to-face contact is not possible or necessary.

Salvo Health’s platform (“Platform”), in particular, allows for the following asynchronous telemedicine services: 1) text-based healthcare practitioner-patient interactions through short message service (“SMS”) and multimedia messaging service (“MMS”) communications; and 2) secure information collection through asynchronous store-and-forward patient questionnaires. 

What are the Possible Risks to Using Asynchronous Telemedicine?

As with any medical treatment, there are potential risks associated with the use of asynchronous telemedicine. Salvo Health believes that the likelihood of these risks materializing is very low. 

These risks may include, without limitation, the following:

• Delays in medical evaluation and consultation or treatment may occur due to deficiencies or failures of the equipment or the Internet, which may include poor data quality, Internet outages, or other service interruption issues. You may reschedule the visit with your healthcare practitioner should these interruptions occur.
• Security protocols could fail, causing a breach of privacy of personal medical information.
• Because Salvo Health does not have access to your complete medical records, if you do not disclose to your healthcare practitioner a full list of your treatments, medications/supplements, and allergies, adverse treatment, drug interactions or allergic reactions, or other negative outcomes may occur.
• Asynchronous telemedicine services are NOT emergency services and your Personal Data (as defined in the Salvo Health Privacy Policy) WILL NOT BE MONITORED 24/7. If you think you are experiencing a medical emergency, CALL 911 IMMEDIATELY.

THE CARE YOU RECEIVE WILL BE AT THE SOLE DISCRETION OF THE HEALTHCARE PRACTITIONER WHO IS TREATING YOU, WITH NO GUARANTEE OF DIAGNOSIS, TREATMENT, OR PRESCRIPTION. THE HEALTHCARE PRACTITIONER WILL DETERMINE WHETHER OR NOT THE CONDITION BEING DIAGNOSED AND/OR TREATED IS APPROPRIATE FOR AN ASYNCHRONOUS TELEMEDICINE ENCOUNTER VIA THE PLATFORM.

Your Rights and Acknowledgements

• You understand that your healthcare information may be shared with other individuals in accordance with the Salvo Health Privacy Policy and regulations or laws in the state or territory in which you are located. 
• You have the same privacy rights via asynchronous telemedicine that you would have during an in-person visit. Dissemination of any identifiable images or information from the asynchronous telemedicine encounter(s) and/or services to researchers or other entities will not occur without your written consent. For more complete information about how we protect your privacy, please read the Salvo Health Privacy Policy here.
• Asynchronous telemedicine may involve electronic communication of your personal medical information to remote healthcare practitioners who may be located outside of your state.
• You understand that no results can be guaranteed or assured—you may not achieve the anticipated benefits of the asynchronous telemedicine services.
• You understand that all information submitted to Salvo Health will be part of your medical record and available to you by emailing support@salvohealth.com and requesting a medical record authorization form in accordance with State and Federal law. 
• You understand you may delete your patient account at any time by emailing support@salvohealth.com.

Call/Email/Text Messaging Consent

You expressly consent to allow Salvo Health or its healthcare practitioners to call, email, or text you (via SMS and/or MMS) with or regarding Personal Data (as defined in the Privacy Policy), appointments, or similar matters related to your asynchronous telemedicine services using the contact information you have provided. Any calls or texts to you may be placed using an auto-dialer or a pre-recorded or artificial voice, even if your number is on a do-not-call list. Your phone carrier’s normal rates may apply. This is consent, not a condition of purchase. You may revoke this consent at any time by emailing us at support@salvohealth.com.

This Asynchronous Telemedicine Informed Consent is valid during your entire treatment with Salvo Health. If you would like to withdraw consent, you must do so prior to receiving any further treatment by emailing us at support@salvohealth.com.