Consent to Telehealth

Last Updated: March 4, 2025

Message from OS-Labs: Our aim is to simplify your access to excellent dermatologic care from licensed dermatologists through our Telehealth platform. Telehealth is the delivery of healthcare services using technology, enabling interactions between a patient and a provider in different locations. Below, we outline the potential benefits and risks associated with telehealth and request your consent for its use as part of your OS-Labs experience. We are committed to informing you about both the advantages and risks, but ultimately, the decision about your care is yours. Please read the following information carefully and don't hesitate to contact us with any questions at support@joinoslabs.com.

By using the OS-Labs platform, you will be engaging with a licensed healthcare provider ("Provider") exclusively through "telehealth." Telehealth involves the use of electronic communication, information technology, and other methods to deliver healthcare services when a healthcare provider and a patient are not in the same physical location. Telehealth may be employed for diagnosis, treatment, follow-up, and/or patient education, and may include, but is not limited to:

Electronic transfer of medical records, photographs, personal health information, or other data between a patient and a healthcare provider.
Patient and healthcare provider interactions via audio, video, and/or data communication.
Utilization of data from medical devices, and audio and video files.

Providers on the OS-Labs platform will interact with you solely through the platform. Therefore, all medical care and treatment you receive from these Providers will be delivered via telehealth, without the opportunity for in-person meetings.

The electronic system utilized by the OS-Labs platform includes network and software security protocols to ensure the privacy and security of health information and imaging data, incorporating measures to protect the data from both intentional and unintentional corruption.

Anticipated benefits of using telehealth through OS-Labs may include:

Easier and more efficient access to medical care for conditions treated by Providers.
Shorter waiting times for diagnosis, treatment, and prescriptions.
Convenience in receiving medical care and treatment at suitable times.
Avoidance of travel, allowing you to receive medical care in the comfort and privacy of your home.
Ongoing care and follow-up communication with your Providers, without the need for travel or missing work or school.

Possible risks associated with telehealth include, but are not limited to:

Insufficient transmission of information (e.g., poor image resolution) for appropriate medical decision-making by Providers.
Limitations due to Providers' inability to conduct certain tests or assess vital signs in-person, possibly affecting diagnosis, treatment, or emergency care recognition.
Providers' inability to offer treatment for specific conditions, necessitating alternative or emergency care.
Delays in evaluation or treatment due to Provider unavailability or technology/equipment issues.
Potential failure of security protocols, leading to privacy breaches.
Regulatory constraints in some regions affecting treatment options, especially concerning certain prescriptions.
Adverse outcomes from incomplete access to your medical records, like drug interactions or allergic reactions.

BY CONSENTING TO THIS FORM, I ACKNOWLEDGE AND AGREE:

All care and treatment I receive from Providers on the OS-Labs platform will be via telehealth, without the option for in-person medical care and treatment.
In some instances, care may be provided by a nurse practitioner or physician assistant, rather than a physician. By opting for care via OS-Labs, I consent to treatment by such non-physician Providers when applicable.
Telehealth is an evolving field, and my medical care and treatment from Providers might involve technology not specifically mentioned in this Patient Consent.
While telehealth can offer potential benefits, no specific outcomes or improvements are guaranteed. My condition might not improve and could potentially worsen.
There are specific risks associated with the use of telehealth, as detailed in this Patient Consent.
I have the right to withdraw my consent to the use of telehealth at any time by discontinuing my use of the OS-Labs platform.
I have read and understood the Privacy Policy and am aware that my medical information is protected by applicable healthcare confidentiality laws. I have the right to access and amend my health information according to these laws.
Telehealth involves the electronic sharing of my personal information with Providers who may be in different locations, including outside my state of residence.
My medical information may be shared with additional Providers to facilitate my care and treatment.
It is my responsibility to provide all relevant medical information to Providers on the OS-Labs platform, including details of care received from other healthcare providers.
Providers, after assessing my medical condition, may determine that diagnosis and/or treatment via telehealth is medically appropriate. By continuing to use OS-Labs, I agree with such medical assessments and consent to receive diagnosis and/or treatment via telehealth technology.
Providers may decide that my condition is unsuitable for treatment using OS-Labs and that I may need to seek care from a specialist or other healthcare provider.
My care at OS-Labs is specifically for the diagnosis and treatment of conditions and disorders covered by the services offered, excluding other medical or dermatological issues like skin cancer. I am aware that OS-Labs is not a replacement for in-person consultations or advice from my local dermatologist, primary care physician, or any other qualified healthcare professional. I understand the importance of not delaying seeking advice from these health professionals, especially if recommended by a OS-Labs healthcare Provider or if I have any health-related concerns.
In case of any emergency health situation, I know to contact my local emergency medical services or take necessary actions as appropriate. In a true emergency, I should call 911.
I accept full responsibility for the payment of all services rendered by Providers or through my use of the OS-Labs platform.

