Effective Date: February 27, 2025

Care Coordination  

Thyme Care provides member-centric, oncology care coordination to its members in order to improve outcomes, overcome health disparities, and reduce the cost of care.

Data Privacy/Confidentiality  

By consenting to participate in the Care Coordination Program, you agree to provide information at the  time of enrollment and periodically thereafter which will assist in data collection, assessment, monitoring, and determination of an individualized support plan. Your progress with meeting the goals identified in your support plan will be through discussions with our Care Team.  You also agree to abide by Thyme Care’s Terms of Use located at https://www.thymecare.com/terms. Any information compiled about you will be maintained consistent with Thyme Care’s Privacy Notice Policy, which you may access at any time at https://www.thymecare.com/privacypolicy.  Any  identifiable information obtained in connection with your participation with the Care Coordination Program will be disclosed only with your consent and maintained in a confidential manner, with access limited to others who are involved in your care, and to others for whom you have provided consent for sharing information.  

Description of Services 

You will be assigned a Care Team who will assist you with identifying and  meeting your service needs.  There are requirements for meeting with and communicating with the members of your Care Team depending on the level or type of service you may need. At some time during participation in the Care Coordination Program the service level may be changed to best suit your needs. Acceptance, refusal, or termination of care coordination services does not affect participation or eligibility  to benefits, treatments, or services otherwise covered by your insurer.  Care Coordination Program Services do not replace care rendered by a primary care physician, oncologist, or other healthcare professional currently engaged in your care.  Thyme Care is not in a position nor is it qualified to order services for or direct the diagnosis or treatment of any individuals.

Duration of Services  

Care Coordination Program Services will end when:  

  • Individual’s stated agreed-upon goals and needs have been met and services are no longer needed.  
  • Individual does not wish to participate in the program regardless of progress on stated goals.  
  • Individual rescinds consent to participate.  
  • Individual has been physically threatening or verbally abusive toward Thyme Care staff.  

Benefits/Compensation  

The Care Coordination Program is provided free of charge to the individual and no form of compensation  will be accepted. Services provided by the Care Coordination Program via secure electronic communications platform, are  considered a beneficial and cost effective means for individuals with complex care needs to identify and address presenting needs  toward enhanced quality of life for themselves.  No form of compensation is available to individuals for participating in the Care Coordination Program. 

Rights and Responsibilities 

As a recipient of Care Coordination Program services you have the right to:  

  • Recognition of your dignity and right to privacy.  
  • Information about the program and the reason for your selection in it. 
  • Confidential treatment of your personal health information (PHI).  
  • Upon request, an explanation of how the program may share your PHI with other entities. 
  • Access to your medical record according to applicable federal and state laws. 
  • Care coordination services performed without discrimination based on race, ethnicity, age, mental or physical disability, genetic  information, color, religion, gender, sexual orientation or national origin. 
  • Means to voice complaints about the Care Coordination Program or individuals on the Care Team.
  • A timely response to questions or complaints. 
  • To refuse Care Coordination Program services and to be told the implications of such  refusal. 
  • To obtain notification and a rationale when Care Coordination Program services are  terminated, upon request.  

As a member of the Care Coordination Program it is important to: 

  • Notify your Care Team  of any changes in address and/or telephone number to achieve regular and effective  communication. 
  • Give the Care Team as much information as possible to help them assist you.  
  • Ask questions to be sure you understand your Care Team’s explanations and instructions.  
  • Treat others with the same respect and courtesy expected. 
  • Keep appointments or give adequate notice if you must delay or cancel them.  
  • Notify your Care Team, if you choose to not participate in the Care Coordination Program. 

Questions about Care Coordination  

You are free to ask whatever questions you have at any time.  You may contact any member of your Care Team with questions you may have regarding the Care Coordination Program.  

Grievance Procedure  

If, at any time during the course of your involvement with the Care Coordination Program, you  experience concerns that warrant formal attention, you are encouraged to resolve the concern with your Care Team. If  this process proves unsatisfactory, if you determine that doing so would jeopardize your relationship with your Care Team, or if there are  concerns for personal safety, you may contact the Care Team Supervisor at 201-526-8484.

