Telehealth Consultation Informed Consent

Telehealth Consultation Informed Consent

Peers.net by Flourish Labs, 530 Divisadero St #108, San Francisco, CA 94117

Last updated: December 2, 2024

Carefully read the Flourish Labs, Inc. (“Flourish Labs,” “we,” “us,” and “our”) Consent for Telehealth Consultation below. 

Flourish Labs runs the Peers.net website (“Website“) and telehealth platform so you can access our peer support services (“Services“). All peer support services are provided by trained Peer Support Specialists who are overseen by a licensed clinician practicing within independently owned and operated professional practices. In California, this is known as “Divisadero Health Services of California, P.C.” In New Jersey, this is known as Divisadero Health Services of New Jersey, P.C.” In all other states, this is known as “Divisadero Health Services, P.A.” (collectively known as “Divisadero Health“).

Divisadero Health is an independent professional entity that provides support services to clients through the use of peer support specialists and other service providers (each, a “Provider”) to provide online peer support, telehealth consultations, and/or care. Flourish Labs, Inc. does not itself provide any peer support services.

Telehealth involves the use of secure electronic communications, information technology, or other means to enable a Provider and a client who are at different locations, to communicate and share individual client health information for the purpose of rendering care.  

This “Consent for Telehealth Consultation” informs you (“client,” “you,” or “your”) concerning the treatment methods and actions, risks, and limitations of using the telehealth platform offered by Divisadero Health. 

Services provided

Telehealth services offered by Divisadero Health, its peer support providers (each a “Provider”) may include client consultations, peer support, and / or a referral to crisis response, in-person care and other services by third parties, as determined to be appropriate.

Flourish Labs does not provide the Services; it performs administrative, payment, and other supportive activities for Divisadero Health and its Providers.

Electronic transmissions

The types of electronic transmissions that may occur using the Website and telehealth platform include, but are not limited to:

• Appointment scheduling (including re-scheduling and cancellations); 
• Completion, exchange, and review of  intake forms and other relevant information (for example: support session records) between you and your Provider via asynchronous communications and/or two-way interactive audio and video interaction;
• Session recording and/or transcribing within HIPAA-compliant partner platforms for documentation and quality assurance purposes;
• Other electronic transmissions for the purpose of rendering peer support services to you.

Expected benefits

• Improved access to care and peer support services by enabling you to remain in your preferred location while your Provider interacts with you.  
• More efficient care and service evaluation and management.

Service limitations

• The primary difference between telehealth and direct in-person service delivery is the inability to have direct, physical contact with you.  Accordingly, some clinical or peer support services needs may not be appropriate for a telehealth visit and your Provider and/or Peer Support Specialist will make that determination.
• OUR PROVIDERS DO NOT ADDRESS MEDICAL EMERGENCIES. IF YOU ARE EXPERIENCING A MENTAL HEALTH CRISIS, CALL OR TEXT 988. IF YOU BELIEVE YOU ARE EXPERIENCING A MEDICAL EMERGENCY, YOU SHOULD DIAL 911 AND/OR GO TO THE NEAREST EMERGENCY ROOM.  PLEASE DO NOT ATTEMPT TO CONTACT FLOURISH LABS, INC., DIVISADERO HEALTH, OR YOUR PROVIDER.  AFTER RECEIVING EMERGENCY HEALTHCARE TREATMENT, YOU SHOULD VISIT YOUR LOCAL PRIMARY CARE PROVIDER.
• Our Providers are an addition to, and not a replacement for, your local primary care provider.  Responsibility for your overall medical care should remain with your local primary care provider, if you have one, and we strongly encourage you to locate one if you do not.
• Divisadero Health does not have any in-person clinic locations but on some occasions we may refer clients to local clinics run by third parties if in-person care is desired.

Security measures

The electronic communication systems we use will incorporate network and software security protocols to protect the confidentiality of client identification and imaging data and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption.  All the Services delivered to you through telehealth will be delivered over a secure connection that complies with the requirements of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).

Possible risks

• Delays in evaluation, care, and peer support services could occur due to deficiencies or failures of the equipment and technologies, or provider availability.
• In the event of an inability to communicate as a result of a technological or equipment failure, please contact Divisadero Health at hello@flourishlabs.com.
• In rare events, your Provider may determine that the transmitted information is of inadequate quality, thus necessitating a rescheduled telehealth consult.
• In very rare events, security protocols could fail, causing a breach of privacy of personal information.

