Telehealth involves the use of electronic communications to enable healthcare providers at different locations to share individual patient medical information to improve patient care.

Telehealth services are offered by third-party professionals who have agreed to work with Samson, Inc. dba Samson (“Samson”). Such services may include chart review, remote prescribing, appointment scheduling, health information sharing, and non-clinical services, such as patient education. The information you provide may be used for diagnosis, therapy, follow-up, and/or patient education, and may include any combination of the following: (1) health records and test results; (2) images and asynchronous communications; (3) live two-way audio and video; (4) interactive audio with store and forward; and (5) output data from medical devices and sound and video files. The electronic communication systems we use will incorporate network and software security protocols to protect the confidentiality of patient identification and imaging data and will include measures to safeguard the data and ensure its integrity against intentional or unintentional corruption.

The providers who provide care in association with Samson, Inc. dba Samson are in 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.

Expected Benefits:

• Improved access to care by enabling you to remain in your home while the provider consults and obtains test results at distant/other sites

• Obtaining the expertise of a specialist as appropriate

Possible Risks:

• Delays in evaluation and treatment could occur due to deficiencies or failures of the equipment and technologies.

• In rare events, our provider may determine that the transmitted information is of inadequate quality, thus necessitating a rescheduled telehealth consult or a meeting with your local primary care doctor.

• In very rare events, security protocols could fail, causing a breach of the privacy of personal medical information.

• In rare events, a lack of access to complete medical records may result in adverse drug interactions, allergic reactions, or other judgment errors.

If you need follow-up care, assistance in the event of an adverse reaction to treatment, or experience an inability to communicate as a result of technological or equipment failure, please contact [email protected].

By creating your account, you acknowledge that you understand and agree with the following:

• I hereby consent to receiving Samson’s services via telehealth technologies. I understand that providers associated with Samson offer telehealth-based medical services, but these services do not replace the relationship between me and my primary care doctor. I also understand it is up to the doctor to determine whether my specific clinical needs are appropriate for a telehealth encounter.

• I understand that federal and state law requires healthcare providers to protect the privacy and security of health information. I understand Samson will take steps to ensure that my health information is not seen by unauthorized individuals. I understand telehealth may involve electronic communication of my personal medical information to health practitioners located in other areas, including out of state.

• I understand there is a risk of technical failures during the telehealth encounter beyond the control of Samson. I agree to hold harmless Samson for delays in evaluation or for information lost due to such technical failures.

• I understand that I have the right to withhold or withdraw my consent to use telehealth in my care at any time, without affecting my right to future care or treatment. I understand that I may suspend or terminate the use of telehealth services at any time for any reason. If experiencing a medical emergency, I understand I should dial 9-1-1 immediately, as Samson doctors cannot connect me directly to local emergency services.

• I understand alternatives to telehealth consultation, such as in-person services, are available. In participating in telehealth consultation, I understand some tests may be conducted by individuals at my location or at a testing facility at the direction of the providers (e.g., labs or blood work).

• I understand I may expect anticipated benefits from telehealth use, but no results can be guaranteed or assured.

• I understand my healthcare information may be shared with individuals for scheduling and billing purposes. I understand that other persons may be present during the consultation to operate telehealth technologies, and I will be informed of their presence. I have the right to request: (1) omission of specific sensitive details of my medical history/examination; (2) non-medical personnel to leave the telehealth examination; and/or (3) termination of the consultation at any time.

• I understand I will not be prescribed narcotics for pain, nor is there any guarantee that I will receive a prescription.

• I understand I have the right to request a copy of my medical records at a reasonable cost for preparation, shipping, and delivery.

• Location:Address: 30 N Gould St Ste R
  City: Sheridan
  State: WY
  Zip: 82801
  Country: USA

• Patient location: See registration information.