Consent to Medical and Telehealth Care

Effective Date: January 1, 2025 

• I understand that I can obtain health care services by Thyme Care Medical, PLLC (“Thyme Care Medical”) that may include telephonic medical consultations, virtual video consultations, and the ordering of tests, referrals, and prescriptions for medications by a Thyme Care provider or other healthcare personnel under such provider’s supervision.
• I understand that participating in telephonic medical consultations and/or virtual video consultations may require the electronic transmission of my health information so that it can be received via telephone or videoconference by a Thyme Care provider or other healthcare personnel under such provider’s supervision. 
• I understand that the care provided during a telephonic or video-enabled medical consultation will meet the same standard of care. I also understand that because I will not be in the same physical location as my Thyme Care Medical care provider during a telephonic or video-enabled medical consultation, certain activities or maneuvers may be different than a typical in-person evaluation and other activities or maneuvers may not be possible. 
• I understand that the use of telehealth in my medical care and treatment may include uses of technology not specifically described in this consent form. I am comfortable using technology to communicate with a Thyme Care provider or other healthcare personnel and understand the limitations of technology.
• I understand there are potential risks to this technology, including interruptions, unauthorized access, delays in medical evaluation and treatment arising from technical difficulties and the potential inability of my health care provider to provide appropriate medical treatment for my condition via telephonic or video-enabled virtual consultation. I understand that my Thyme Care Medical care provider or I can discontinue the telephonic or virtual video medical consultation if it is felt that the use of these modalities are not adequate for the situation.
• I understand that my Thyme Care Medical care provider may determine in his or her sole discretion that my condition is not suitable for treatment using the telephonic or virtual video medical consultation, and that I may need to seek medical care and treatment from an alternative source.
• I understand that while the medical services, including use of telephonic or virtual video medical consultations may provide potential benefits to me, as with any medical care service no such benefits or specific results can be guaranteed.
• I understand that in the event of an emergency, I should not contact Thyme Care Medical but should immediately call “911” and request emergency care assistance.
• I understand that in addition to my Thyme Care Medical care provider other Thyme Care Medical staff members may be present during the telephonic or virtual video medical consultations. I understand that I will be informed of their presence, and I have a right to consent to their presence. The Thyme Care Medical staff will at all times maintain confidentiality of the information obtained. I understand that the same confidentiality and privacy protections that apply to onsite health care services also apply to the telephonic or virtual video consultations.
• I understand that I may withhold or withdraw this consent at any time by providing Thyme Care Medical with such notice. Otherwise, this consent will be considered renewed and ongoing upon each telephonic or virtual video medical consultation provided by Thyme Care Medical and its affiliated professional entities and their health care providers.
• I understand that I can have a direct conversation with my Thyme Care medical care provider to discuss my medical treatment, including physical examinations and telephonic or virtual video consultations, as applicable. I know I can ask questions, have them answered, and discuss the risks, benefits, and practical alternatives in a way that I understand
• I understand that I will be billed for telehealth services according to my insurance plan and am responsible for any copayments or deductibles associated with these services
  
  

By signing this Consent to Medical and Telehealth Care, I certify that:

• I am at least eighteen (18) years of age or older.
• I have carefully read and consent to the terms and conditions stated herein.
• I have carefully read and acknowledge the terms and conditions stated in the Notice of Privacy Practices provided to me and also available at thymecare.com.
• I understand that I have the opportunity to ask questions about my medical treatment, and I know I can reach out if I have any concerns or need additional information.