Telephone and email communications 

As part of the Care Coordination Program, Thyme Care may communicate with you using the contact information you have provided or that is on record. These communications are designed to support your care and provide information about Thyme Care’s services. 

Phone Calls

Thyme Care may contact you by phone at your home, work, or cell number. These calls may include information about your health care or updates about our services. Calls may be monitored or recorded to help improve the quality of our services.

Text Messages (SMS)

You consent to receive text messages from Thyme Care at the cell number you have provided. These messages may include reminders, updates about your care, or other important information. Standard message and data rates may apply. If you wish to stop receiving text messages, you can reply “STOP” to any message from Thyme Care.

Emails

You consent to receive emails from Thyme Care at the email address you have provided. Emails may include updates about your care or information about Thyme Care’s services. Please note there is a risk that email communications may be intercepted by third parties or sent to unintended recipients. You can unsubscribe from emails at any time by following the opt-out instructions included in the message.

You may update your communication preferences or opt out of any communication method at any time by contacting Thyme Care at 201-526-8484 or using the instructions provided in our messages.

Informed Consent for Telehealth Services 

DO NOT USE THIS SERVICE IF YOU MAY BE EXPERIENCING A MEDICAL EMERGENCY. In an emergent situation, you can: (i) call 911; (ii) go to the nearest emergency room; (iii) contact your local crisis center; (iv) if applicable, call the National Suicide Prevention Lifeline (1-800-272-8255); or (v) if applicable, contact the Crisis Text Line (text “GO” to 741-741).

We are pleased you have chosen Thyme Care for your telehealth needs. This document is intended to inform you of what you can expect of your clinician in terms of his or her credentials and in connection with your treatment via telehealth. After you have carefully read this document and had an opportunity to have your questions answered, certain state laws mandate that you must sign and date it before commencing services.

Your telehealth providers's credentials. Your provider’s credentials were made available to you before scheduling an appointment. If you have any questions about these credentials, please direct them to your telehealth provider. For those states that require it, you can find an explanation of the levels of regulation applicable to telehealth clinicians under the STATE REGULATIONS section of this document.

IMPORTANT INFORMATION REGARDING YOUR TREATMENT BY TELEHEALTH HEALTH PROVIDERS, INCLUDING POTENTIAL RISKS AND BENEFITS.  Thyme Care offers treatment by various types of healthcare providers via telecommunications technology (also referred to as “telehealth”). Our providers include physicians, nurses, and equivalent licensed professionals. Thyme Care coordinates care and services based on your personal needs and goals. Our program’s goal is to improve quality of life and address clinical needs and barriers to care.   By joining, you agree to share information with us at the time of enrollment and afterwards so we can create your personal support plan. The services provided may also include chart review, remote prescribing, appointment scheduling, refill reminders, health information sharing, and non-clinical services, such as patient education.  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.  There are various benefits associated with telehealth services, including improved access to care by enabling you to remain in your home while the provider consults with you, more efficient care evaluation and management, and obtaining expertise of a specialist as appropriate. Possible risks include delays in evaluation and treatment could occur due to deficiencies or failures of the equipment and technologies, and 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.

Patient Rights. You understand that you have the right to: 

  • Be treated with dignity, respect, and right to privacy 
  • Receive program information and why you were selected to be in it 
  • Confidentiality of your personal health information 
  • Ask about how we share information with others 
  • Access your medical records 
  • Be free from discrimination based on race, ethnicity, age, mental or physical disability, genetic information, color, religion, gender, sexual orientation or national origin
  • Share complaints
  • Timely responses to questions or complaints 
  • Refuse services and be told about how this may impact your care 
  • Get notified when services end and why they ended, upon request - It’s important to: 
    •  Let us know of any changes in address or telephone number 
    • Give your care team information to help with your care 
    • Ask questions to understand your care team’s explanations and instructions 
    • Treat others with respect and courtesy 
    • Keep appointments or give notice if you must delay or cancel them 
    • Contact your care team if you do not want to be in the program

By agreeing to this form, you are representing that you have read and understand your rights detailed above.  

