Smartphone Apps for NuPhysicia Health of Texas (NuPhysicia Patient Portal)
(MedAtWork, AMTEL, MCHD)
Notice, Informed Consent and Usage Agreement
NOTE – By using the smartphone application (Patient Portal) and its related services, you are indicating that you understand and agree to these terms and conditions:
Having medical information available online and receiving medical services online can be a valuable tool, but has certain risks. Participation is voluntary. In order to manage these risks NuPhysicia must impose some conditions of participation. This Notice and Consent is, therefore, intended to show that we have informed you of these risks and the conditions of participation, and that you accept the risks, limitations of receive these services and agree to the conditions of participation by downloading, logging in, and using the application. You acknowledge that you have previously been given access to a copy of our Notice of Privacy Practices. The Notice of Privacy Practices provides information about how NuPhysicia and its affiliates may use and disclose protected health information about you. A copy of the Notice of Privacy Practices is available at www.nuphysicia.com/privacypolicy.
NON-EMERGENCY Telehealth Services
I understand that “telehealth” includes the delivery of health care services, diagnosis, consultation, treatment, transfer of medical data, and education using interactive audio, video, or data communications. I understand that telehealth also involves the communication of my medical/mental information, both orally and visually, to health care practitioners, who may be located in the same state as I am or in another state. The information I provide may be used for diagnosis, therapy, follow-up and/or education. The electronic data systems and transmission protocols used will incorporate security protocols to protect the confidentiality of the data and will include reasonable measures to safeguard the data’s integrity against intentional or unintentional corruption. Telehealth, like all medical services, has certain benefits and risks. The expected benefits of telehealth are:
1. Improved access to medical care by enabling me to remain in my home or other location while a physician provides services to me .
2. More efficient medical evaluation and management.
3. The potential risks associated with the use of telehealth, include, but may not be limited to:
4. In unusual cases, information transmitted may not be sufficient (e.g. poor resolution of images) to allow for appropriate medical decision making by the physician and consultant(s) and in some cases signs and symptoms that might be detected during an in-person physical examination may not be detected through telehealth;
5. Delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment and networks used for the telehealth service, including disruption or distortion in the transmission of my medical information including as a result of technical failures, power failures, loss of communications or corruption of electronic records by outsiders (hackers);
6. In very rare instances, security protocols could fail, causing a breach of privacy of personal medical information; including interception of my medical information by unauthorized persons; and
7. In rare cases, a lack of access to complete medical records may result in adverse drug interactions or allergic reactions or other judgment errors.
I understand that I may expect certain benefits from my use of a telehealth consultation for my health care needs, but also understand that no results can be guaranteed or assured.
I hereby consent to participate in a telehealth visit under the terms described herein and authorize your health care professionals to provide me with their observations and recommendations regarding my medical condition and potential courses of action, using telehealth.
I consent to audio/video recording or photography if necessary. The resulting audio, video and images will become part of the medical record and be used for documentation or health care purposes only.
I understand that the observations and recommendations you provide will be limited in scope and nature to the specific issues discussed during the telehealth consult and will be based upon the information I provide.
I have the right to withdraw my consent for telehealth at any time without affecting my right to future care, treatment, benefits, or programs for which I am otherwise entitled. Alternative methods of care may be available to me, and I may choose other options at any time. I understand the alternatives to a telehealth consultation as they have been explained to me.
I further understand the health care professional, in his or her sole discretion and professional judgment, may determine that telehealth services are not appropriate for some or all of my healthcare needs and, accordingly, may elect not to provide telehealth services and will refer me to a health care professional for in-person services. The telehealth services provided are not intended to replace my primary care physician relationship or to be my permanent medical home AND ARE NOT INTENDED FOR THE PROVISION OF URGENT OR EMERGENCY MEDICAL SERVICES. I should seek emergency help or, when recommended by my tele-health healthcare provider or when otherwise needed, follow-up care, and continue to consult with my primary care physician and other health care professionals as recommended. My telehealth professional may make arrangements for follow-up care either through my primary care provider, a health care facility or other health care providers. If the transmission fails during my telehealth consultation, then a member of your customer support team will use reasonable commercial efforts to contact me to help me get reconnected or will refer me to another health care professional. I will also make efforts to reconnect with the health care professional, if the transmission fails. If I am unable to reconnect with you, I will seek services from my primary care physician or other local health care professional. I understand that I will have access to your health care professionals to follow-up on medication reactions, side effects, or other adverse events in accordance with the terms of the health care program I am eligible to participate in.
