Featured in USA Today: Reperio is revolutionizing annual checkups | Click here to learn more
Featured in USA Today: Reperio is revolutionizing annual checkups | Click here to learn more
Last Updated: May 1, 2025
This Virtual Visit Agreement (the "Agreement") explains the terms and conditions under which Reperio Health Medical Group, PLLC ("Practice" or "RHMG") provides telemedicine services and manages recordings and protected health information in connection with your virtual visit. By proceeding with a virtual visit, you accept and agree to be bound by this Agreement.
Telemedicine is the delivery of healthcare services when the healthcare provider and the patient are not in the same physical location and communicate through technology. Electronically transmitted information may be used for diagnosis, treatment, follow-up, prescribing, or education and may include medical records, medical images, interactive audio, video and/or data communications, and output data from medical devices, sound and video files.
You are hereby advised that the care provided by practitioners through Reperio Health Medical Group, PLLC is not a replacement for an in-person relationship with a primary care provider. If you do not have a primary care practitioner, you are advised to seek the care of one.
You understand the following with respect to telehealth offered by the Practice:
a) You have elected to have a telehealth visit instead of an in-office visit at the Practice. You agree that the Practice will determine whether your condition is appropriate for telehealth and acknowledge that the Practice may recommend an in-person visit in lieu of, or in addition to, the telehealth visit.
b) You have had an opportunity to review the Practice's providers' credentials and have selected your preference for a provider.
c) You understand that telehealth often involves electronic transmission of your protected health information ("PHI"). Your PHI includes, but is not limited to, your individually identifiable health information, medical history, diagnoses, communications to and from your other health care provider(s), etc.
There are potential risks associated with the use of telehealth, including, but not limited to:
You assume these risks and hold the Practice and its providers harmless from any claims arising out of the use of telehealth to conduct the visit. You understand that PHI obtained during the telehealth visit will not be disclosed to others without your consent unless permitted by applicable law and in accordance with the Practice's Notice of Privacy Practices.
You consent to the Practice recording your virtual meeting with the Practice's licensed professional (the "Provider") (such meeting being referred to as the "Encounter"), and you grant the Practice and Reperio Health, Inc. ("Company"), as its business associate, the non-transferable, non-sublicensable, non-exclusive right and license to photograph or otherwise record you, and to edit, transcribe, use, and reproduce your image, performance, voice, and/or physical likeness, as well as your personal information, including but not limited to your name and biographical information (individually and collectively, your "Likeness"), in whole or in part, and on a perpetual and worldwide basis, but only in connection with:
a) Your health care treatment, as recommended by the Provider during and after the Encounter;
b) The use of de-identified Encounter data for the continued development of AI-powered learning pathways that assist the Practice and its Providers to furnish efficient Encounters; and
c) The use of de-identified data for purposes of enhancing the Company's platform.
De-identification refers to the process of redacting certain PHI to render the data not individually identifiable.
In accordance with applicable state and federal law, you provide your consent to the recording of your Encounters, and you acknowledge that the information disclosed pursuant to this Agreement may be redisclosed and therefore, no longer protected under HIPAA.
You have the following rights:
a) You have the right to request that we submit information about your treatment with the Practice to your primary care physician. If you make such a request and consent to the disclosure of PHI, the Practice will send your medical record, and/or a report containing an explanation of your treatment, to your primary care physician within 72 hours of your consultation with the Practice.
b) You have the right to withhold or withdraw consent for telehealth at any time without affecting the right to your future care, treatment, benefits, or programs for which you are otherwise entitled.
c) You understand that if others are present at your location during your telehealth visit, the confidentiality of your telehealth visit may be compromised.
d) You understand the alternatives to telehealth, such as an in-person encounter, as they have been explained, and in choosing to participate in a telehealth visit understand that some parts of the exam may require in-person physical testing to be performed at the direction of the Practice providers.
e) You may request the Practice to provide a copy of this signed Agreement.
f) You may revoke the recording authorization at any time by submitting a written notice to hipaa@reperiomedical.com. You understand that any use or disclosure of your Likeness, any Encounter recording, or PHI obtained from any Encounter recording that occurred prior to the Practice's receipt of your revocation will not be impacted. You understand that your ability to revoke this authorization may be limited in circumstances in which the Practice has taken action in reliance on your authorization.
You understand that you must be physically located in Oregon or Washington during your telehealth consultation(s) and represent that you will be physically located in your home state during the entirety of each telehealth visit. You understand that if you are not physically located in your home state at the time of the scheduled telehealth visit, the Practice may decline to treat you via telehealth.
You understand that the Practice's healthcare professionals may exercise their professional judgement to prescribe medication to you specifically to treat your diagnosed condition, but there is no guarantee that you will be prescribed a medication. If a medication is prescribed, you, at all times, have the ability to request that your medication be fulfilled at the pharmacy provider of your choice.
You understand that this Agreement is voluntary. If you do not sign this Agreement, the treatment, payment, enrollment, or eligibility for benefits provided by the Practice will not be affected, except to the extent that your Likeness and recording may be used to: (i) inform a Provider's treatment decisions; and (ii) utilized to facilitate AI-powered support to assist the Provider in the provision of the applicable health care services. The use of your PHI, as described herein, other than for treatment, payment or healthcare operations, requires your advance written permission.
This authorization will expire upon your express revocation or 10 years from the date of this authorization, whichever is earlier.
You can contact the Practice at info@reperiomedical.com for a copy of this Virtual Visit Agreement.