Client acknowledgements

You further acknowledge and understand the following:

• Prior to receiving Services from Divisadero Health, you have been given an opportunity to select a Provider as applicable, including a review of the Provider’s credentials and experience, or you have elected to receive care from the next available Provider, and have been provided with your Provider’s credentials and experience on their profile page.
• You understand that you may be asked to provide your identification and confirm your physical location prior to or during your interaction with a Provider.
• If you are experiencing a mental health emergency, you will text or call 988. If you are experiencing a medical emergency, you will call 911 immediately
• You may elect to seek services from a medical group with in-person clinics as an alternative to receiving telehealth services from Divisadero Health.
• You have the right to withhold or withdraw your consent to the use of telehealth in the course of your interaction with Divisadero Health at any time without affecting your right to future receipt of Services
• Federal and state law requires health care providers to protect the privacy and the security of health information.  You are entitled to all confidentiality protections under applicable federal and state laws and you understand that your health information is part of the health record.  
• Divisadero Health will take steps to make sure that your health information is not seen by anyone who should not see it. Telehealth may involve electronic communication of your personal health information to other health practitioners who may be located in other areas, including out of state. You consent to Divisadero Health using and disclosing your health information for purposes of your treatment and care coordination, to receive reimbursement for the services provided to you, and for Divisadero Health’s health care operations.
• Dissemination of any client-identifiable images or information from the telehealth visit to researchers or other educational entities will not occur without your consent unless authorized by state or federal law.
• There is a risk of technical failures during the telehealth visit beyond the control of Divisadero Health.  
• Persons may be present during the telehealth visit other than your Provider, who will be participating in, observing, or listening to your consultation with your Provider (e.g., as a part of transition of care, in order to operate the telehealth technologies). If another person is present during the telehealth visit, you will be informed of the individual’s presence and his/her role.
• You understand that by creating a treatment plan for you, your Provider has reviewed your health history and clinical information and, in your Provider’s professional assessment, has made the determination that the Provider is able to meet the same standard of care as if the health care services were provided in-person when using the selected telehealth technologies, including but not limited to, asynchronous store-and-forward technology.
• You have the right to request a copy of your health records.  You can request to obtain or send a copy of your health records to your primary care or other designated health care provider by contacting Divisadero Health at hello@flourishlabs.com or by sending a message through your account at peers.net/account/. A copy will be provided to you at a reasonable cost of preparation, shipping and delivery.  
• When receiving any Services from a Provider with Divisadero Health, you understand it is necessary to provide your Provider a complete, accurate, and current health history as deemed necessary to provide safe and effective peer support.  When interacting with your Peer Supporter, you understand it is necessary to be honest with them, as well.  You understand that you can log into your “Portal” at peers.net/account/ at any time to access, amend, or review your health information.
• There is no guarantee that you will be receiving care from a Divisadero Health Provider. Your Provider reserves the right to deny care for potential misuse of the Services or for any other reason if, in the professional judgment of your Provider, the provision of the Services is not clinically or ethically appropriate. 

Additional state-specific consents

The following consents apply to clients accessing Divisadero Health’s website (Peers.net) for the purposes of participating in a telehealth consultation as required by the states listed below:

Alaska

You have been informed that if you want to register a formal complaint about a provider, you should visit the medical board’s website, here.

California

You have been informed of the following notice: 

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.

Iowa

You have been informed that if you want to register a formal complaint about a provider, you should visit the medical board’s website, here.

Idaho

You have been informed that if you want to register a formal complaint about a provider, you should visit the medical board’s website, here.

Indiana

You have been informed that if you want to register a formal complaint about a provider, you should visit the medical board’s website, here.

Kentucky

You have been informed that if you want to register a formal complaint about a provider, you should visit the medical board’s website, here.

Maine

You have been informed that if you want to register a formal complaint about a provider, you should visit the medical board’s website, here; Or, the Maine Board of Osteopathic Licensure’s website, here.

Oklahoma

You have been informed that if you want to register a formal complaint about a provider, you should visit the medical board’s website, here; Or, the Oklahoma Board of Osteopathic Examiners’ website, here.

Oregon

You have been informed that if you want to register a formal complaint about a provider, you should visit the medical board’s website, here.

Rhode Island

You have been informed that if you want to register a formal complaint about a provider, you should visit the medical board’s website, here.

Texas

You 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 http://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 http://www.tmb.state.tx.us  

Vermont

You have been informed that if you want to register a formal complaint about a provider, you should visit the medical board’s website, here; Or, the Vermont Board of Osteopathic Examiners’ website, here.

Revisions to this notice

We reserve the right to revise this Notice and to make the revised Notice effective for protected health information we already have about you as well as any information we receive in the future.  You are entitled to a copy of the Notice currently in effect.  Any significant changes to this Notice will be posted on our website.  

Breach of health information

We will notify you if a breach of your unsecured protected health information is discovered.  Notification will be made to you no later than 60 days from the breach discovery and will include a brief description of how the breach occurred, the protected health information involved and contact information for you to ask questions.

Complaints

Complaints about this Notice or how we handle your protected health information should be directed to our HIPAA Privacy Officer.  You may also submit a formal complaint to the Department of Health and Human Services, Office for Civil Rights.  We will not retaliate against you for filing a complaint.

We must follow the duties and privacy practices described in this Notice.  If you have any questions about this Notice, please contact us at hello@flourishlabs.com.