TELYRX
Consent to Telehealth
Effective Date: February 24, 2025
TelyRx ("TelyRx," "we," "our," or "us") provides websites, applications, and/or services (collectively, the "TelyRx Services") that enable online visits with independent, licensed health care professionals (each a "Provider"). The TelyRx Services facilitate the provision of Telemedicine Services to Patients through the TelyRx Website. Telemedicine Services include virtual consultations, diagnosis, and the prescribing of medications by licensed Providers when clinically appropriate.
Definitions
(a) “Patients” or “Customers” shall mean prospective and returning customers of TelyRx.
(b) “Practice” refers to an independent medical group that provides Telemedicine Services through the TelyRx Website.
(c) “Providers” mean licensed and credentialed prescribers who have contracted with or are employed by the Practice and who are made available for Telemedicine Services through the TelyRx Website.
(d) “Telemedicine Services” means a telehealth encounter and/or the prescribing of prescription drugs when appropriate by a Practice’s Provider to Patients as a result of a telehealth encounter.
(e) “TelyRx Services” means the provision of Telemedicine Services through the TelyRx Website.
(f) “TelyRx Website” means a website and the related platform which facilitates the provision of TelyRx Services.
Telemedicine Services Providers
Telemedicine Services provided through the TelyRx Website are conducted by the following independent medical group Practice’s and their Providers:
- Professional Health Care of Pinellas, LLC
- First Medical Imaging, P.A., Inc.
- NA Medical NJ LLC
- Alpine Woods Medical, PLLC
- Siloam Medical LLC
- Community MD Partners, LLC
- J Mix DO LLC
- Dr. Phillip Omega LLC
- ASM, LLC dba Preventive Medical Care
- James Doghramji MD, LLC
- Adnan Dahdul, MD, PC
- Worley Telemedicine, LLC
- MB Consultants USA LLC
- North Boulder Dental
These independent medical groups and their providers are solely responsible for delivering Telemedicine Services, including virtual consultations, medical evaluations, and prescriptions, using their unfettered professional discretion in compliance with applicable standards of care, federal and state laws and regulations. Each Provider operates independently and is not an employee or agent of TelyRx. TelyRx does not practice medicine but acts solely as a facilitator for the provision of Telemedicine Services.
These Telemedicine Services constitute telehealth, a form of health care delivery using electronic communication between a patient and a Provider who are not in the same physical location. Telehealth may include, but is not limited to:
· Electronic transmission of medical records, images, personal health information, and other data.
· Virtual synchronous consultations via audio, video, and/or asynchronous communication (such as secure messaging and email).
· Use of remote monitoring devices, medical equipment, and video/audio files.
TelyRx employs industry-standard security protocols to protect the privacy, security, and integrity of your health information when using the TelyRx Services.
POTENTIAL BENEFITS OF TELEHEALTH
· Convenient access to medical care from the comfort of your home.
· Reduced costs compared to in-office visits.
· Increased flexibility in scheduling medical consultations.
· Access to Providers regardless of your geographic location.
POSSIBLE LIMITATIONS & RISKS OF TELEHEALTH
While telehealth offers advantages, it has limitations:
· Insufficient Information for Diagnosis – Your Provider may lack sufficient data to make a complete medical decision, requiring an in-person evaluation.
· Limited Physical Examination – Certain assessments, tests, or vital sign monitoring may be unavailable through telehealth.
· Technology Risks – Interruptions due to network failures, software malfunctions, or device errors may disrupt or delay medical care.
· Data Privacy Risks – Despite security measures, electronic data transmission carries a risk of unauthorized access or breaches.
· State-Specific Restrictions – Certain treatments, prescriptions, and medical advice may be restricted or unavailable in some states.
STATE-SPECIFIC DISCLOSURES
Telehealth is subject to different state laws. By using TelyRx Services, you acknowledge and understand the following state-specific telehealth regulations:
California (Cal. Bus. & Prof. Code § 2290.5)
· You must provide verbal or written consent before any telehealth consultation.
