Telemedicine Consent
Today you are requesting Abortion on Demand’s telemedicine services (“Services”). Telemedicine is the practice of medicine that involves the use of electronic communications to diagnose or treat patients who are in different locations than their healthcare providers. When using these Services you will be treated by and enter into a patient-physician relationship with a physician licensed in your state.
The expected benefits of using telemedicine for your abortion care include:
- Improved and quicker access to medical care through reduced travel and visit time.
- Ability to access care from any location in your state, provided it is a state in which Services are offered.
- More efficient medical evaluation and management.
The potential limitations associated with using telemedicine for abortion care include:
- Delays in medical evaluation and treatment due to failures in technology, such as power outages and disconnected internet.
- Information may be lost due to technical failures.
- Despite reasonable precautions, unauthorized persons could interrupt the transmission or electronic storage of your medical information.
- In rare cases, a lack of access to complete medical information may result in adverse drug interactions, allergic reactions, or other complications including undiagnosed or delayed diagnosis of ectopic pregnancy and maternal alloimmunization.
The inability to have direct, physical contact with your healthcare provider is the primary difference between telemedicine and in-person health care. The alternative to telemedicine is receiving care in a traditional in-person care setting. Traditional in-person care for abortion may include ultrasound diagnosis for confirming gestational age, confirming pregnancy location and to rule out ectopic pregnancy; laboratory testing as indicated, and the option for surgical management of your abortion.
Abortion on Demand uses the services of American Mail Order Pharmacy for dispensing medications. You may opt to use a different pharmacy of your choosing for medications other than mifepristone by notifying the physician during your appointment. Whereas American Mail Order Pharmacy exclusively manages, stores, and ships mifepristone on behalf of the physician, another pharmacy cannot be used for shipping mifepristone.
In receiving the telemedicine Services, you understand and agree:
1) It is necessary for you to provide complete and accurate medical history. Providing inaccurate history can result in serious complications.
2) You cannot use our telemedicine Services for care beyond the scope of first-trimester medication abortion. We do not offer prescriptions for DEA controlled substances.
3) You cannot use telemedicine Services for life-threatening emergencies. If you think you are experiencing a medical emergency, you need to call 911 or go immediately to the closest emergency room.
4) There is no guarantee that you will be treated by a physician. The physician reserves the right to deny care for potential misuse of Services or for any other reason if, in the professional judgment of the physician, the provision of the services is not medically or ethically appropriate.
5) You understand that a variety of alternative methods of medical care may be available to you and that you may choose one or more of these at any time. These include in-person medication abortion, surgical abortion, parenting, or adoption.
6) You understand that you have the right to withhold or withdraw your consent to the use of telemedicine in the course of your care at any time, without affecting your right to future care or treatment.
7) You have the right to receive medication counseling from a pharmacist directly, and you may notify the physician during your visit if you wish to exercise this right.
8) You may be required to provide full payment at the time you schedule a visit. You will be refunded your entire payment should your attended appointment not result in a medication prescribed to you. Should you not attend your appointment or cancel less than 24 hours before your scheduled appointment, all but a $50 administrative fee will be refunded. You understand that other payment models for abortion care are available including health insurance, but that these options are beyond the scope of this Service.
9) You consent to use text and personal email to communicate about your medical care with Abortion on Demand and your physician. SMS and data charges may apply, depending on your carrier. You may contact orders@abortionondemand.org to opt-out of SMS notifications. Email sent from Abortion on Demand is encrypted to meet federal privacy standards. You understand that by using personal email, it is your responsibility to ensure privacy as the receiver.
Your use of this service is voluntary and you have the right to withdraw your consent to the services at any time. If you choose to end your session or cancel your appointment, your right to future telemedicine Services will not be affected. Information collected and stored in the medical record may be used in the future for quality improvement or other research purposes. All information will be anonymous; your personal information will not be used or shared.
By selecting "NEXT" below, I hereby give my informed consent to participate in the use of telemedicine Services under the terms described herein.
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