Portal Personal Health RecordElectronic Communication
I agree to abide by NuPhysicia’s guidelines for the use of NuPhysicia’s Patient Portal electronic medical information system, as outlined below. I understand that I am to contact my physician directly for any urgent or emergent situations. NuPhysicia’s Patient Portal provides only limited internet based medical information and non-emergent telehealth consultations. THIS SYSTEM IS ONLY FOR NON-URGENT MEDICAL PURPOSES AND CONTAINS ONLY LIMITED INFORMATION. MEDICAL DECISIONS SHOULD NOT BE BASED SOLELY UPON THE INFORMATION CONTAINED IN THE PORTAL. I AGREE TO CONTACT MY PERSONAL PHYSICIAN FOR ANY MEDICAL NEEDS I MAY HAVE, except in connection with telehealth visits described above. My failure to adhere to the following guidelines may result in termination of my access to NuPhysicia’s Patient Portal. NuPhysicia reserves the right, at its own discretion, to terminate patient portal offering, suspend user access, or modify services offered through the patient portal.
COVID-19 Testing and Related Services
If you are requesting COVID-19 testing, NuPhysicia Health of Texas (NHOT) will provide this testing to assess the risks to your health, the health of your co-workers, and the public from SARS-CoV-19. This is done through non-invasive testing arranged by and paid for by your employer.
I understand the that this testing falls under HIPAA’s workplace medical surveillance exception. This service is being provided at the employer’s request, and the employer needs the information to comply with legal obligations related to workplace health monitoring. NHOT is providing you with this notice that the information will be disclosed to this employer at the time of the service and NHOT will limit the disclosure to the findings regarding the medical surveillance at issue. (45 CFR 164.512(b)(1)(v).) On April 23, 2020, the Equal Employment Opportunity Commission (EEOC) updated its Technical Assistance Questions and Answers about COVID-19 to state that, given the current pandemic status, employers may test employees before they enter the workplace to determine if they are infected with the virus.
I authorize the NuPhysicia Health of Texas (NHOT) to perform this testing and disclose the results information to my employer, for purposes of protecting my health, that of my co-workers, and the safety of the workplace. (45 C.F.R. § 164.508).
If I have an urgent or emergent medical condition I WILL NOT USE THE PORTAL TO CONTACT NUPHYSICIA – I WILL CONTACT MY OWN PERSONAL PHYSICIAN OR AN EMERGENCY MEDICAL PROVIDER IMMEDIATELY. NuPhysicia strives to keep all of the information in my records correct. If I identify a part of my record that is incorrect, I will notify NuPhysicia immediately. In addition, by use of this portal I agree to not provide false or misleading information.
The information on this site is maintained by NuPhysicia Incorporated whose mailing address is 4635 Southwest Freeway Suite 210, Houston, Texas, 77027. For questions about this site you may contact us at 713-358-9270. I agree to use reasonable and appropriate security practices to protect my electronic patient information and prevent unauthorized access (password protection, encryption, proxy authorizations, etc.). I will notify you should my password be stolen or otherwise compromised.
The Texas Medical Board requires that we inform you that: 1) All internet communication with our staff is required by the Texas Medical Board to be recorded in your medical record. 2) Staff members other than your physician will be involved in receiving your messages, and routing them to the doctor, nurse, or client service desk as necessary. 3) NuPhysicia’s hours of operation are 9am – 5 pm on Monday through Friday. We encourage you to use the web site at any time, however messages are held for review until we return the next business day. Messages are typically handled within 1 business day. If the applicable doctor is out of the office that day, my request may be handled by the doctor on call, or held until the applicable doctor returns to the office. If I do not get a response within 1 business day, I will call your office, as necessary. 4) The types of transactions available online are: a) Messaging to medical office staff b) Review of certain wellness and laboratory test results c) Provision of certain on-line medical consultations.
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 the Board’s website at www.tmb.state.tx.us.
I understand that e-mail is not a confidential means of communication. I agree to waive any rights that I may have against NuPhysicia Health of Texas and NuPhysicia or any of their affiliated organizations, or physician, or the supplier or operator of NuPhysicia’s Patient Portal, for any loss of information due to technical failures and/or unintended breach of confidentiality, due to unauthorized access to my information, as a result of my decision to communicate with my physician in this manner.
I acknowledge that I have read and fully understand this notice and consent. I understand the risks associated with online communications of limited medical information, and consent to the conditions outlined herein. In addition, I agree to follow the instructions set forth herein, as well as any other instructions that NuPhysicia may impose to communicate limited medical information via online communications. I have had a chance to ask any questions that I had and to receive answers. I have been proactive about asking questions related to this consent agreement. All of my questions have been answered and I understand and concur with the information provided in the answers. I hereby receive this notice and give my informed consent to the above.
CDC health information is provided by the United States Centers for Disease Control. For more information please visit www.CDC.gov.
Updated July 2020
