General Information
Counsel Medical Group, P.A. and its associated medical groups (collectively “Counsel Medical”, “we”, “our” or “us”) provides medical and health services through its engaged physicians and health professionals (the “Providers”) with support from its technology partner, Counsel, Inc. (“Counsel”). This Agreement describes Counsel Medical’s services and clinical programs. It is important for you to read this document and discuss any questions you might have with us.
By using the Services and where applicable, you further certify that you have legal authority to act as guardian or personal representative of all children registered under your account and you consent to the treatment of all minors registered under your account.
Our Services and Technology
When you become a patient of Counsel Medical (a “Member”), you will be given access to Counsel’s website and applications (the “Counsel App”), inclusive of our AI Technology as described in our Terms of Use, and Counsel Medical’s team of Providers. The Counsel App provides you personalized content and interactive resources, services as your hub for information, and connects you to Counsel Medical’s Providers. Counsel Medical provides you with an opportunity to ask personalized questions to our Providers and interact with our AI Technology. The AI Technology is a large language model that allows you to ask questions and receive real-time answers and feedback. You understand that while the AI Technology may provide informational content, it does not intend to provide medical or clinical advice and is not a licensed clinical provider. If you are seeking medical or clinical advice, please reach out to our Providers or your primary care provider. For more information about our use of AI Technology, please refer to the our Terms of Use.
Telehealth Informed Consent - Risks and Benefits
Our Providers will interact with you via telehealth primarily using asynchronous messaging services. They may prescribe you medication or recommend other treatment, as needed. Telehealth is a flexible and convenient way to get health care, but it may not be right for treating certain symptoms or illnesses that need an in-person doctor or urgent care visit. Responsibility for your overall medical care should remain with your primary care provider. If you are having a medical emergency, call 9-1-1 or go to the nearest emergency room.
Telehealth services are convenient and offer better access to health care. However, as with any health service, there are potential risks associated with using technology. These risks include service problems due to technology or internet failures, not having enough information to make health care decisions, rare security errors, and other risks. These risks are inherent to telehealth and you accept the risk of information loss due to technology problems.
The AI Technology is intended to be a helpful tool for education, information, and self-assessment. It is not a substitute for our telehealth services. There are risks associated with use of the AI Technology as described in our Terms of Use.
Payment and Billing
Each bill for all charges must be paid by the date shown on the bill. If you choose to pay your bill using a credit card, you are authorizing us to charge the provided credit card number for the agreed upon services and use your credit card details for future transactions on your account. Your charges will not be refunded in the event that you cannot complete a session due to an interruption in your internet service or other malfunction of your technology.
Lab Ordering
We work with third parties, including Adept Labs, Inc. (dba “Junction”), to order and process labs. In some cases, a telehealth clinician at any one of the following medical groups that work in collaboration with Junction may be involved in your care and in the ordering of labs: Openloop Healthcare Partners, PC, Openloop Healthcare Partners, PC, Openloop Healthcare Partners California, PC, Openloop Healthcare Partners Colorado, PC, Openloop Healthcare Partners New Jersey, PC, Openloop Healthcare Partners Wisconsin SC, Reliant.MD Medical Associates, PLLC, Reliant.MD Medical Associates California, PC, Reliant.MD Medical Associates Colorado, PC, Reliant.MD Medical Associates New Jersey, PC, Reliant.MD Medical Associates Wisconsin, SC, MECNB Physician Services, PC, MECNB Physician Services California, PC, MECNB Physician Services Colorado, PC, MECNB Physician Services New Jersey, PC, and MECNB Physician Services, SC (collectively, the Openloop Medical Groups).
You acknowledge and understand that the risks and benefits of telehealth, as described in this Informed Consent, apply with respect to all care received by the Openloop Medical Groups, and that you may be responsible for payment of any fees associated with telehealth visits performed by the Openloop Medical Groups.
Privacy Practices
We follow certain healthcare privacy and security protocols to protect your health information. We work hard to make sure that your personal information is secure. We use physical, electronic, and business security methods (such as encryption) customary among telehealth providers to help prevent access to your health information by people who should not see it. Despite our best efforts, we cannot promise that data sent over the Internet or through a data storage facility will be perfectly secure. So, although we try to protect your personal information, we cannot guarantee the security of any information you send to us. You can read more information about our use of health information and other personal information in our Notice of Health Information Privacy Policy.
When you use our AI Technology, you consent to allow us to process your Personal Information (including health information) through the AI Technology. If you have any questions about the AI Technology, please contact us at support@counselhealth.com.