· You have the right to in-person services upon request, subject to availability.
· I have been informed of the following notice:
o 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.
Texas (Tex. Occ. Code § 111.005)
· A telehealth visit must meet the same standard of care as an in-person visit.
· Texas law prohibits certain prescriptions from being issued via telehealth without an in-person evaluation.
· I have been informed of the following notice:
o 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.
o 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.
Florida (Fla. Stat. § 456.47)
· Telehealth Providers must be licensed in Florida to provide services.
· Controlled substances cannot be prescribed via telehealth for chronic pain management.
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, https://medicalboard.iowa.gov/consumers/filing-complaint.
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, https://www.in.gov/health/ltc/aide-training-and-certification/cna/report-a-complaint-or-incident/
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, https://www.maine.gov/md/complaint/file-complaint; Or, the Maine Board of Osteopathic Licensure’s website, https://www.maine.gov/osteo/contact.
New York (N.Y. Pub. Health Law § 2999-cc)
· Telehealth Providers must maintain patient confidentiality under HIPAA regulations.
· You have the right to access your telehealth visit records.
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, chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.oregon.gov/omb/OMBForms1/complaint-form.pdf
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, https://health.ri.gov/licensing/submit-complaint
If you reside in a different state, additional telehealth restrictions may apply. You should check with your state’s medical board for more details.
PATIENT CONSENT & LEGAL ACKNOWLEDGMENT
By accepting this Consent to Telehealth, you agree and acknowledge:
1. I have read and understood this Consent to Telehealth, including potential risks and benefits.
2. I voluntarily consent to receive medical care via Telemedicine Services from independent Providers affiliated with TelyRx.
3. I understand that telehealth is an evolving field, and its applications may extend beyond what is described in this consent.
4. I acknowledge that telehealth does not guarantee specific results, and my condition may remain unchanged or worsen despite treatment.
5. I am responsible for ensuring that the attestation I provide under oath is accurate, complete, and fully covers all information I know to be relevant to my prescription request, my medical history and current condition. I also confirm that any additional information I provide to a Provider, via secure texting, phone, audio, video, or pictorially, about my medical history and current condition will be truthful, accurate, and complete.
6. I understand that certifying to or providing false, misleading, or incomplete health information may result in incorrect treatment, delayed care, or harm.
7. I acknowledge that my Provider may determine that my condition requires in-person care, refuse to prescribe a medication, and/or refer me accordingly.
8. I understand that telehealth does not replace my existing healthcare providers, and I am encouraged and directed to maintain care with them and visit with them immediately after receiving Telemedicine Services.
9. I understand that neither TelyRx nor the Practices or Providers provide emergency medical care. If I experience a medical emergency, I will call 911 and/or seek immediate in-person assistance.
10. I understand how my health information will be collected, used, and protected in accordance with the TelyRx Privacy Policy.
11. I have access to my telehealth records in compliance with applicable laws. These records can be accessed through my account on TelyRx.com. Additionally, my telehealth records can be requested at [email protected].
12. I understand that my telehealth records will only be shared with TelyRx and Practices. I may request record transfers by contacting [email protected].
13. I acknowledge that technical failures may cause loss of data or service interruptions. I agree to hold TelyRx, its subsidiaries, and my Provider harmless for any resulting delays or issues.
14. I may withdraw my consent at any time by emailing [email protected] with a written request to discontinue telehealth services.
15. I authorize TelyRx and my Providers to collect, use, and share my health information for treatment, payment, and healthcare operations, as permitted by law.
16. I acknowledge receipt of the California Open Payments Database notice: The Open Payments Database is a federal tool for researching payments made by drug and medical device companies to physicians and hospitals. It is available at [https://openpaymentsdata.cms.gov](https://openpaymentsdata.cms.gov).
17. I acknowledge there is no guarantee that I will be issued a prescription and that the decision of whether a prescription is appropriate will be made solely in the professional judgment of my Provider.
