Last updated: April 11, 2022
To receive telehealth services through Amazon VHS, LLC (“Amazon Clinic”), Amazon Clinic will connect you with a healthcare provider or care team members affiliated with “Curai Health” (i.e., First Opinion Health Services (FL) PLLC, First Opinion Health Services (IL), P.C., NY Medicine/Telemedicine, PLLC, First Opinion Health Services (NC), PLLC, First Opinion Health Services, Inc., First Opinion Health Services (TX), PLLC, First Opinion Health Services (GA), LLC, First Opinion Health Services NJ, LLC) (each, a “Provider”) who will provide the telehealth services.
Your Provider will use asynchronous and/or synchronous telehealth technologies that are furnished by Amazon Clinic (“Telehealth Technology”) to provide the telehealth services. If you have questions about the Telehealth Technology furnished by Amazon Clinic or risks associated with using the Telehealth Technology, please contact Amazon Clinic Customer Care at 866-682-2766.
If you have questions about whether the use of the Telehealth Technology is appropriate for your condition, the risks associated with using the Telehealth Technology for a visit with your Provider, or the Provider’s credentials and professional background, please ask your Provider. In exchange for your use of the Telehealth Technology to receive care, you acknowledge and agree to the following terms and conditions of this informed consent (this "Consent"):
1. Use of Telehealth Technology. You understand and agree that:
• There are many benefits, but also risks associated with receiving care via Telehealth Technology. Benefits include convenience, increased access, and the ability to receive care in your home. Risks are outlined in Section 2 below.
• The Provider will decide, in his or her sole discretion, whether it is appropriate to treat your condition using Telehealth Technology. The Provider may request that you halt receiving care via Telehealth Technology and instead receive in-person care if the Provider deems it appropriate.
• Services provided through Telehealth Technology may include behavioral health services, including telepsychiatry, and you expressly agree to receive such services through Telehealth Technology.
• Services provided through Telehealth Technology may involve electronic communication of your personal medical information to Providers that may be located in other areas, including out of state.
• Your Provider will take reasonable steps to protect the privacy and security of any protected health information maintained by Provider for purposes of your telehealth visit in accordance with federal, state, and other applicable law.
• You have the right to request copies of your medical records maintained by Provider, which may be provided electronically or in hard copy format at reasonable cost of preparation, shipping and delivery.
• The anticipated response time for electronic communications submitted through the Telehealth Technology varies and you accept any risk associated with the response time, including a delay in obtaining medical care.
• No warranty or guarantee has been made to you concerning any particular result related to your condition or diagnosis.
2. Risks Associated with Use of Telehealth Technology. You understand that use of the Telehealth Technology has risks associated with it, such as (1) information that you transmit through the Telehealth Technology may be insufficient to allow for appropriate decision-making by the Provider; (2) failures of equipment (e.g., servers, devices) or infrastructure (e.g., communications lines, power supply, software failures) may cause interruptions and delays in the provision of care and treatment, or loss of information; and (3) in rare events, security protocols could fail, causing unauthorized access to your health information. You acknowledge that, although Curai Health and Amazon Clinic strive to prevent unauthorized access to information about you through implementation of certain security measures, neither Curai Health nor Amazon Clinic can guarantee that your use of the Telehealth Technology and the information you provide will be private or secure, and you consent to this risk. You understand and consent to the risks associated with your use of the Telehealth Technology.
3. Your Telehealth Provider’s Credentials. You acknowledge that your health care provider’s credentials were made available to you before receiving care. If you have any questions about these credentials, please direct them to your health care provider.
4. Accuracy of Information Submitted to the Provider. You acknowledge and agree that you are solely responsible for ensuring that the information submitted by you through the Telehealth Technology is accurate, complete and current at all times when you use the Telehealth Technology. You understand that the Provider will rely on this information to provide services to you.
5. Release and Waiver. You acknowledge and agree to limit, disclaim, and release Curai Health from liability in connection with the use of Telehealth Technology.
6. Expenses. You understand and agree that you may be responsible for the cost of certain professional fees associated with your use of the Telehealth Technology and the cost of any medications or supplies prescribed by the Provider, if applicable.
7. Other Legal Terms. This Consent cannot be amended by Curai Health except in writing and with your consent. If any provision is or becomes unenforceable or invalid, the other provisions will continue with the same effect.
