Last modified: February, 2022
Hello, and welcome to Galileo!
Galileo is a technology company that offers exceptional and comprehensive clinical care directly from your phone.
This Informed Consent agreement explains the benefits and certain limitations of using virtual visits to receive medical care. As a courtesy, we want to call your attention to several parts of it. You should know though that these highlights are not part of our official, binding legal terms. The official legal terms follow under the “Informed Consent” heading below.
Remote digital healthcare allows you to receive health care service in the convenience of your home, get timely and efficient appointments, and can help you better navigate the health system. However, there are also potential limitations like, in rare cases, your doctor could find the information you transmitted is insufficient to make a medical decision, meaning you will have to go in-person to a doctor, or that despite our strong security measures, your information could be breached by a bad actor.
The Medical Group that you (or your child, if applicable) will be connected to through Galileo uses a team-based approach. All care teams consist of multiple licensed physicians and other healthcare professionals, and in any given encounter you may interact with multiple healthcare professionals. This allows you (or your child, if applicable) to get better care faster. You (or your child, if applicable) can identify the doctor(s) involved in your medical visit and his or her credentials by clicking on the Galileo icon at any time during a telehealth visit in the app.
If you (or your child, if applicable) are a Medicaid patient, you (or your child, if applicable) may be entitled to receive the same digital healthcare services at little or no cost to you. By using the Galileo service, you authorize Galileo to bill you directly for the digital healthcare services as a private patient.
You have a right to refuse to participate in services delivered via telehealth.
By registering an account
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. Such electronic communications may involve synchronous or asynchronous text-based, audio-only, or audiovisual communications and/or recordings. Telehealth services offered by Galilea Medical Group, P.A. and its related practices (collectively the “Medical Group”) may include chart review, remote prescribing, appointment scheduling, health information sharing, and non-clinical services, such as patient education. The information you (or your child, if applicable) provide may be used for diagnosis, therapy, follow-up and/or patient education, and may include any combination of the following: (1) health records and test results; (2) interactive, asynchronous chat, audio, and/or video communications; (3) live two-way audio and video; and (4) output data from medical devices and sound and video files.
The Medical Group provides clinical services through a team-based care approach. All care teams consist of multiple licensed physicians and healthcare practitioners (our “providers”), and in any given encounter, you (or your child, if applicable) may interact with multiple licensed medical providers. You can identify the providers involved in an encounter and their credentials by clicking on the Galileo icon in the app.
In an effort to gain a more complete picture of your health (or your child’s health, if applicable) and to help avoid unnecessary testing and duplicated efforts, the Medical Group supports coordinating access to your (or your child’s, if applicable) health records and health data that is created by various third-party sources (“Third-Party Sources”) before, after and/or in between your visit(s). You can connect your (or your child’s, if applicable) account in the app with Third-Party Source platforms and/or products to share (1) your (or your child’s, if applicable) patient health records from other providers and/or (2) your (or your child’s, if applicable) electronic health data created by your (or your child’s, if applicable) use of different wellness, fitness or medical devices, with the app.
Once you (or your child, if applicable) elect to connect your (or your child’s, if applicable) account with Third-Party Sources, the Medical Group will be able to see any of your (or your child’s, if applicable) records and data that such Third-Party Sources share with the app. Your (or your child’s, if applicable) information will only be shared with the Medical Group in this manner as long as your (or your child’s, if applicable) account remains connected. Your (or your child’s, if applicable) decision to connect your (or your child’s, if applicable) accounts is completely voluntary and you (or your child, if applicable) may disconnect from third party platforms or products at any time. The electronic communication systems we use will incorporate network and software security protocols to protect the confidentiality of patient data and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption.
Improved access to care by enabling you (and your child, if applicable) to remain at home while the Medical Group provider consults and obtains test results at distant/other sites.
More efficient care evaluation and management.
Obtaining expertise of a specialist as appropriate.
