Remote Patient Monitoring (RPM) Informed Consent

Ramona Health Inc

Introduction

Remote Patient Monitoring (RPM) involves the use of electronic communications and devices that automatically record data to enable healthcare providers at different locations to monitor physiologic metrics and share individual patient medical information for the purpose of managing patient care. This document informs you about the rights, risks, and benefits associated with RPM services provided by Ramona Health Inc (the "Company").

Services Provided

RPM services offered by the Company may monitor a variety of physiologic metrics, including, but not limited to:

  • Blood pressure (systolic and diastolic)
  • Heart rate
  • Glucose levels (pre and post meal)
  • Exercise
  • Weight
  • Steps walked
  • Sleep quantity and quality

These RPM services are an addition to, and not a replacement for, your primary care physician. Responsibility for your overall medical care should remain with your local primary care doctor, if you have one, and we strongly encourage you to locate one if you do not.

Electronic Systems

The electronic monitoring systems we use will incorporate network and software security protocols to protect the confidentiality of patient identification and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption.

Benefits of RPM

Expected benefits of RPM services include:

  • Improved access to care by enabling you to remain in your home while a clinical care team obtains results at distant/other sites.
  • More efficient care evaluation and management.

Risks and Limitations

Possible risks and limitations of RPM services include:

  • Delays in evaluation and treatment could occur due to deficiencies or failures of the equipment and technologies.
  • In rare events, your provider may determine that the transmitted information is of inadequate quality, thus necessitating an in-person meeting with your local primary care doctor.
  • In very rare events, security protocols could fail, causing a breach of privacy of personal medical information.

Consent to RPM Services

By agreeing to this Informed Consent, you acknowledge that you understand and agree with the following:

  1. I hereby consent to receiving RPM services. I understand that the RPM services are provided in connection with my current treatment plan with the Company.

  2. I understand that federal and state law requires health care providers to protect the privacy and the security of health information. I understand that the Company will take steps to make sure that my health information is not seen by anyone who should not see it, in accordance with the Company's standard practices.

  3. I understand that RPM services may involve electronic communication or monitoring of my personal medical information to or by other health practitioners or clinical staff who may be located in other areas, including out of state.

  4. I understand there is a risk of technical failures during the RPM services beyond the control of the Company. I agree to hold harmless the Company for delays in evaluation or for information lost due to such technical failures.

  5. I understand that I have the right to withhold or withdraw my consent to RPM in the course of my care at any time, without affecting my right to future care or treatment. I understand that I may suspend or terminate use of the RPM services at any time for any reason or for no reason.

  6. I understand that if I am experiencing a medical emergency, that I will be directed to dial 9-1-1 immediately and that the Company or the Company's clinical staff are not able to connect me directly to any local emergency services.

  7. I understand that I may expect the anticipated benefits from the use of RPM in my care, but that no results can be guaranteed or assured.

  8. I understand that my healthcare information may be shared with other individuals for scheduling and billing purposes. Persons may be present during the consultation other than the Company in order to operate the RPM technologies. I further understand that I will be informed of their presence in the consultation and thus will have the right to request the following: (1) omit specific details of my medical history/examination that are personally sensitive to me; (2) ask non-medical personnel to leave the consultation; and/or (3) terminate the consultation at any time.

  9. I understand that if I need to receive follow-up care, assistance in the event of an inability to communicate as a result of a technological or equipment failure, I should contact my local physician.

By checking the box associated with "RPM INFORMED CONSENT", I acknowledge that I understand and agree with the following:

  • I certify that I have read and fully understand the above consent for RPM services, including the nature of the service, the benefits, and the risks.
  • I have had the opportunity to ask questions, and all my questions have been answered to my satisfaction.
  • I hereby give my informed consent to participate in RPM services under the terms described herein.

Ramona Health Inc · Oakland, CA · hiramona.com