DO NOT USE THIS SITE FOR EMERGENCY MEDICAL NEEDS. If you experience a medical emergency, call 911 immediately.
- A telemedicine visit is appropriate to address non-emergency conditions.
- It is not appropriate for emergency conditions such as severe shortness of breath, severe abdominal pain, severe bleeding, or urgent conditions like sprains, falls, or cuts needing stitches.
- There may also be times when the physician will advise an in office visit to better care for you.
Welcome to the Kura website (“Online Services”) which is owned and operated by Kura for the purpose of facilitating access to electronic medical and health-related consultations with physicians, licensed behavioral health providers and other practitioners licensed to diagnose health care conditions (“Providers”), and, as appropriate, to nurses, pharmacists, health and wellness coaches, and disease management personnel (“Consumer Advisors”), as well as to provide other information about Kura and its products and services. Kura provides a communication link, via this website and by email, between you and the Providers and Consumer Advisors.
PROVIDER AND CONSUMER ADVISOR INDEPENDENCE
Kura does not provide any physicians’ or other Providers’ services itself; all of the Providers and many of the Consumer Advisors are independent of Kura and are merely using Kura as a way to communicate with you. Any information or advice received from a Provider or a non-affiliated Consumer Advisor comes from them alone, and not from Kura. Your interactions with the Providers or the Consumer Advisors through Online Services are not intended to take the place of your relationship with your regular health care practitioners. Neither Kura nor any of its licensors or suppliers shall be liable for any damages or losses related to any medical diagnosis, treatment or professional advice obtained from a Provider or non-affiliated Consumer Advisor nor for any damages or losses related to any other information obtained on the website.
Other than information received directly from Providers, the content on the website should not be considered medical advice. You should always talk to a Provider or other appropriately qualified health care professional for diagnosis and treatment, including information regarding which medications or treatment may be appropriate for you. None of the content on this website represents or warrants that any particular medication or treatment is safe, appropriate, or effective for you. Without limitation, Kura does not recommend or endorse any specific tests, Providers, Consumer Advisors, medications, products or procedures.
AVAILABLE PROVIDERS AND CONSUMER ADVISORS
You will be provided with a list of Providers and Consumer Advisors for whom you are eligible to access based solely on the information that you provide to Kura, e.g. desired medical specialty or employer affiliation. While many of the available Providers and Consumer Advisors are independent (i.e., not employed by, or under contract to, Kura to provide services on its behalf), certain Consumer Advisors are affiliated with Kura (i.e., are not independent), and certain other Providers and Consumer Advisors are affiliated with your employer. You will know which type of Provider or Consumer Advisor is available to you, including whether they are independent or affiliated, because they will be identified as such on the website.
SELECTING A PROVIDER OR CONSUMER ADVISOR
While Kura does credential some of the Providers and Consumer Advisors, Kura does not make any representations or warranties about the Providers’ or the Consumer Advisors’ training or skill. You are ultimately responsible for selecting a Provider or Consumer Advisor from the list of available Providers or Consumer Advisors. Kura will not select a Provider or Consumer Advisor for you. Additionally, Kura does not guarantee the continued availability of any certain Provider or Consumer Advisor.
EXCHANGE OF INFORMATION
The medical advice or health-related information provided through the Online Services is based on your personal health data as provided by you, or on personal health data that you authorize us to obtain. You understand that you may choose to give access to only certain portions of your medical records, but that doing so may interfere with your care.
ACCOUNT ENROLLMENT AND YOUR REQUIREMENTS
To access the Online Services, you must first enroll to establish an individual user account (“Account”), by providing certain information. With the exception of subaccounts (as described below) established for minor children of whom you are a parent or legal guardian, you agree that you will not create more than one Account, or create an account for anyone other than yourself without first receiving permission from the other person. In exchange for your use of the website and the Online Services and, if applicable, in order for Providers to send notices to you, you agree to: (i) provide true, accurate, current and complete information about yourself as prompted by our account enrollment form; and (ii) each time you log on, maintain and promptly update such account information to keep it true, accurate, current and complete. If you provide any information that is untrue, inaccurate, not current or incomplete, or we have reasonable grounds to suspect that such account information is untrue, inaccurate, not current or incomplete, we reserve the right to suspend or terminate your Account and refuse any and all current or future use of the website or the Online Services or any portion thereof.
