VIOS PATIENT WAIVER
VIOS PATIENT AGREEMENT
In proceeding with the appointment booking, I acknowledge that:
I am 18yrs or older. If I am below 18yrs old, an adult caregiver will be my chaperone during the session
I will be searching for out of network providers where out of pocket purchasing will be involved, via valid credit card transactions in a third-party payment portal
I have willingly chosen the Provider based on their competencies based on the details provided in webpages linked to www.viosapp.com.
If I am a US resident, I may only select a US Physician based in their specific state licensures, clearly mentioned in their bio page. I may freely choose any international specialist.
If I am based overseas (outside of the United States) I may select any physician based intehir speciality training, regardless of location.
My present health condition is not life threatening, and I am seeking professional guidance for consultation/counselling/remote second opinions. My health condition(s) has been previously diagnosed by a primary care provider and I am under treatment and/or clinical management by the guidelines of my primary provider.
The Provider is an Independent Contractor, tasked with providing video consultations, counselling and remote second opinions. Their credentials, background checks, on boarding training and quality monitoring is the sole responsibility of the capacity of ViOS, Inc.
No prescription will be provided in any form. The Provider may suggest a generic drug name that is commonly used in their practice, in their country. I may use this information to refer back to my local primary provider
I understand that I will be interacting with verified, certified and insured healthcare specialists, who are not liable for litigations for adverse outcomes that is due to my own choices.
No personal health data will be asked nor recorded in the website nor with any affiliated third party service provider. I am obliged to share the name of the patient or caregiver, email address and financial details only to third party API’s that will appear to complete the booking process.
During the video session and/or immediately afterwards, my chosen Provider my take down some handwritten notes pertaining to the information I share during the session. These notes are to aid in decision making and record-keeping. The Provider is not obliged to share the contents of these notes with myself nor any other party unless verbally requested by me.
If I want a photo scan or report of any notes taken during a scheduled video session, I must make a verbal request to the Provider during the session, the Provider will take a photo of any notes pertaining to my interaction and upload the image file via the ZOOM Chat box. If my scheduled time is complete prior to this action, I must book a follow up appointment with the same Provider in order to receive the previous session notes via ZOOM Chat box. No email correspondence will occur for this purpose except with the Company via [email protected]
The handwritten notes will be maintained by the Provider for safe-keeping, analysis and future decision-making pertaining to my care alone, for a duration of 6 months.
The Provider may be asked to discard any notes within 6 months.
My personally identifiable information (i.e. email address) is shared willingly and without coercion. This data may be used for sending invoices and/or marketing materials from ViOS, Inc only.
The data will remain in the database of ViOS, Inc. for a maximum of 6 months before being manually discarded, unless I request for immediate erasure by sending a request via [email protected]
The ZOOM video sessions are fully encrypted. Only my chosen provider and myself will receive the session recording by email only. End user data localisation will be according to the IP address of the Provider and myself.
I must provide an honest recollection of appropriate health information as per request, to the best of my abilities
I shall only share any relevant health records (eg. reports, scans, charts, prescription details) by uploading the image file or PDF in the ZOOM chat box, or provide information via google drive/dropbox shareable link or display any scanned reports with Zoom screen share
The Provider may view my shared data for a duration of 7 days after sharing, after which they are instructed to discard the files from their devices.
Further details may be viewed in the FAQ section: https://viosapp.com/faq/
In depth information on terms and conditions can be found here: https://tinyurl.com/edbvs6hs
I consent to the entirety of this form which will be considered an informed user consent, as I proceed with the appointment booking process.