At times, your clinician may seek supervision or consultation with other Thyme Care or non-Thyme Care clinicians regarding your treatment, to enhance the services being provided to you given the multiple perspectives, experiences, and treatment philosophies. All team members are ethically and legally bound to maintain your privacy and confidentiality in this scenario and none of your personal information will be shared or disclosed with any other individual without your consent. Exceptions to confidentiality do exist in certain situations, such as: threat of serious harm to self or others; reasonable suspicion of abuse or neglect of a child, or abuse, neglect, or exploitation of an incapacitated or dependent adult; court order and/or subpoena; permission from the client or guardian (i.e. voluntary release signed by the client or guardian); during supervisory consultations; diagnosis and dates of service shared with an insurance company to collect payments; information released as outlined Thyme Care’s Notice of Privacy Practices and Privacy Policy; and as otherwise required by law.

Fees and billing arrangements. Thyme Care care coordination services are available at no cost.. Any visits with Thyme Care Nurse Practitioners or Doctors are covered as other in-network primary care visits under your insurance plan and may have a cost associated with them. Those services are optional and we’ll always tell you about any costs beforehand. Your medical plan, costs, and coverage are not affected by participation in Thyme Care. We will not provide payment to you for being in our program.

By checking the box associated with “Informed Consent”, you acknowledge that you understand and agree with the following:

  1. You hereby consent to receive Thyme Care’s services via telehealth technologies.  You understand that Thyme Care and its providers offer telehealth-based medical services but that these services do not replace the relationship between you and your primary care doctor, your oncologist, or other healthcare professionals who care for you.  You also understand it is up to the Thyme Care provider to determine whether or not your specific clinical needs are appropriate for a telehealth encounter.
  2. You have been given an opportunity to select a provider from Thyme Care prior to the consult, including a review of the provider’s credentials. 
  3. You understand that Thyme Care cannot make a cancer diagnosis or provide cancer treatment.
  4. You understand that federal and state law requires health care providers to protect the privacy and security of health information.  You understand that Thyme Care will take steps to make sure that your health information is not seen by anyone who should not see it. You understand that telehealth may involve electronic communication of your personal medical information to other health practitioners who may be located in other areas, including out of state.
  5. You understand there is a risk of technical failures during the telehealth encounter beyond the control of Thyme Care.  You agree to hold harmless Thyme Care for delays in evaluation or for information lost due to such technical failures.
  6. You understand that you have the right to withhold or withdraw your consent to the use of telehealth in the course of your care at any time without affecting your right to future care or treatment. You understand that You may suspend or terminate uthe se of the telehealth services at any time for any reason or for no reason.  You understand that if you are experiencing a medical emergency, you will be directed to dial 9-1-1 immediately and that the Thyme Care providers are not able to connect you directly to any local emergency services.
  7. You understand that alternatives to telehealth consultation, such as in-person services, are available to you, and in choosing to participate in a telehealth consultation, you understand that some parts of the services involving tests may be conducted by individuals at your location or at a testing facility, at the direction of the Thyme Care provider (e.g., labs or bloodwork).
  8. You understand that you may expect the anticipated benefits from the use of telehealth in your care, but that no results can be guaranteed or assured.
  9. You understand that your healthcare information may be shared with other individuals for scheduling and billing purposes. Persons other than the Thyme Care provider may be present during the consultation in order to operate the telehealth technologies. You further understand that you will be informed of their presence in the consultation and thus will have the right to request the following: (a) omit specific details of your medical history/examination that are personally sensitive to you; (b) ask non-medical personnel to leave the telehealth examination; and/or (c) terminate the consultation at any time.
  10. You understand that you will not be prescribed any narcotics, nor is there any guarantee that you will be given a prescription at all.
  11. You understand that if you participate in a consultation, that you have the right to request a copy of your medical records which will be provided to you at reasonable cost of preparation, shipping and delivery. 
  12. You have read and you understand the disclosures set forth next to the state in which you are located at the time of the telehealth encounter, as set forth below: 

State Regulations: 

Alaska: You understand your primary care provider may obtain a copy of your records of your telehealth encounter.  (Alaska Stat. § 08.63.210(C)(2).

Arizona: You understand that all medical records resulting from a telemedicine consultation are part of your medical record. (Ariz. Rev. Stat. Ann. § 36-3602(D)).

Connecticut: You understand that your primary care provider may obtain a copy of your records of your telehealth encounter, and that you can revoke your consent at any time.  (Conn. Gen. Stat. Ann. § 19a-906). 