BY PROCEEDING, I HEREBY: Consent to the Use of Telehealth.

‍I have read and understand the information provided above regarding telehealth, have been afforded the opportunity to discuss it with my provider or such assistants as may be designated, and all of my questions have been answered to my satisfaction. I hereby give my informed consent for the use of telehealth in my medical care. I hereby authorize the provider to use telehealth in the course of my diagnosis and treatment. Additionally, acknowledge that I have been informed about the federal Open Payments database.

Consent to Telehealth Services.

Purpose: The purpose of this form is to obtain your consent to participate in a telehealth interaction for dermatology services.

Introduction: Telehealth involves the use of audio, video, or other electronic communications to interact with you, consult with your health care provider and/or review your medical information for the purpose of diagnosis, therapy, follow-up and/or education.

Activities using telehealth include the delivery dermatology services, to the extent permitted by state law, which may involve, among other things, patient assessment/ examination, ordering/interpreting of tests/studies, prescribing of medications, prescription refills, appointment scheduling, patient education, etc. In a telehealth experience, you enjoy a medical provider-patient relationship, with the provider participating in your care remotely.

All existing confidentiality protections under federal and state law apply to information disclosed during the telehealth interaction. Electronic systems used will incorporate network and software security protocols to protect the privacy and security of health information and imaging data and will include measures to safeguard the data to ensure its integrity against intentional or unintentional corruption.

Information regarding follow-up care, assistance in the event of an adverse reaction, assistance in the event of a failure in the telehealth equipment, or safety measures which should be taken by the patient and the provider if an emergency or urgent situation arises, is to be provided verbally and/or in written form.

Anticipated Benefits:

Improved access to medical care by enabling a patient to remain in his/her location while the provider may provide care from a distant site.
More efficient medical evaluation and management.

Possible risks. As with any medical procedure, there are potential risks associated with the use of telehealth. These risks include, but may not be limited to:

In rare cases, information transmitted may not be sufficient (e.g. poor resolution of images) to allow for appropriate medical decision making by the provider.
Delays in medical evaluation/treatment could occur due to deficiencies or failures of the electronic equipment.
In rare instances, security protocols could fail, causing a breach of privacy of personal medical information.
In rare cases, a lack of access to all of your medical records may result in adverse drug interactions or allergic reactions or other judgment errors.

I Acknowledge the Following:

I understand that I may expect the anticipated benefits from the use of telehealth in my care, but that no results can be guaranteed.
I understand that it is the role of the provider to determine whether or not the condition being diagnosed and/ or treated is appropriate for the telehealth interaction.
I understand that the laws that protect the privacy and security of health information apply to telehealth, and that no information obtained in the use of telehealth which identifies me will be disclosed to researchers or other entities without my authorization. I understand that information obtained in the telehealth interaction will be retained in the medical records in compliance with all applicable state and federal laws including the Health Insurance Portability and Accountability Act (HIPAA).
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, and without risking the loss or withdrawal of any program benefits to which I would otherwise be entitled. I understand that I may have to travel to see a healthcare practitioner in-person if I decline the telehealth service.
I understand that I have the right to inspect all information obtained and recorded in the course of a telehealth interaction, and may receive copies of this information for a reasonable fee.
I understand that a variety of alternative methods of medical care may be available to me, and that I may choose one or more of these at any time. Alternatives include, but are not limited to, presentation to my primary care physician, the nearest urgent care facility, or the nearest Emergency Department. I have been afforded the opportunity to discuss alternatives with my provider to my satisfaction.
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.
I understand that it is my duty to inform my provider of electronic interactions regarding my care that I may have with other health care providers.
I understand that I am fully responsible for payment.
I understand that I have a right to be informed of the parties who will be present at both the originating site and the distant site during the telehealth interaction, and that I shall have the right to exclude anyone from either site.
I understand that any dispute arising from the use of telehealth will be resolved in the state in which I am located, and that state’s law shall apply.
I understand that information could be lost during the telehealth interaction as a result of technical failures. By agreeing to this consent, I agree to release, indemnify, and hold harmless OS-Labs LLC and Old School Labs LLC, as well as their employees, agents, representatives, etc., from all losses, claims, theft, demands, liabilities, causes of action, or expenses, known or unknown, arising out of my receipt of telehealth services.
I understand that I may be referred to an in-person provider after my telehealth interaction if in-person services are indicated as determined by my OS-Labs provider and/or an urgent need arises.
I understand that, while photographs may be taken during the clinical visit, my telehealth interaction will not be videotaped or recorded without my consent. I further understand that I have the option to share photographs to support the telehealth interaction before, during, and after the visit.