Kura grants you permission to use the Online Services for your personal, non-commercial purposes. Your use is limited as follows:
- You will not use the Online Services for unlawful purposes, and you will comply with all applicable laws and regulations while using the Online Services.
- You will not post or transmit any threatening, false, misleading, abusive, libelous, pornographic, or profane material.
- You will not incorporate any code into the code of the Online Services or use the Online Services to post or transmit any computer code that is harmful, or may be or is intended to, damage or to monitor the use or operation of the Online Services or any other user of the Online Services.
- You will not use the Online Services to harvest or collect personally identifiable information about users of the Online Services or any other information concerning the Online Services.
- You will not allow any other person or entity to use your identification to post or view comments, or to otherwise access or use the Online Services.
- You will not infringe the copyright or other intellectual property rights of others or violate the privacy or publicity rights of others.
You must not interfere with, disrupt, or attempt to interfere with or disrupt the operation of the website through which you access the Online Services, and you must abide by the security policies adopted by Kura. You acknowledge and agree that, for security and other purposes, Kura may monitor utilization of your Account. We are monitoring utilization in order to ensure appropriate use of the Online Services, including, but not limited to, limitations set forth in the section titled “Acceptable Use” or as otherwise brought to our attention by a Provider or Consumer Advisor.
You will be informed of any fees to be charged when applicable.. If your employer or agency has arranged with Kura to cover the fee or any portion of the fee, or if the fee will be pursuant to some other arrangement with Kura, that adjustment will be reflected in the fee that you are ultimately charged. In the event we charge you a fee, the total fee will include two separate components: one part will cover time spent with Providers and the other part will cover your use of the Online Services (the “Administrative Fee”). You will be responsible for providing a valid credit card number, expiration date, and card security code at the time you purchase a product, service or schedule an appointment. We may charge a fee if you fail to attend or cancel an appointment in accordance with any stated cancellation policy.
RESPONSIBILITY FOR APPLICABLE FEES
You are solely responsible for all fees for the Online Services. Charges do not include or cover any pharmacy fees; you are separately responsible for any such fees. Of course, you are free to seek payment from your health plan. Please check with your physician or health plan to determine if an Online Service may be covered. You agree that you will not use the Online Services for any service that must be provided to you by your regular physician as a follow-up to an in-office visit, at no additional charge to you or your health care plan, as required by your health care plan. If you do use the Online Services in such a situation, and it is ultimately determined that the Provider may not bill you for its services provided through the Online Services, you understand that you will still be liable for the component of the charge attributable to the Administrative Fee.
OPERATION AND RECORD RETENTION
Kura reserves complete and sole discretion with respect to the operation of Online Services. Kura may withdraw, suspend or discontinue any functionality or feature of the Online Services. Kura has entered into arrangements with the Providers to allow them access to any data or records that they may want to include in your medical records. Consumer Advisors will have access to transcripts generated in connection with an online consultation and any data, records, or other information to which you authorize access. If you desire a copy of your medical records, you should contact the applicable Provider (contact information is provided via the Online Services). Kura is not responsible to you for maintaining any data arising from use of the Online Services.
Areas of the Online Services may contain links to other websites. Please note that when you click on any of these links, you are entering another website over which Kura has no responsibility or control. The inclusion of any link does not imply affiliation, endorsement or adoption by Kura of the linked website or any medical or other information contained therein. You are encouraged to read the terms and conditions, data-gathering practices and privacy policies of all linked websites as they may materially differ from ours. Kura is not responsible for any loss or damage of any sort due to the presence or use of any such links.
ACCESS TO THE ONLINE SERVICES AND THE CONTENT IS PROVIDED “AS IS” AND “AS AVAILABLE” WITHOUT ANY WARRANTY OF ANY KIND, EXPRESS OR IMPLIED. KURA DISCLAIMS ALL WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO ANY IMPLIED WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE OR NON-INFRINGEMENT.