8. Right to Revoke. You have the right to withhold or withdraw your consent to receive telehealth services via the Telehealth Technologies in the course of your care at any time, without affecting your right to future care or treatment. You may suspend or terminate access to the services at any time for any reason or for no reason in accordance with this Section 7. You understand that you can revoke this Consent by sending written notice using electronic mail to Curai Health at: support.curaihealth.com (“Revocation”). You agree that your Revocation must contain your name and your address. You also understand that your Revocation means that you are not permitted to receive care using Telehealth Technology. Your Revocation will be effective upon Curai Health’s receipt of your written notice, except that your Revocation will not have any effect on any action taken by the Provider in reliance on this Consent before Curai Health received your written notice of Revocation.
Privacy Consent
1. Consent to Use and Disclosure of Health Information. You hereby permit and provide your express consent for Curai Health or third parties who work on behalf of Curai Health to use, disclose, and/or release your health information, including, without limitation, Highly Confidential Information (which is defined below), for purposes of treatment, payment, health care operations, or other permitted purposes described below, to the fullest extent permitted by applicable law. Without limiting the preceding sentence, Curai Health may release your health information to your primary care or treating provider and any person or entity liable for payment on your behalf in order to verify coverage or payment questions, or for any other purpose related to benefit payment. Curai Health may also release your health information to your employer’s designee when the services delivered are related to a claim under workers’ compensation.
If you would like to request your records or have Curai Health send your medical records to another provider, please let your Provider know or contact Amazon Customer Care. Curai Health will ask you to complete a release of information form, and we will then release your records.
Additional State-Specific Consents: the following consents apply to the extent applicable to your receipt of telehealth services:
• Connecticut: You understand that your primary care provider may obtain a copy of your records of your telehealth visit. (Conn. Gen. Stat. Ann. § 19a-906).
• New Jersey: You understand that your medical information may be forwarded directly to your primary care provider or other health care provider of record, or upon your request, to any other health care provider. (NJ Rev. Stat. § 45:1-62).
• Ohio: You understand that your medical records may be sent to your primary care provider or other health care provider, if applicable, or you may be referred to an appropriate health care provider or health care facility. (Ohio Admin. Code. Rule 4731-11-09).
• South Carolina: You understand that your medical records may be sent to any of your other health care providers in accordance with applicable laws and regulations. (SC Code § 40-47-37).
• Texas: You understand that your medical records may be sent to your primary care physician. (Tex. Occ. Code Ann. § 111.005).
• Utah: You understand that your medical records may be sent to your designated health care provider (Utah Code § 26-60-103).
“Highly Confidential Information” means information about (a) substance use disorder treatment, (b) genetic information or test results, (c) mental health or illness or developmental or intellectual disability, (d) psychiatric treatment, (e) HIV/AIDS testing or treatment or status, (f) communicable or blood borne diseases, (g) sexually transmitted diseases, (h) child or domestic abuse and neglect, (i) abuse of an adult with a disability, (j) sexual assault, (k) maternity records (including medical records of new mothers and newborns), (l) infertility or fertility assistance, IVF, or artificial insemination, and (m) any other type of information that is given special privacy protection under state or federal laws.
Please refer to our Notice of Privacy Practices for more information.
2. Consent/Release to Disclose HIV/AIDS-Related Information. Without limiting Section 1, you hereby authorize Curai Health to disclose any HIV/AIDS-related testing, test results, status, diagnoses, or treatment information (including if an HIV test was ordered, performed, or reported, regardless of the results) (a) to certain vendors and subcontractors that help us provide services and that we have entered into an agreement with specifically for the purposes of safeguarding your health information, to facilitate your use of the app, for case management and care coordination purposes, and for payment and health care operations purposes, and (b) to your health plan for payment and health care operations purposes.
Other State Specific Consents
• California: You have been informed that medical doctors are licensed and regulated by the Medical Board of California. To check up on a license or to file a complaint go to www.mbc.ca.gov, email licensecheck@mbc.ca.gov, or call (800) 632-2322.
You understand that you have been provided information regarding the Open Payments database as set forth below.
The Open Payments database is a federal tool used to search payments made by drug and device companies to physicians and teaching hospitals. It can be found here. For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here. The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public.
• Iowa: You have been informed that if you want to register a formal complaint about a provider, you should visit the medical board’s website (https://medicalboard.iowa.gov/consumers/filing-complaint).
• 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 (https://www.maine.gov/md/complaint/file-complaint).
• Oregon: You have been informed that if you want to register a formal complaint about a provider, you should visit the medical board’s website (https://www.oregon.gov/omb/investigations/Pages/How-to-File-a-Complaint.aspx)
• Texas:
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.
You may revoke this consent at any time except to the extent that Curai Health has taken action in reliance on this consent. Unless you revoke your consent earlier, this consent will expire automatically when your participation in the app has ended.
