Telehealth Informed Consent
Effective September 2026
Telehealth involves the use of secure electronic communications, information technology, or other means to enable a healthcare provider and patient at different locations to communicate and share individual patient health information for clinical care. This Telehealth Informed Consent informs you about the treatment methods, risks, and limitations of using a telehealth platform.
Services Provided
Telehealth services offered by Logos Care, P.C. (“Group”) and the Group’s engaged providers may include a patient consultation, diagnosis, treatment recommendation, prescription, and/or referral to in-person care, as clinically appropriate. BIOS Life, Inc. does not provide these services; it performs administrative, payment, and other supportive activities for Group and its providers.
Electronic Transmissions
Electronic transmissions through the telehealth platform may include appointment scheduling; completion, exchange, and review of medical intake forms and clinically relevant information; asynchronous communications; interactive audio and video interaction; treatment recommendations; consultation reports; prescription refill reminders; and other electronic transmissions used to provide clinical care.
Expected Benefits
Telehealth may improve access to care while you remain in your preferred location, provide convenient access to non-emergent follow-up care, and support more efficient care evaluation and management. Telehealth services are available 8 hours a day, 5 days a week. For non-emergent follow-up care, contact your provider through the mobile application.
Electronic messages and other communications transmitted through telehealth technologies are addressed according to the care team’s applicable response-time practices, including during weekdays, weekends, and holidays.
Communication response times: Provide a description of the uses of and response times for e-mails, electronic messages, and other communications transmitted via telehealth technologies, including applicable weekday, weekend, and holiday response times.
Service Limitations
The primary difference between telehealth and in-person care is the inability to have direct physical contact. Some clinical needs may not be appropriate for telehealth, and your provider will make that determination. Providers do not address medical emergencies. If you believe you are experiencing a medical emergency, dial 9-1-1 or go to the nearest emergency room. Do not attempt to contact BIOS Life, Group, or your provider. Providers supplement—but do not replace—your local primary care provider. Group does not have in-person clinic locations.
Security Measures
Our electronic communication systems use network and software security protocols to protect the confidentiality and integrity of patient identification and imaging data. Services are delivered over a secure connection that complies with HIPAA requirements.
Possible Risks
Delays in evaluation or treatment may occur due to technology, equipment, or provider availability. If technology or equipment prevents communication, contact Group at support@bioslife.ai. In rare cases, transmitted information may be inadequate in quality and require a rescheduled consultation or an in-person meeting with your local primary care doctor. In very rare cases, security protocols could fail and result in a privacy breach.
Patient Acknowledgments
I further acknowledge and understand the following:
1. Before the telehealth visit, I may select an appropriate provider and review that provider’s credentials, or I may elect to visit with the next available provider and receive the provider’s credentials.
2. I may be asked to provide identification and confirm my physical location before or during the telehealth visit. If I experience a medical emergency, I will be directed to dial 9-1-1 immediately; my provider cannot directly connect me to local emergency services.
3. I may seek services from a medical group with in-person clinics as an alternative. I may withhold or withdraw consent to telehealth at any time without affecting my right to future care or treatment.
4. I am entitled to confidentiality protections under applicable federal and state law, and medical reports from a telehealth visit are part of my medical record. Group will take steps to prevent unauthorized access to my health information and may communicate it to other practitioners, including practitioners located out of state, for treatment, care coordination, reimbursement, and health care operations.
5. Patient-identifiable images or information will not be disseminated to researchers or educational entities without my consent unless permitted by law. Technical failures may occur beyond Group’s control, and some services such as laboratory tests may be performed at another location at my provider’s direction.
6. Others may be present during the telehealth visit to participate in, observe, or listen to the consultation, for example to operate the technology. I will be informed of their presence and role. My provider will explain my diagnosis, its evidentiary basis, and the risks and benefits of treatment options.
7. My provider will review my medical history and clinical information and determine whether the same standard of care as an in-person visit can be met using the selected telehealth technology. I may request a copy of my medical records at reasonable cost, and I must provide complete, accurate, and current medical history.
8. There is no guarantee that I will be issued a prescription; prescribing decisions are made in my provider’s professional judgment. If a prescription is issued, I may select my pharmacy. There is no guarantee that I will be treated by a Group provider, who may deny care when services are medically or ethically inappropriate.
9. In choosing to participate in a telehealth visit, I understand that some parts of the Services involving tests, such as labs or bloodwork, may be conducted at another location, including a testing facility, at my provider’s direction.
10. Persons may be present during the telehealth visit other than my provider who will participate in, observe, or listen to my consultation, for example to operate the telehealth technologies. If another person is present, I will be informed of the individual’s presence and role.