D.C.: You have been informed of alternate forms of communication between you and a physician for urgent matters.  (D.C. Mun. Regs. tit. 17, § 4618.10). Relevant communications with the physician, including those done via electronic methods shall be documented and filed in your medical record. (D.C. Mun. Regs. tit. 17, § 4618.9).

Georgia: You have been given clear, appropriate, accurate instructions on follow-up in the event of needed emergent care related to the treatment.  (Ga. Comp. R. & Regs. 360-3-.07(7)).

Idaho: You have been informed that if you want to register a formal complaint about a provider, you should visit the medical board’s website, here: https://dopl.idaho.gov/filing-a-complaint/ (Idaho Guidelines for Appropriate Regulation of Telemedicine). You further understand that your informed consent for the use of telehealth services shall be obtained by applicable law. Idaho Statutes 54-5708.

Indiana:  If a prescription is issued to you, and subject to your consent the prescriber shall notify your primary care provider of any prescriptions the prescriber has issued for you if the primary care provider's contact information is provided by you. This requirement does not apply if: (A) The practitioner is using an electronic health record system that your primary care provider is authorized to access. (B) The practitioner has established an ongoing provider-patient relationship with the patient by providing care to the patient at least 2 consecutive times through the use of telehealth services. If the conditions of this clause are met, the practitioner shall maintain a medical record for you and shall notify your primary care provider of any issued prescriptions. Ind. Code Ann. 25-1-9.5-7. 

Iowa: To file a complaint, fill out the complaint form and email it to the medical board at ibmcomplaints@iowa.gov. Iowa Admin. Code 653-13.11(147,148,272C)(13.11(18)).

As appropriate your provider will identify the medical home or treating physician(s) for you, when available, where in-person services can be delivered in coordination with the telemedicine services. Your provider shall provide a copy of the medical record to your medical home or treating physician(s). Iowa Admin. Code 653-13.11(147,148,272C)(13.11(11))

Kansas: You understand that if you have a primary care provider or other treating physician, the person providing telemedicine services must send within three business days a report to such primary care or other treating physician of the treatment and services rendered to you during the telemedicine encounter.  (Kan. Stat. Ann. § 40-2,212(2)(d)(2)(A). 

Kentucky: You have been informed that if you want to register a formal complaint about a provider, you should visit the medical board’s website, here:

https://kbml.ky.gov/board/Pages/default.aspx. 

If requested by you, your physician must share the medical record with your primary care physician and other relevant members of your existing care team. Kentucky Board Opinion on the Use of Telemedicine Technologies (2014), as amended September 15, 2022.

Louisiana: You understand the role of other health care providers that may be present during the consultation other than the telehealth provider.  (46 La. Admin. Code Pt XLV, § 7511).

Maine:  You have been informed that if you want to register a formal complaint about a provider, you should visit the medical board’s website, here: https://www.maine.gov/md/complaint/file-complaint. (Code Me. R. tit. 02-373 Ch. 11, § 3.).

New Hampshire:  You understand that the telehealth provider may forward your medical records to your primary care or treating provider.  (N.H. Rev. Stat. § 329:1-d).

New Jersey:  You understand that you have the right to request a copy of your medical information and you understand your medical information may be forwarded directly to your primary care provider or health care provider of record, or upon your request, to other health care providers. If you do not have a primary care provider or other health care provider of record, the health care provider engaging in telemedicine or telehealth may advise you  to contact a primary care provider, and, upon request by you, may assist you with locating a primary care provider or other in-person medical assistance that, to the extent possible, located within reasonable proximity to you. N.J. Rev. Stat. Ann. § 45:1-62.

Ohio: You understand that the telehealth provider may forward your medical records to your primary care or treating provider. Ohio Admin. Code 4731-37-01(C)(4).