Delays in evaluation and treatment could occur due to deficiencies or failures of the equipment and technologies.
In rare events, our provider may determine that the transmitted information is of inadequate quality, thus necessitating a rescheduled telehealth consult or a meeting with your (or your child’s, if applicable) 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.
If you need to receive follow-up care, assistance in the event of an adverse reaction to the treatment, or in the event of an inability to communicate as a result of a technological or equipment failure, please contact your Medical Group care team in the app or contact the Medical Group at email@example.com. If you are experiencing an emergency, please call 911 for immediate access to emergency services.
By clicking to accept this consent, you attest that you are at least 18 years of age and have legal authority to agree to this consent on behalf of yourself, if you are the patient, or on behalf of your minor child, if you are the parent/guardian of the patient:
I hereby consent to Medical Group providing its services via telehealth technologies. I understand that Medical Group and its providers offer telehealth-based medical services, but that these services are not intended to be a primary care provider relationship if I (or my child, as applicable) have not designated, or been assigned to, Galileo as my (or my child’s, as applicable) primary care provider. I also understand it is up to the Medical Group provider to determine whether or not my (or my child’s, if applicable) specific clinical needs are appropriate for a telehealth encounter, and I understand that Medical Group is not intended to replace my in-person provider(s) for services which Medical Group determines are not appropriate for a telehealth encounter.
I have been given an opportunity to review the provider(s) involved in an encounter and their credentials by clicking on the Galileo icon at any time during a telehealth encounter in the app. I may review any Medical Group provider’s credentials in the message section of the app. If I would like to speak to a different provider than the one involved in my encounter, I have the right to select another provider, although there could be a delay in service. If I would like to see an in-person provider, I may request a referral and will need to arrange for travel to the in-person provider’s location.
I understand that the Medical Group is not affiliated with any Third-Party Sources, and therefore Galileo makes no promise that Third-Party Source platforms or products will be fault free. Further, I understand that the Medical Group is not responsible for the accuracy of health records or health data that are created by any Third-Party Sources.
I understand that federal and state law requires health care providers to protect the privacy and the security of health information. I understand that Galileo’s Notice of Privacy Practices describes how the Medical Group protects, uses and discloses medical information and how I can get access to this information. I understand that telehealth may involve electronic communication of personal medical information to other health practitioners who may be located in other areas, including out of state.
I understand there is a risk of technical failures during the telehealth encounter beyond the control of the Medical Group. I agree to hold harmless the Medical Group for delays in evaluation or for information lost due to such technical failures.
I understand that I have the right to withhold or withdraw this consent to the use of telehealth at any time, and I may suspend or terminate use of the telehealth services 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 Medical Group providers are not able to connect me directly to any local emergency services.
I understand that alternatives to telehealth consultation, such as in-person services, are available, and in choosing to participate in a telehealth consultation, I understand that some parts of the services involving tests may be conducted by individuals at my location, or at a testing facility, at the direction of the Medical Group provider (e.g. labs or bloodwork).
I understand that I may expect the anticipated benefits from the use of telehealth in my care (or my child’s care, if applicable), but that no results can be guaranteed or assured.
I understand that my (or my child’s, if applicable) healthcare information may be shared with other individuals for scheduling and billing purposes. Persons may be present during the consultation other than the Medical Group provider in order to operate the telehealth technologies. I have a right to ask for the identities of parties present during the consultation.
I understand that Medical Group does not prescribe any narcotics for pain, nor is there any guarantee that a prescription will be given at all.
I understand that I have the right to request a copy of any medical records Medical Group has regarding any services provided to me or any non-confidential services provided to my child (if applicable). Requested medical records will be provided to at reasonable cost of preparation, shipping and delivery.
I understand that I have the opportunity to provide my PCP’s information through the app. If I do so, I consent to Galileo sharing all my medical records with my PCP, including any sensitive records related to mental health, reproductive health, substance use, HIV, and STDs/STIs.