Informed Consent for Treatment via Telemedicine

Telemedicine services through our site (AlgoRX) are provided by independent medical providers, including Architek Health PLLC and its affiliated providers (Providers). Dr. Jabourian and Architek Health are licensed in all 50 States, with his NPI being 1740691195, California (20A14278), Massachusetts (1019081), Rhode Island (DO01323), and Vermont (162.0000226). Please reach out with any questions regarding other state licensures to support@algorx.ai

By signing this form, you hereby consent to communicate with the Providers through telemedicine and receive diagnostic and treatment services via telemedicine. You further acknowledge the following:

• I understand that telemedicine is the use of electronic information and communication technologies by a healthcare provider to deliver services to an individual when they are located at a different site than the provider; and hereby consent to the Providers providing healthcare services to me via telemedicine.
• I understand that the same standard of care applies to a telemedicine visit as applies to an in-person visit.
• I understand that health care delivery via telehealth is not analogous to an in-person delivery and assessment and that distorted photos, videos, or audio could lead to an incorrect diagnosis or conclusion and that there are potential risks to using telehealth, including interruptions, unauthorized access, and technical difficulties. If it is determined that the method of communication, videoconferencing equipment and/or connection is not adequate, I understand that my healthcare provider or I may discontinue the telemedicine visit and make other arrangements to continue the visit.
• I understand that telehealth is not appropriate for every condition and/or situation.
• I understand that telehealth involves the communication of mental and/or medical information, both orally, in writing, and/or visually, to Providers at other locations. I understand that I will not be physically in the same room as my healthcare provider. I will be notified of and my consent obtained for anyone other than my healthcare provider to be present in the room.
• I understand that my health care information may be shared with other individuals for scheduling and billing purposes.
• I understand that the laws that protect privacy and the confidentiality of medical information also apply to telemedicine.
• I understand that I can only have a telemedicine appointment if I am located in a jurisdiction (i.e., a state) in which my provider is licensed and will inform my provider at least 24 hours in advance if that will not be the case for a scheduled appointment.
• I understand that I have the right to withhold or withdraw my consent to the use of telemedicine in the course of my care at any time. I may revoke my consent orally or in writing at any time by contacting Support@algorx.ai
• By placing your order, I am certifying that I have read or had this form explained to me, have had my questions answered to my satisfaction, and fully understand its contents. I have been offered a copy of this consent form. This document will become part of my medical record.