Terms and Conditions
Informed Consent for Technology-Assisted Care
I understand that True Mobile Health, LLC (TMH) and its tenants of True Mobile Health are providing to me (or my dependent child) a technology-assisted care support service. I further understand that this service is designed to provide mental health and addiction recovery support that I may be receiving through my healthcare provider or standalone coaching service. The term “Coach” used throughout this agreement may be unique to my provider as a designated peer support specialist, care coordinator, nurse practitioner, counselor, therapist, navigator, etc.
Prior to gaining access to the True Mobile Health (TMH) platform, I consent to the following terms of use:
I understand that I am voluntarily participating in an app-based engagement and communication tool designed to foster personal accountability. This is achieved through personalized coaching and support to help improve and/or sustain my health and well-being.
I hereby consent for my Coach to obtain personal health information to design a personalized app platform that includes: tracking my daily & weekly goals; my journey through GPS mapping; targeted recovery support resources; contact information for my personal support team; and assignment of my Coach so I may communicate confidentially through the TMH app via phone and text messaging.
When applicable, I agree to participate in DNA drug testing protocols to support outcomes and accountability. If this service will be implemented in conjunction with my program, I will be made aware prior to receiving these terms and conditions. TMH Coaches will engage the use of technology which may include video, face time, or skype for contacting me for check-in’s as well as obtaining proof of swab for initial drug testing.
I understand that my Coach is not a physician and does not diagnose illness or disease or any other physical or mental disorder.
I clearly understand that my Coach’s guidance is not a substitute for a medical examination. It is recommended that I attend my personal physician and or mental health professional for any ailments that I may be experiencing.
I acknowledge that no assurance or guarantee has been provided to me as to the results of the using the TMH platform. I will get out of the program what I put it to achieve my personal success.
I acknowledge that with any coaching there can be risks and those risks have been explained to me and I assume those risks.
I acknowledge and understand that my Coach may be aware of my existing medical conditions following a release of information to access my personal electronic health record, if applicable.
I agree to disclose to my Coach all medical conditions affecting me. It is my responsibility to keep my Coach updated on my medical history. The information I have provided during on boarding is true and complete to the best of my knowledge.
I understand that I may refuse or stop participation at any time.
I also understand that my provider may end my program with TMH due to inactivity or noncompliance, engaging in threatening or harassing communication with my Coach, or if it is determined that a higher level of care and/or treatment may be necessary.I understand it may be necessary for my Coach to contact my healthcare provider(s)to coordinate care, to discuss an emergency and/or to share appropriate personal health information. If my Coach may suspect a medical emergency or determine there is a danger to myself or others, a wellness check may be initiated by the Coach.
I authorize my Coach to obtain signed releases of information pertaining to my condition(s) and/or treatment to/from my other caregivers or third-party payers, as applicable.
I have read the above terms and conditions for TMH. I have also had an opportunity to ask questions about its content, and by accepting these terms and conditions, I agree to obtain access to the TMH technology-assisted care platform.
I intend this consent to cover the entire course of the TMH coaching program for my present condition and for any future engagement should I decide to restart or extend my program in the future.