Last modified: April, 2019
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 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 to get better care faster. You 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.
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 offered by Galilea Medical Group, P.A. and its related practices (collectively the “Medical Group”) may also include chart review, remote prescribing, appointment scheduling, health information sharing, and non-clinical services, such as patient education. The information you 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 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.
The electronic communication systems we use 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.
Improved access to care by enabling you to remain in your 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 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 firstname.lastname@example.org.
By clicking to accept this consent, you acknowledge that you understand and agree with the following:
I hereby consent to receiving Medical Group’s services via telehealth technologies. I understand that Medical Group and its providers offer telehealth-based medical 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 Medical Group provider to determine whether or not my specific clinical needs are 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.
I understand that federal and state law requires health care providers to protect the privacy and the security of health information. I understand that the Medical Group 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 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 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 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 to me, 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, but that no results can be guaranteed or assured.
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 Medical Group 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.
I understand that I will not be prescribed any narcotics for pain, nor is there any guarantee that I will be given a prescription at all.
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.