WITHOUT LIMITING THE FOREGOING, KURA DOES NOT WARRANT THAT ACCESS TO THE ONLINE SERVICES WILL BE UNINTERRUPTED OR ERROR-FREE, OR THAT DEFECTS, IF ANY, WILL BE CORRECTED; NOR DOES AMERICAN WELL OR KURA MAKE ANY REPRESENTATIONS ABOUT THE ACCURACY, RELIABILITY, CURRENCY, QUALITY, COMPLETENESS, USEFULNESS, PERFORMANCE, SECURITY, LEGALITY OR SUITABILITY OF THE ONLINE SERVICES OR ANY OF THE INFORMATION CONTAINED THEREIN. YOU EXPRESSLY AGREE THAT YOUR USE OF ONLINE SERVICES AND YOUR RELIANCE UPON ANY OF ITS CONTENTS IS AT YOUR SOLE RISK.
LIMITATION OF LIABILITY
EXCEPT AS PROHIBITED BY LAW, AND WITHOUT LIMITATION:
KURA SHALL NOT BE LIABLE FOR THE ACTS OR OMISSIONS OF ANY OF THE INDEPENDENT PROVIDERS AND CONSUMER ADVISORS.
YOU SHALL BE SOLELY AND FULLY RESPONSIBLE FOR ANY DAMAGE TO KURA AND THE ONLINE SERVICES OR ANY COMPUTER SYSTEM, ANY LOSS OF DATA, OR ANY IMPROPER USE OR DISCLOSURE OF INFORMATION ON THE ONLINE SERVICES CAUSED BY YOU OR ANY PERSON USING YOUR USER NAME OR PASSWORD. KURA CANNOT AND DOES NOT ASSUME ANY RESPONSIBILITY FOR ANY LOSS, DAMAGES OR LIABILITIES ARISING FROM THE FAILURE OF ANY TELECOMMUNICATIONS INFRASTRUCTURE, OR THE INTERNET OR FOR YOUR MISUSE OF ANY OF THE ADVICE, IDEAS, INFORMATION, INSTRUCTIONS OR GUIDELINES ACCESSED THROUGH ONLINE SERVICES.
IN THE EVENT OF ANY PROBLEM OR DISSATISFACTION WITH THE ONLINE SERVICES, YOUR SOLE REMEDY IS TO CEASE USING THE ONLINE SERVICES. UNDER NO CIRCUMSTANCES SHALL KURA, OR ANY KURA LICENSOR OR SUPPLIER, BE LIABLE IN ANY WAY FOR YOUR USE OF THE ONLINE SERVICES OR ANY OF ITS CONTENT.
UNDER NO CIRCUMSTANCES SHALL KURA OR ITS LICENSORS OR SUPPLIERS, PROVIDERS AND CONSUMER ADVISORS BE LIABLE FOR ANY PUNITIVE, EXEMPLARY, CONSEQUENTIAL, INCIDENTAL, INDIRECT OR SPECIAL DAMAGES, EVEN IF WE OR THEY HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.
YOU HEREBY RELEASE, INDEMNIFY AND HOLD KURA, ITS LICENSORS AND SUPPLIERS, PROVIDERS AND CONSUMER ADVISORS HARMLESS FROM ANY AND ALL CLAIMS, DEMANDS, AND DAMAGES OF EVERY KIND AND NATURE ARISING OUT OF OR IN ANY WAY CONNECTED WITH YOUR USE OF ONLINE SERVICES OR YOUR BREACH OF ANY OF YOUR OBLIGATIONS.
The Online Services may contain typographical errors or other errors or inaccuracies and may not be complete or current. Kura reserves the right to correct any errors, inaccuracies or omissions and to change or update information at any time without prior notice. Kura does not guarantee that any errors, inaccuracies or omissions will be corrected.
The Online Services are designed for and intended for users in the United States. Kura makes no representation that the information and services provided on the Online Services are applicable to, appropriate for, or available outside the United States. Accessing the Online Services from territories where the content is illegal is prohibited.
LIMITATION, SUSPENSION AND TERMINATION OF USE
If you have any questions, concerns or complaints about the Online Services, please feel free to contact Customer Relations at: 855-200-8572. This Customer Service line is maintained by Kura and not by any of the Providers or Consumer Advisors. Contact numbers for the Providers and the independent Consumer Advisors are available via the Online Services.
E-SIGN DISCLOSURE AND CONSENT
All Notices that Kura or a Provider or Consumer Advisor elect to provide to you in electronic form will be provided either (i) via e-mail to the address that you provided upon enrollment or (ii) by posting the Notice on the website by which you access the Online Services. The delivery of any Notice is effective when sent, regardless of how it is delivered to you, whether you read the Notice when you receive it, or whether you actually receive the delivery.