11. My provider will explain my diagnosis and its evidentiary basis, and the risks and benefits of various treatment options.
12. I understand that by creating a treatment plan for me, my provider has reviewed my medical history and clinical information and, in the provider’s professional assessment, determined that the same standard of care as an in-person visit can be met using the selected telehealth technologies, including asynchronous store-and-forward technology.
13. I have the right to request a copy of my medical records. I may request that a copy be sent to my primary care provider or another designated health care provider by contacting Group. A copy will be provided at reasonable cost of preparation, shipping, and delivery.
14. It is necessary to provide my provider a complete, accurate, and current medical history. I understand that I can log into the Portal at any time to access, amend, or review my health information.
15. There is no guarantee that I will be issued a prescription; the decision of whether a prescription is appropriate will be made in my provider’s professional judgment. If my provider issues a prescription, I have the right to select the pharmacy of my choice.
16. There is no guarantee that I will be treated by a Group provider. My provider may deny care for potential misuse of the Services or for any other reason if, in the provider’s professional judgment, providing Services is not medically or ethically appropriate.
Medical records request details: Patients may request that records be obtained or sent to their primary care provider or another designated provider by contacting Group at the designated contact information or through the applicable portal location. A copy will be provided at reasonable cost of preparation, shipping, and delivery.
Portal access details: Patients can log into the Portal to access, amend, or review their health information. Include the appropriate link or clear instructions for locating the Portal.
17. I understand that my provider reserves the right to deny care for potential misuse of the Services or for any other reason if, in the provider’s professional judgment, the provision of Services is not medically or ethically appropriate.
Additional State-Specific Consents
The following consents apply to patients accessing Group’s website for a telehealth consultation as required by the listed states.
Alaska, Iowa, Indiana, Kentucky, Maine, Oregon, Rhode Island, and Vermont: If you wish to file a formal complaint about a provider, visit the applicable state medical board’s complaint website. California: The Open Payments database is a federal tool for searching payments made by drug and device companies to physicians and teaching hospitals, available at openpaymentsdata.cms.gov.
Texas Notice Concerning Complaints
Complaints about physicians and other licensees or registrants of the Texas Medical Board may be reported to: Texas Medical Board, Attention: Investigations, 1801 Congress Avenue, Suite 9.200, P.O. Box 2018, Austin, Texas 78768-2018. Assistance is available at 1-800-201-9353. More information is available at www.tmb.state.tx.us. Aviso sobre las quejas: Si necesita ayuda para presentar una queja, llame al 1-800-201-9353.
Alaska: commerce.alaska.gov/web/cbpl/ComplaintFAQs.aspx. Iowa: medicalboard.iowa.gov/consumers/filing-complaint. Indiana: in.gov/attorneygeneral/consumer-protection-division. Kentucky: kbml.ky.gov/grievances/Pages/default.aspx. Maine: maine.gov/md/complaint/file-complaint and maine.gov/osteo/contact. Oregon: oregon.gov/omb/OMBForms1/complaint-form.pdf. Rhode Island: health.ri.gov/complaints/. Vermont: healthvermont.gov/health-professionals-systems/board-medical-practice/file-complaint and sos.vermont.gov/opr/complaints-conduct-discipline/.
Vermont Audio-Only Telehealth Notice
Where clinically appropriate, Vermont patients may choose to receive services by audio-only telephone, in person, or through telemedicine. Patients choosing audio-only services are not prevented from receiving services in person or through telemedicine at a later date. If billed to insurance, audio-only services may be billed to the patient’s health plan, and the patient remains responsible for applicable copayments, coinsurance, and deductibles. Not all audio-only health care services are covered by every health plan.
Aviso Sobre Las Quejas
Quejas sobre médicos, así como sobre otros profesionales médicos de la Junta Médica de Texas, incluyendo asistentes médicos profesionales, acupunturistas, asistentes quirúrgicos, tecnólogos médicos en radiología, técnicos radiólogos no certificados, profesionales de cuidados respiratorios, físicos médicos, y perfusionistas se pueden presentar para investigación ante: Texas Medical Board, Attention: Investigations, 1801 Congress Avenue, Suite 9.200, P.O. Box 2018, Austin, Texas 78768-2018. Si necesita ayuda para presentar una queja, llame al 1-800-201-9353. Para obtener más información, visite www.tmb.state.tx.us.
Vermont audio-only requirement: Opportunities and limitations of delivering and receiving health care services using audio-only telephone must be explained in language patients can easily understand. If insurance is billed, disclose that patients are financially responsible for applicable copayments, coinsurance, and deductibles, and that not all audio-only services are covered by all health plans.