The document below is from TandemCare Provider Group, PA and applies to their healthcare services and telemedicine services.

TandemStride supports and enables access to TandemCare services, including information exchange, and collects acknowledgment/consent on TandemCare's behalf. TandemStride is not the provider of TandemCare healthcare services.

Telemedicine Informed Consent  

The purpose of this Telemedicine Informed Consent ("Consent”) is to ensure that you are fully informed about the procedures, benefits, risks, and alternatives associated with the evaluation and treatment provided by the TandemCare Provider Group, PA, and to obtain your voluntary agreement to proceed with such evaluation and treatment.  

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.  

Benefits of Using Telemedicine  

The benefits of telemedicine include having access to medical care anywhere you have access to the internet—including from the comfort of your home. Telemedicine means you don’t risk exposure to illness in busy waiting rooms, and you do not have to wait several days for an in-person appointment.  Telemedicine also means you do not have to travel great distances to gain access to specialty care that may not be available in your community.  

Possible Risks of Using Telemedicine  

As with any medical treatment, there are potential risks associated with the use of telemedicine. 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 video and data quality,  Internet outages, or other service interruption issues. You may reschedule the visit with your  healthcare practitioner should these interruptions occur. If you need assistance in the event of a  telemedicine equipment failure, please contact us at: patientsupport@tandemstride.com.  

  • Security protocols could fail, causing a breach of privacy of personal medical information.  

  • Because TandemCare Provider Group, PA does not have access to your complete medical records, if you do not disclose to your Provider a full list of your medical history, including diagnoses, treatments, medications/supplements, and allergies, adverse treatment, drug interactions, or allergic reactions, or other negative outcomes may occur.  

  • Telemedicine services are NOT emergency services, and your personal data 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 PROVIDER 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 A TELEMEDICINE ENCOUNTER VIA THE SERVICE. 

Your Rights and Acknowledgements  

  • You acknowledge you have been informed of the potential risks and benefits associated with the proposed evaluation and treatment. This includes, but is not limited to, the expected benefits of  improved health and well-being, as well as the potential risks of side effects, allergic reactions, or  other adverse outcomes that may arise from the treatment.  

  • You understand that while the goal of treatment is to improve health, no guarantees can be made regarding the outcome of any evaluation or treatment.  

  • You acknowledge you have had the opportunity to ask questions and seek clarification regarding the proposed evaluation and treatment, including inquiries about alternative treatments and  their associated risks and benefits.  

  • You understand that you have the option to refuse a telehealth visit at any time without affecting your right to future care or treatment and without risking the loss or withdrawal of any benefits  to which you would otherwise be entitled.  

  • You understand that there are no additional or hidden fees associated with the use of telemedicine.  

  • You understand that your healthcare information may be shared with other individuals in accordance with the TandemStride Inc. Privacy Policy and regulations or laws in the state or  territory in which you are located. You further understand that you have the right to request  disclosure of your Healthcare Information to any third party, and that such disclosure will be  made upon TandemCare Provider Group, PA’s receipt of your signed written authorization.  

  • You understand that dissemination of any identifiable images or information from the telemedicine visit to researchers or other entities will not occur without your express written consent.  

  • Telemedicine may involve electronic communication of your personal medical information to remote healthcare practitioners who may be located outside of your state.  

  • You have the same privacy rights via telemedicine that you would have during an in-person visit.  

  • You understand that no results can be guaranteed or assured—you may not achieve the anticipated benefits of the telemedicine services.  

  • You understand that a variety of alternative methods of medical care may be available to you,  and that you may choose one or more of these at any time.  

  • You understand that all information submitted to TandemCare Provider Group, PA will be part of your medical record, and you have the right to review and receive copies of your medical records in accordance with applicable law. For more information on how to access your medical records,  please contact patientsupport@tandemstride.com.  

  • You understand that your telemedicine visit may be with a non-physician provider. You may  request that your telemedicine visit be scheduled with a physician. 

  • You will provide your accurate physical location when asked by a Provider (and/or this information could be collected as a part of the intake process by the technology platform(s) used  to facilitate your telemedicine visit), to ensure that Provider is licensed to provide telemedicine services to you. Your Provider will validate this prior to commencing your visit.  

  • You consent to the disclosure of any medical records prepared by TandemCare Provider Group,  PA to your primary care provider.  

  • If you would like to withdraw consent, you may do so at any time by emailing us at  patientsupport@tandemstride.com. Your withdrawal of consent will not affect your right to future care  or treatment.  

  • By typing my name below, I acknowledge that I have read and understood the above and agree.  Patient Signature: ____________________