Consent is a condition to the use of Kura Online Services. If at any time you decide to withdraw your consent, you may do so by canceling or discontinuing your use of the Online Services. Should you subsequently resume use of the Online Services, you will be deemed to have ratified your original consent.
Kura may treat the provision of an invalid e-mail address, or the subsequent malfunction of a previously valid e-mail address, as a withdrawal of your consent to receive Notices in electronic form. Kura will not impose any fee to process the withdrawal of your consent to receive Notices in electronic form; however, your access to and use of the website and Online Services may be terminated. Any withdrawal of your consent to receive Notices in electronic form will be effective only after we have a reasonable period of time to process your withdrawal.
Consistent with the section entitled “Account Enrollment and Your Requirements,” it is your responsibility to provide true, accurate, current, and complete information about yourself, and to maintain and update promptly such information. You can update your information (e.g., your e-mail address) through the website (click on “My Account”).
In order to access, view, and retain electronic Notices that Kura makes available to you, you must: (i) have access to an Internet service account, (ii) an e-mail account (and any necessary e-mail software), and (iii) have access to a personal computer, operating system, and telecommunications connections to the Internet capable of receiving, accessing, displaying, and either printing or storing Notices received from Kura in electronic form via a plain text-formatted e-mail or by access to the website using your Internet browser application (e.g., Google Chrome, Internet Explorer, Firefox, Safari).
Neither Kura nor the applicable Provider or Consumer Advisor will send you a paper copy of a Notice which is available electronically unless you request it, or we otherwise deem it appropriate to do so. You can obtain a paper copy of an electronic Notice by printing it yourself or by requesting that we or the applicable Provider or Consumer Advisor mail you a paper copy, provided that such request is made within a reasonable time after we first provided the electronic Notice to you. To request a paper copy, call us at 855-200-8572, or contact your Provider or Consumer Advisor via the contact information listed on the appropriate Profile Page. Kura may charge you a reasonable service charge, of which we will have provided you prior notice, for the delivery of paper copies of any Notice provided to you electronically pursuant to this authorization. Kura reserves the right, but assumes no obligation, to provide a paper (instead of electronic) copy of any Notice that you have authorized us to provide electronically.
All Notices in either electronic or paper format from us to you will be considered “in writing.” You should print or download for your records a copy of this Disclosure and any other Notice that is important to you.
You acknowledge and agree that your consent to electronic Notices is being provided in connection with a transaction affecting interstate commerce that is subject to the federal Electronic Signatures in Global and National Commerce Act, and that you and Kura both intend that the Act apply to the fullest extent possible to validate our ability to conduct business with you by electronic means.
Kura reserves the right, in its sole discretion, to discontinue the provision of your electronic Notices, or to terminate or change the terms and conditions on which it provides electronic Notices. Kura will provide you with notice of any such termination or change as required by law.
Your Information. Your Rights. Our Responsibilities.
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
You have the right to:
- Get a copy of your paper or electronic medical record
- Correct your paper or electronic medical record
- Request confidential communication
- Ask us to limit the information we share
- Get a list of those with whom we’ve shared your information
- Get a copy of this privacy notice
- Choose someone to act for you
- File a complaint if you believe your privacy rights have been violated
You have some choices in the way that we use and share information as we:
- Tell family and friends about your condition
- Provide disaster relief
- Include you in a hospital directory
- Provide mental health care
- Market our services and sell your information
- Raise funds
Our Uses and Disclosures
We may use and share your information as we:
- Treat you
- Run our organization
- Bill for your services
- Help with public health and safety issues
- Do research
- Comply with the law
- Respond to organ and tissue donation requests
- Work with a medical examiner or funeral director
- Address workers’ compensation, law enforcement, and other government requests
- Respond to lawsuits and legal actions
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
- You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
- We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
- You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
- We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications
- You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
- We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
- You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
- If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
- You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
- We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
- You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
- If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
- We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
- You can complain if you feel we have violated your rights by contacting us.
- You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
- We will not retaliate against you for filing a complaint.
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
- Share information with your family, close friends, or others involved in your care
- Share information in a disaster relief situation
- Include your information in a hospital directory
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases, we never share your information unless you give us written permission:
- Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes
In the case of fundraising:
- We may contact you for fundraising efforts, but you can tell us not to contact you again.