Oregon: If you have a concern or complaint about the providers  providing care to you, you may contact a board agency to assist you. You understand that the provider may ask if you need more detail. ORS 17-52-677.07. See also Or. Medical Board, Statement of Philosophy: Telemedicine (Oct 2, 2020)

Complaints may be filed with:

Oregon Medical Board

1500 SW 1st Ave., Suite 620

Portland, OR 97201-5847

Complaint Resource Staff:  971-673-2702  |  complaintresource@omb.oregon.gov

Rhode Island:  If you use e-mail or text-based technology to communicate with your provider, then you understand the types of transmissions that will be permitted and the circumstances when alternate forms of communication or office visits should be utilized.  You have also discussed security measures, such as encryption of data, password protected screen savers and data files, or utilization of other reliable authentication techniques, as well as potential risks to privacy.  You acknowledge that your failure to comply with this agreement may result in the telehealth provider terminating the relationship.  (Rhode Island Medical Board Guidelines).

South Carolina:  You understand your medical records may be distributed in accordance with applicable law and regulation to other treating health care practitioners. You understand the value having of having a primary care medical home and, if requested, we can provide assistance in identifying available options for a primary care medical home. S.C. Code Ann. § 40-47-37.

South Dakota: You have received disclosures regarding the delivery models and treatment methods or limitations. You have discussed with the telehealth provider the diagnosis and its evidentiary basis, and the risks and benefits of various treatment options. (S.D. Codified Laws § 34-52-3).

Texas: You understand that your medical records may be sent to your primary care physician within 72 hours. Tex. Occ. Code Ann. § 111.005. You have been informed of the following notice:

NOTICE CONCERNING COMPLAINTS -Complaints about physicians, as well as other licensees and registrants of the Texas Medical Board, including physician assistants, acupuncturists, and surgical assistants may be reported for investigation at the following address: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018, Assistance in filing a complaint is available by calling the following telephone number: 1-800-201-9353, For more information, please visit our website at www.tmb.state.tx.us.  

AVISO SOBRE LAS QUEJAS- Las quejas sobre médicos, asi como sobre otros profesionales acreditados e inscritos del Consejo Médico de Tejas, incluyendo asistentes de médicos, practicantes de acupuntura y asistentes de cirugia, se pueden presentar en la siguiente dirección para ser investigadas: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018, Si necesita ayuda para presentar una queja, llame al: 1-800-201-9353, Para obtener más información, visite nuestro sitio web en www.tmb.state.tx.us.

Utah: You are able to a (i) access, supplement, and amend your patient-provided personal health information; (ii) contact your provider for subsequent care; (iii) obtain upon request an electronic or hard copy of your medical record documenting the telemedicine services, including the informed consent provided; and (iv) request a transfer to another provider of your medical record documenting the telemedicine services. Utah Admin. Code r. 156-1-602.

Virginia: You acknowledge that you have received details on security measures taken with the use of telemedicine services, such as encrypting date of service, password protected screen savers, encrypting data files, or utilizing other reliable authentication techniques, as well as potential risks to privacy notwithstanding such measures; You agree to hold harmless Thyme Care for information lost due to technical failures; and you provide your express consent to forward patient-identifiable information to a third party.  (Virginia Board of Medicine Guidance Document 85-12).

Vermont: You understand that you have the right to receive a consult with a distant-site provider and will receive one upon request immediately or within a reasonable time after the results of the initial consult. You understand that receiving telehealth services via store-and-forward technologies by Thyme Care does not preclude you from receiving real-time telemedicine or face-to-face services with the distant provider at a future date. (Vt. Stat. Ann. § 9361).

You have been informed that if you want to register a formal complaint about a provider, you should visit the medical board’s website, here: http://www.healthvermont.gov/health-professionals-systems/board-medical-practice/file-complaint; Board of Osteopathic Examiners can be found at: https://sos.vermont.gov/opr/complaints-conduct-discipline/#emr (Vt. Board of Medical Practice, Policy on the Appropriate Use of Telemedicine Technologies in the Practice of Medicine (March 1, 2023). 

By agreeing to this consent, you acknowledge that: 

  • I have read and understand the above information and agree to receive Care Coordination and Telehealth Program services.  
  • I understand the risks and benefits of telehealth services. My questions about these services have been answered, and I agree to take part in a telehealth consultation based on the terms explained here.
  • I may, without consequence, withdraw my participation from the program at any time after signing this document.  
  • I may request, and receive, a copy of this signed consent form at any time. Any and all copies of this document are to be considered as binding as the original.

Para ver este consentimiento en español, haga clic aquí.