To receive telehealth services through Amazon VHS, LLC (“Amazon Clinic”), Amazon Clinic will connect you with a healthcare provider or care team members affiliated with “Curai Health” (i.e., First Opinion Health Services (FL) PLLC, First Opinion Health Services (IL), P.C., NY Medicine/Telemedicine, PLLC, First Opinion Health Services (NC), PLLC, First Opinion Health Services, Inc., First Opinion Health Services (TX), PLLC, First Opinion Health Services (GA), LLC, First Opinion Health Services NJ, LLC) (each, a “Provider”) who will provide the telehealth services.
Your Provider will use asynchronous and/or synchronous telehealth technologies that are furnished by Amazon Clinic (“Telehealth Technology”) to provide the telehealth services. If you have questions about the Telehealth Technology furnished by Amazon Clinic or risks associated with using the Telehealth Technology, please contact Amazon Clinic Customer Care at 866-682-2766.
If you have questions about whether the use of the Telehealth Technology is appropriate for your condition, the risks associated with using the Telehealth Technology for a visit with your Provider, or the Provider’s credentials and professional background, please ask your Provider. In exchange for your use of the Telehealth Technology to receive care, you acknowledge and agree to the following terms and conditions of this informed consent (this "Consent"):
1. Use of Telehealth Technology. You understand and agree that:
• There are many benefits, but also risks associated with receiving care via Telehealth Technology. Benefits include convenience, increased access, and the ability to receive care in your home. Risks are outlined in Section 2 below.
• The Provider will decide, in his or her sole discretion, whether it is appropriate to treat your condition using Telehealth Technology. The Provider may request that you halt receiving care via Telehealth Technology and instead receive in-person care if the Provider deems it appropriate.
• Services provided through Telehealth Technology may include behavioral health services, including telepsychiatry, and you expressly agree to receive such services through Telehealth Technology.
• Services provided through Telehealth Technology may involve electronic communication of your personal medical information to Providers that may be located in other areas, including out of state.
• Your Provider will take reasonable steps to protect the privacy and security of any protected health information maintained by Provider for purposes of your telehealth visit in accordance with federal, state, and other applicable law.
• You have the right to request copies of your medical records maintained by Provider, which may be provided electronically or in hard copy format at reasonable cost of preparation, shipping and delivery.
• The anticipated response time for electronic communications submitted through the Telehealth Technology varies and you accept any risk associated with the response time, including a delay in obtaining medical care.
• No warranty or guarantee has been made to you concerning any particular result related to your condition or diagnosis.
2. Risks Associated with Use of Telehealth Technology. You understand that use of the Telehealth Technology has risks associated with it, such as (1) information that you transmit through the Telehealth Technology may be insufficient to allow for appropriate decision-making by the Provider; (2) failures of equipment (e.g., servers, devices) or infrastructure (e.g., communications lines, power supply, software failures) may cause interruptions and delays in the provision of care and treatment, or loss of information; and (3) in rare events, security protocols could fail, causing unauthorized access to your health information. You acknowledge that, although Curai Health and Amazon Clinic strive to prevent unauthorized access to information about you through implementation of certain security measures, neither Curai Health nor Amazon Clinic can guarantee that your use of the Telehealth Technology and the information you provide will be private or secure, and you consent to this risk. You understand and consent to the risks associated with your use of the Telehealth Technology.
3. Your Telehealth Provider’s Credentials. You acknowledge that your health care provider’s credentials were made available to you before receiving care. If you have any questions about these credentials, please direct them to your health care provider.
4. Accuracy of Information Submitted to the Provider. You acknowledge and agree that you are solely responsible for ensuring that the information submitted by you through the Telehealth Technology is accurate, complete and current at all times when you use the Telehealth Technology. You understand that the Provider will rely on this information to provide services to you.
5. Release and Waiver. You acknowledge and agree to limit, disclaim, and release Curai Health from liability in connection with the use of Telehealth Technology.
6. Expenses. You understand and agree that you may be responsible for the cost of certain professional fees associated with your use of the Telehealth Technology and the cost of any medications or supplies prescribed by the Provider, if applicable.
7. Other Legal Terms. This Consent cannot be amended by Curai Health except in writing and with your consent. If any provision is or becomes unenforceable or invalid, the other provisions will continue with the same effect.
