For avoidance of any doubt, the term “MedSomma” refers to licensed medical clinics doing business as MedSomma, including but not limited to Brent A. Scroggins MD (Arkansas) PA and Carrie Carda MD (Texas) PLLC, the terms “you” and “yours” refer to the person receiving the Service.

Telemedicine involves the delivery of healthcare services using electronic communications, information technology or other means between a healthcare provider and a patient who are not in the same physical location. Telemedicine may be used for diagnosis, treatment, follow-up and/or patient education, and may include, but is not limited to:

• Electronic transmission of medical records, photo images, personal health information or other data between a patient and a healthcare provider;
• Interactions between a patient and healthcare provider via audio, video and/or data communications;
• Usage of output data from medical devices, sound and video files.
• The electronic systems utilized at MedSomma will incorporate network and software security protocols to protect the privacy and security of health information and imaging data, and will include measures to safeguard the data to ensure its integrity against intentional or unintentional corruption.

MedSomma believes there are benefits to utilizing telemedicine:

• Access to medical care and treatment is easier to access and more efficient for access to treatment
• You have the ability to interact with providers without the necessity of an in-office appointment.
• You have the ability to obtain medical care and treatment at times that are convenient for you.

There are possible risks with telemedicine.
Information submitted to MedSomma provider(s) may not be sufficient to allow for appropriate medical decision making by the provider(s).

• The inability of the MedSomma provider(s) to conduct certain tests or assess vital signs in-person may in some cases prevent the provider(s) from providing a treatment or from identifying the need for treatment for you.
• The MedSomma provider may not be able to provide medical treatment for your particular condition via telemedicine and you may be required to seek alternative care.
• Should there be failure in technology services, there may be delays in your medical evaluation or treatment.
• A breach of privacy may occur if security protocols or safeguards fail.
• Certain states and jurisdictions have various regulations which regulatory requirements in certain jurisdictions, your provider(s) treatment options, especially pertaining to certain prescriptions may be limited.

By accepting this Consent to Telehealth, you acknowledge your understanding and agreement to the following:

have read this special Consent to Telehealth carefully, and understand the risks and benefits of telemedicine in the medical care and treatment provided to me through the telemedicine technology platform used by MedSomma.

I give my informed consent to care by providers affiliated with MedSomma.

I understand that the delivery of healthcare services via telemedicine is an evolving field and that the telemedicine in my medical care and treatment may include the use of technology not specifically described in this consent.

I understand that while the use of telemedicine may provide potential benefits to me, as with any medical care service no such benefits or specific results can be guaranteed. My condition may not be cured or improved, and in some cases, may get worse.

understand that MedSomma pProviders may determine in his or her sole discretion that my condition is not suitable for treatment using telemedicine, and that I may need to seek medical care and treatment in-person or from an alternative source.

I understand that the same confidentiality and privacy protections that apply to my other health care services also apply to these telemedicine services.

I understand that I have access to all of my health information pertaining to the telemedicine services in accordance with applicable laws and regulations.

I understand that I can withhold or withdraw this consent at any time by emailing MedSomma with such instruction at care@MedSomma.com. Otherwise, this consent will be considered renewed upon each new telemedicine consultation with MedSomma providers.

I agree and authorize my health care provider to share information regarding the telemedicine exam with other individuals for treatment, payment and health care operations purposes.

I agree and authorize my health care provider to release information regarding the telemedicine exam to MedSomma and its affiliates.