Our Uses and Disclosures
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.
Bill for your services
We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues
We can share health information about you for certain situations such as:
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health or safety
We can use or share your information for health research.
Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Respond to organ and tissue donation requests
We can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director
We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
- For workers’ compensation claims
- For law enforcement purposes or with a law enforcement official
- With health oversight agencies for activities authorized by law
- For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena.
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice and give you a copy of it.
- We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request and on our web site.
For more information, please contact:
Kura MD Inc.
9328 Elk Grove Blvd, Suite 105 #329
Elk Grove CA 95624-5063
Consent Form for ePrescriptions
ePrescriptions are a way for doctors to send electronically an accurate, error free, and understandable prescriptions from the doctor’s office to the pharmacy. ePrescription’s also include:
- Formulary and benefit transactions – Gives the health care provider information about which drugs are covered by your drug benefit plan.
- Fill status notification – Allows the health care provider to receive an electronic notice from the pharmacy telling them if your prescription has been picked up, not picked up, or partially filled.
- Medication history transactions – Provides the health care provider with information about your current and past prescriptions. This allows health care providers to be better informed about potential medication issues and to use that information to improve safety and quality. Medication history data can indicate: compliance with prescribed regimens; therapeutic interventions; drug-drug and drug-allergy interactions; adverse drug reactions; and duplicative therapy.
The medication history information would include medications prescribed by your health care provider at Kura MD as well as other health care providers involved in your care and may include sensitive information including, but not limited to, medications related to mental health conditions, venereal diseases/sexually transmitted diseases, abortion(s), rape/sexual assault, substance (drug and alcohol) abuse, genetic diseases, and HIV/AIDS. As part of this Consent Form, you specifically consent to the release of this and other sensitive health information.
By signing this consent form you are agreeing that your provider at Kura MD may request and use your prescription medication history from other healthcare providers and/or third party pharmacy benefit payors for treatment purposes.
You may decide not to sign this form. Your choice will not affect your ability to get medical care, payment for your medical care, or your medical care benefits. Your choice to give or to deny consent may not be the basis for denial of health services. You also have a right to receive a copy of this form after you have signed it. This consent form will remain in effect until the day you revoke your consent. You may revoke this consent at any time in writing but if you do, it will not have an effect on any actions taken prior to receiving the revocation.
Understanding all of the above, I hereby provide informed consent to Kura MD to enroll me in ePrescriptions. I have had the chance to ask questions and all of my questions have been answered to my satisfaction.
Informed Consent for Telemedicine Services
Telemedicine involves the use of electronic communications to enable health care providers at different locations to share individual patient medical information for the purpose of improving patient care. Providers may include primary care practitioners, specialists, and/or subspecialists. The information may be used for diagnosis, therapy, follow-up and/or education, and may include any of the following:
- Patient medical records
- Medical images
- Live two-way audio and video
- Output data from medical devices and sound and video files
- Telephone, chat, instant messaging and/or email conversations
Electronic systems used 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 medical care by enabling a patient to remain at a remote site while the practitioner obtains test results and consults from healthcare practitioners at distant/other sites.
- More efficient medical evaluation and management.
- Obtaining expertise of a distant specialist.
As with any medical procedure, there are potential risks associated with the use of telemedicine. 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 practitioner;
- Delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment. In the event that there is an equipment or technological failure during a telemedicine encounter, you should call (855) KURA220 for instructions from Kura Medical Group practitioner on how to receive follow-up or ongoing care.
- In very rare instances, security protocols could fail, causing a breach of privacy of personal medical information;
- In rare cases, a lack of access to complete medical records may result in adverse drug interactions or allergic reactions or other judgment errors;
By agreeing to this form, I understand the following:
- I understand that I have the right to withhold or withdraw my consent to the use of telemedicine in the course of my care at any time, without affecting my right to future care or treatment.
- 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. My practitioner has explained the alternatives to my satisfaction.
- I understand that telemedicine 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 practitioner of electronic interactions regarding my care that I may have with other healthcare providers.
- I understand that I may expect the anticipated benefits from the use of telemedicine in my care, but that no results can be guaranteed or assured.
I have read and understand the information provided above regarding telemedicine, have discussed it with my practitioner 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 telemedicine in my medical care.