DO NOT USE THIS SERVICE IF YOU MAY BE EXPERIENCING A MEDICAL EMERGENCY. In an emergency, call 911, go to the nearest emergency room, or contact your local crisis center. In the U.S., you can call or text 988 for the Suicide & Crisis Lifeline. You can also text HOME to 741741 to reach the Crisis Text Line.
Please review this Consent to Care, which explains what to expect when receiving services via telehealth from Hoopcare Medical of Florida, P.A., and its affiliated professional entities (collectively, “Hoopcare Affiliated Practices,” “we,” “our,” or “us”).
By using Hoopcare Eva at app.hoopcare.com, you consent to receive services from the Hoopcare Affiliated Practices. Services can include identifying care gaps, health check recommendations, care coordination, and other treatment where applicable. No warranty or guarantee is made as to results or cure. We may use health information exchange systems to transmit, receive, and/or access your medical information, including demographics, medical history, lab results, prior diagnoses and treatments, and immunization records. This Consent to Care remains in effect while you receive services from the Hoopcare Affiliated Practices unless you revoke it in writing.
If you receive access to Hoopcare Eva through an employer or health plan, you may be eligible for telemedicine visits with Hoopcare providers.
Your provider’s credentials are available before you schedule a visit. Direct any questions about credentials to your telehealth provider.
The Hoopcare Affiliated Practices deliver care via telecommunications technology (“telehealth”). Our providers include physicians, nurses, and other licensed professionals. Services can include chart review, remote prescribing where permitted, scheduling, refill reminders, health information sharing, and non-clinical services such as patient education.
We use network and software security protocols designed to protect the confidentiality and integrity of your information. Benefits can include improved access, efficient evaluation and management, and specialist input when appropriate. Possible risks include delays due to equipment or technology failures; in rare cases the information transmitted may be insufficient, requiring rescheduling or in-person follow-up with a local clinician.
Your clinician may consult or receive supervision from other Hoopcare or non-Hoopcare clinicians to enhance your care. All team members must follow privacy and confidentiality laws. Limits to confidentiality include threats of serious harm to self or others, suspected abuse or neglect of a child or vulnerable adult, court orders, your written permission, consultations between treating providers, disclosures to insurers for payment, disclosures described in our Notice of Privacy Practices, and other uses or disclosures permitted or required by law.
Where required by state law, only a parent or current legal guardian may consent to treatment for a minor.
BY CLICKING “I ACCEPT,” “I AGREE,” OR USING OUR TELEHEALTH SERVICES, YOU ACKNOWLEDGE:
• You have read and understand this Consent to Care, had the chance to ask questions, and consent to receive services from the Hoopcare Affiliated Practices via telehealth.
• Hoopcare telehealth services do not replace your relationship with your primary care clinician. Hoopcare providers determine whether your needs are appropriate for telehealth.
• If you are consenting for a minor, you are the parent or legal guardian and have authority to make healthcare decisions.
• Alternatives to telehealth, including in-person care, are available. Some tests may be performed at your location or an external facility at your provider’s direction.
• Anticipated benefits are not guaranteed.
• Controlled substances such as narcotics will not be prescribed, and no prescription is guaranteed.
• You may review a provider’s credentials before your consult, including confirmation the provider practices in your state.
• Telehealth can involve electronic communication of your medical information to other practitioners, including those in other states.
• We implement safeguards designed to prevent unauthorized use or disclosure of your information in accordance with federal and state law.
• Your information can be shared with individuals and third-party contractors for scheduling and billing. Non-clinical personnel may be present to operate telehealth technology—if so, you will be told and you can: (a) omit details you consider sensitive, (b) ask non-medical personnel to leave, and/or (c) stop the visit at any time.
• Technical failures may occur. You agree to hold the Hoopcare Affiliated Practices harmless for delays or data loss due to such failures.
• You may request a copy of your medical records; reasonable copy and delivery fees may apply.
• You may withhold or withdraw consent to telehealth at any time without affecting future care options. You can stop using telehealth services at any time. Hoopcare providers cannot directly connect you to local emergency services.
• You have read and understand the state-specific disclosures below for the state where you are located at the time of the visit.