8. Right to Revoke. You have the right to withhold or withdraw your consent to receive telehealth services via the Telehealth Technologies in the course of your care at any time, without affecting your right to future care or treatment. You may suspend or terminate access to the services at any time for any reason or for no reason in accordance with this Section 7. You understand that you can revoke this Consent by sending written notice using electronic mail to Curai Health at: support.curaihealth.com (“Revocation”). You agree that your Revocation must contain your name and your address. You also understand that your Revocation means that you are not permitted to receive care using Telehealth Technology. Your Revocation will be effective upon Curai Health’s receipt of your written notice, except that your Revocation will not have any effect on any action taken by the Provider in reliance on this Consent before Curai Health received your written notice of Revocation.
Privacy Consent
1. Consent to Use and Disclosure of Health Information. You hereby permit and provide your express consent for Curai Health or third parties who work on behalf of Curai Health to use, disclose, and/or release your health information, including, without limitation, Highly Confidential Information (which is defined below), for purposes of treatment, payment, health care operations, or other permitted purposes described below, to the fullest extent permitted by applicable law. Without limiting the preceding sentence, Curai Health may release your health information to your primary care or treating provider and any person or entity liable for payment on your behalf in order to verify coverage or payment questions, or for any other purpose related to benefit payment. Curai Health may also release your health information to your employer’s designee when the services delivered are related to a claim under workers’ compensation.
If you would like to request your records or have Curai Health send your medical records to another provider, please let your Provider know or contact Amazon Customer Care. Curai Health will ask you to complete a release of information form, and we will then release your records.
Additional State-Specific Consents: the following consents apply to the extent applicable to your receipt of telehealth services:
• Connecticut: You understand that your primary care provider may obtain a copy of your records of your telehealth visit. (Conn. Gen. Stat. Ann. § 19a-906).
• New Jersey: You understand that your medical information may be forwarded directly to your primary care provider or other health care provider of record, or upon your request, to any other health care provider. (NJ Rev. Stat. § 45:1-62).
• Ohio: You understand that your medical records may be sent to your primary care provider or other health care provider, if applicable, or you may be referred to an appropriate health care provider or health care facility. (Ohio Admin. Code. Rule 4731-11-09).
• South Carolina: You understand that your medical records may be sent to any of your other health care providers in accordance with applicable laws and regulations. (SC Code § 40-47-37).
• Texas: You understand that your medical records may be sent to your primary care physician. (Tex. Occ. Code Ann. § 111.005).
• Utah: You understand that your medical records may be sent to your designated health care provider (Utah Code § 26-60-103).
“Highly Confidential Information” means information about (a) substance use disorder treatment, (b) genetic information or test results, (c) mental health or illness or developmental or intellectual disability, (d) psychiatric treatment, (e) HIV/AIDS testing or treatment or status, (f) communicable or blood borne diseases, (g) sexually transmitted diseases, (h) child or domestic abuse and neglect, (i) abuse of an adult with a disability, (j) sexual assault, (k) maternity records (including medical records of new mothers and newborns), (l) infertility or fertility assistance, IVF, or artificial insemination, and (m) any other type of information that is given special privacy protection under state or federal laws.
Please refer to our Notice of Privacy Practices for more information.
2. Consent/Release to Disclose HIV/AIDS-Related Information. Without limiting Section 1, you hereby authorize Curai Health to disclose any HIV/AIDS-related testing, test results, status, diagnoses, or treatment information (including if an HIV test was ordered, performed, or reported, regardless of the results) (a) to certain vendors and subcontractors that help us provide services and that we have entered into an agreement with specifically for the purposes of safeguarding your health information, to facilitate your use of the app, for case management and care coordination purposes, and for payment and health care operations purposes, and (b) to your health plan for payment and health care operations purposes.
Other State Specific Consents
• California: You have been informed that medical doctors are licensed and regulated by the Medical Board of California. To check up on a license or to file a complaint go to www.mbc.ca.gov, email licensecheck@mbc.ca.gov, or call (800) 632-2322.
You understand that you have been provided information regarding the Open Payments database as set forth below.
The Open Payments database is a federal tool used to search payments made by drug and device companies to physicians and teaching hospitals. It can be found here. For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services (CMS) Open Payments web page is provided here. The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical devices, and biologics to physicians and teaching hospitals be made available to the public.
• Iowa: You have been informed that if you want to register a formal complaint about a provider, you should visit the medical board’s website (https://medicalboard.iowa.gov/consumers/filing-complaint).
• 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 (https://www.maine.gov/md/complaint/file-complaint).
• Oregon: You have been informed that if you want to register a formal complaint about a provider, you should visit the medical board’s website (https://www.oregon.gov/omb/investigations/Pages/How-to-File-a-Complaint.aspx)
• Texas:
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.
You may revoke this consent at any time except to the extent that Curai Health has taken action in reliance on this consent. Unless you revoke your consent earlier, this consent will expire automatically when your participation in the app has ended.