18. I acknowledge that I will be treated by a Provider licensed in my state. My Provider reserves the right to deny care for potential misuse of the Services or for any other reason if, in the professional judgment of my Provider, the provision of the Services is not medically or ethically appropriate.
19. I acknowledge that there is a risk of technical failures during the telehealth visit beyond the control of TelyRx and my Provider and will hold the Provider and TelyRx harmless for such loss.
LIMITATION OF LIABILITY & DISCLAIMERS
1. No Warranty of Service – TelyRx makes no representations or warranties, express or implied, regarding the availability, reliability, accuracy, or uninterrupted operation of the telehealth services. The Services are provided on an “as-is” and “as-available” basis, and TelyRx expressly disclaims any warranties of merchantability, fitness for a particular purpose, non-infringement, or any warranties arising from course of dealing or usage of trade. TelyRx shall not be liable for any interruptions, errors, delays, or deficiencies in the Services, including but not limited to technical failures, system outages, security breaches, or unauthorized access to personal health information.
2. No Provider-Patient Relationship with TelyRx – TelyRx is not a licensed medical provider or health care facility and does not engage in the practice of medicine or nursing. The independent, licensed health care Providers who deliver telehealth consultations via the Services are not employees, agents, or representatives of TelyRx. As such, any medical advice, diagnosis, prescriptions, or treatment recommendations provided through the Services are solely the responsibility of the independent Provider, and TelyRx assumes no liability for any medical decisions, treatment plans, prescriptions, or clinical outcomes arising from a Provider’s care.
3. Prescription Restrictions – The availability of prescription medications through telehealth is subject to applicable state and federal laws, regulations, and medical guidelines. Certain medications, including but not limited to controlled substances and compounded medications are unavailable via TelyRx. TelyRx cannot and does not guarantee that any prescription will be issued to a patient following a telehealth consultation, and all prescribing decisions are at the sole discretion of the independent Provider.
4. Informed Consent & Assumption of Risk – By accessing or using the TelyRx Services, you expressly acknowledge and agree that:
· You have been provided with information regarding the risks, limitations, and benefits of telehealth and have been given an opportunity to ask questions.
· You voluntarily consent to receive health care services via telehealth.
· You understand that telehealth does not replace in-person medical evaluations and that certain conditions may require in-person examination, diagnostic testing, or treatment.
· You assume all risks associated with the use of telehealth, including but not limited to technological failures, security breaches, limitations in physical assessments, delays in care, and the unavailability of certain treatments or prescriptions.
5. Limitation of Liability – To the fullest extent permitted by applicable law, TelyRx, its affiliates, subsidiaries, officers, directors, employees, contractors, and agents shall not be liable for any direct, indirect, incidental, consequential, special, exemplary, or punitive damages, including but not limited to lost profits, loss of data, or personal injury, arising out of or in connection with (i) your use of or inability to use the Services; (ii) any Provider’s medical advice, treatment, or failure to provide care; (iii) any prescription decision or medication availability; (iv) any telehealth limitations, system failures, or security breaches; or (v) any other matter relating to the Services. In jurisdictions that do not allow the exclusion or limitation of certain liabilities, TelyRx’s liability shall be limited to the maximum extent permitted by law.
6. Emergency Medical Care Disclaimer – Neither TelyRx nor the Practices or their Providers provide emergency medical care. If you are experiencing a medical emergency, you must call 911 or seek immediate in-person medical assistance. The Services are not a substitute for emergency or urgent care, and TelyRx bears no responsibility for any delays or adverse health outcomes resulting from failure to seek emergency medical attention.
By using the TelyRx Services, you agree that you understand and accept these limitations of liability and disclaimers, and that your continued use of the TelyRx Services constitutes your legally binding agreement to these terms.
Patient Informed Consent
I acknowledge that I have carefully read, understand, and agree to the terms of this “TELEHEALTH INFORMED CONSENT” and consent to receive the TelyRx Services.
For questions about this Consent to Telehealth, please contact:
Email: [email protected]
Mailing Address:
TelyRx
24761 US Hwy 19N
Clearwater, FL 33763