The following apply to patients located in the listed states and receiving a telehealth consultation from a Hoopcare Affiliated Practice serving that state:
Alaska — Your primary care provider may obtain a copy of your telehealth records. (Alaska Stat. § 08.64.364)
Arizona — All medical records from a telemedicine consultation are part of your medical record. (A.R.S. § 12-2291)
Colorado — To file a complaint about a provider: https://dpo.colorado.gov/FileComplaint
Connecticut — Your primary care provider may obtain a copy of your telehealth records; you can revoke consent at any time. (Conn. Gen. Stat. Ann. § 19a-906)
District of Columbia — You have been informed of alternate ways to reach a physician for urgent matters. (17 DCMR § 4618.10)
Georgia — You received clear follow-up instructions for emergent issues related to treatment. (Ga. Comp. R. & Regs. 360-3-.07(7))
Iowa — To file a complaint: https://stateofiowa.seamlessdocs.com/f/BoardOfMedicineComplaint
Idaho — To file a complaint: https://apps-dopl.idaho.gov/IBOMPortal/LINKS/discipline/IDBOM_complaint_form.pdf
Illinois — To file a complaint: https://dph.illinois.gov/topics-services/health-care-regulation/complaints.html
Indiana — To file a complaint: https://www.in.gov/idoi/consumer-services/file-a-provider-complaint/
Kansas — If you have a primary care or treating clinician, the telemedicine provider must send a report within three business days describing the services rendered. Complaint info: https://www.ksbha.ks.gov/Home/Components/FormBuilder/FormBuilder/793c446dd5bb46e2b1f0ef20e4eea166/324
Kentucky — To file a complaint: https://kbml.ky.gov/grievances/Pages/default.aspx
Louisiana — You understand the roles of other healthcare personnel who may be present during the consult. (46 La. Admin. Code Pt XLV, § 7511)
Maine — To file a complaint: https://www.maine.gov/md/complaint/file-complaint/online-complaint
Maryland — For certain licensed professionals, telehealth differs from in-person care because physical contact is not possible; transmission quality and environment can affect services; services cannot be provided by correspondence only. To file a complaint: https://www.mbp.state.md.us/forms/complaint.pdf (COMAR 10.41.06.04)
Nebraska — All existing confidentiality protections apply. You may access information from the telehealth consult as allowed by law. We will not share identifiable images or information from the consult with researchers without your written consent. You can request an in-person consult immediately after a telehealth consult and will be told if one is not available. Complaints: https://dhhs.ne.gov/Pages/Facilities-Complaints.aspx (Neb. Rev. Stat. § 71-8505; 471 NAC § 1-006.05)
New Hampshire — The telehealth provider may forward your records to your primary care or treating provider. (N.H. Rev. Stat. § 329:1-d)
New Jersey — You can request a copy of your medical information; your information may be sent directly to your primary care provider or, at your request, to other providers. (N.J. Stat. § 45:1-62)
Ohio — The telehealth provider may forward your records to your primary care or treating provider. (Ohio Admin. Code 4731-11-09(C))
Oklahoma — Medical Board complaints: http://www.okmedicalboard.org/complaint
Board of Osteopathic Examiners: https://secure.okmedicalboard.org/complaint/
Rhode Island — If you use email or text to communicate with your provider, you understand permitted transmission types, when to use alternatives, and related security measures and risks. Non-compliance can result in termination of the relationship. (Rhode Island Medical Board Guidelines)
South Carolina — Your medical records can be distributed to other treating practitioners as allowed by law. (S.C. Code Ann. § 40-47-37)
South Dakota — You received disclosures about delivery models, methods, and limits, and discussed diagnosis, evidence basis, and risks/benefits of options. (S.D. Codified Laws § 34-52-3)
Texas — Your records may be sent to your primary care physician. Notice concerning complaints: Texas Medical Board, Investigations, P.O. Box 2018, MC-263, Austin, TX 78768-2018, 1-800-201-9353, www.tmb.state.tx.us.
Aviso sobre las quejas: mismo contacto y teléfono 1-800-201-9353, www.tmb.state.tx.us. (Tex. Occ. Code § 111.005)
Utah — You understand any additional fees for telehealth, disclosure recipients and purposes, your rights regarding health information, appropriate use and limits of the site, and that services meet industry security and privacy standards. You were warned about privacy risks and potential technical failures and agree to hold the provider harmless for such loss. You can choose your provider and pharmacy where possible, access and amend your information, contact your provider for follow-up, obtain records, and request record transfer. (Utah Admin. Code r.156-1-603)
Virginia — You received details on security measures and potential privacy risks; you agree to hold the Hoopcare Affiliated Practices harmless for information lost due to technical failures; you consent to forwarding identifiable information to a third party. (VA Board of Medicine Guidance 85-12)
Vermont — You may refuse services delivered by store-and-forward means and request real-time telehealth instead. To file a complaint:
Medical Practice Board: http://www.healthvermont.gov/health-professionals-systems/board-medical-practice/file-complaint
Board of Osteopathic Examiners: https://governor.vermont.gov/boards_and_commissions/osteopathic_physicians_surgeons
Hoopcare Medical of Florida, P.A.
Email: support@hoopcare.com
Web: app.hoopcare.com