Sharing of Health Records with Your Providers and Health Plans
By signing this agreement, you authorize Counsel Medical to share your health records including information relating to genetic tests, mental health, and other health conditions:
● With your PCP and other health care providers, either directly or through our participation in health information exchanges, for healthcare coordination, payment, operations and treatment purposes.
● With other individuals involved in your care such as caregivers or family members.
● With your health plan for payment purposes, if applicable.
● With Counsel, its and our subcontractors as necessary for Counsel Medical to conduct its health care operations including collection and payment.
● As otherwise permitted in our Notice of Health Information Privacy Policy and by applicable law.
By signing this agreement, you acknowledge receipt of the Notice of Health Information Privacy Policy.
Communications
As part of providing services, we may communicate with you, including for purposes such as clinical care, using SMS, MMS, and RCS text messages and emails. Text messages and emails are not always secure because they travel over networks that we do not control. By signing this agreement and providing us your cell phone number and email address, you permit us to contact you by text message and email. You may also ask us to stop sending SMS text messages at any time, by contacting support@counselhealth.com. You understand that you may have to pay standard data and messaging costs (from your wireless provider) to receive SMS text messages that we send to your mobile phone. You can cancel the SMS service at any time by contacting support@counsel.health. If you have any questions about your text plan or data plan, it is best to contact your wireless provider. If you have any questions regarding privacy, please read our Privacy Policy.
Complaint Policy
All Members have the right to communicate grievances regarding their care. Should you wish to make a formal complaint about one of your care providers you may do so in writing and submit the concern to Counsel Medical at support@counselhealth.com.
Additional State-Specific Consents: The following consents apply to Members accessing our website for the purposes of participating in a telehealth consultation as required by the states listed below:
Alaska: I have been informed that if I want to register a formal complaint about a
provider, I should visit the medical board’s website, here.
California: I have been informed of the following notices: 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 at https://openpaymentsdata.cms.gov.
NOTICE TO PATIENTS Medical doctors are licensed and regulated by the Medical
Board of California. To check up on a license or to file a complaint here, email:
licensecheck@mbc.ca.gov, or call (800) 633-2322.
Iowa: I have been informed that if I want to register a formal complaint about a provider,
I should visit the medical board’s website, here.
Indiana: I have been informed that if I want to register a formal complaint about a
provider, I should visit the medical board’s website, here.
Kentucky: I have been informed that if I want to register a formal complaint about a
provider, I should visit the medical board’s website, here (or, alternatively, by accessing
this URL in my browser: kbml.ky.gov/grievances/Pages/default.aspx).
Maine: I have been informed that if I want to register a formal complaint about a
provider, I should visit the medical board’s website, here; Or, the Maine Board of
Osteopathic Licensure’s website, here.
New York: I have been informed that to get information regarding your rights and how to
report professional misconduct, I should visit medical board’s website, here.
New York and New Jersey: I have the right under my state's patient billing laws to request
an itemized price list from Counsel Health for their laboratory tests.
Oregon: I have been informed that if I want to register a formal complaint about a
provider, I should visit the medical board’s website, here.
Rhode Island: I have been informed that if I want to register a formal complaint about a
provider, I should visit the medical board’s website, here.
Texas: I have been informed of the following notice:
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.
Vermont: I have been informed that if I want to register a formal complaint about a
provider, I should visit the medical board’s website, here; Or, the Vermont Board of
Osteopathic Examiners’ website, here. I understand that I may be presented with the
option to receive services in person, through telehealth, or by audio-only telephone, to
the extent clinically appropriate. In the event I receive services by using audio-only
telephone, it will be my choice to do so, but I am not prevented from receiving services in
person or through telehealth at a later date. Opportunities and limitations of delivering
and receiving health care services using audio-only telephone include: convenience and
access to care from any location with phone service, but can also reduce the amount of
information that is available to my Provider (e.g., such as the availability of medical
images, clinical records, etc). If Counsel Medical is enrolled with my health insurance
plan, the services delivered by audio-only telephone will be billed to my health insurance
plan, if appropriate. In the event the audio-only services are billed to my health insurance
plan, I acknowledge I am financially responsible for any applicable co-payments,
coinsurance, and deductibles, and I understand that not all audio-only health care
services are covered by all health plans.
Wyoming: I have been informed that if I want to register a formal complaint about a
provider, I should visit the medical board’s website, here.
