This program is supervised by Kirk G. Voelker MD.
We will need to complete the necessary paperwork to enroll you into this practice.
There are four steps to this process.
After completing this information, you will receive a text with your log on credentials for the MiHealth App as well as an introductory e-mail. Our staff will then contact you to answer additional questions,review your goals and discuss initial equipment requirements.
This is your first step to a safer, healthier life. Thank you for allowing us to be part of it.
The MiHealth Team
For insurance enrollment we will need to be monitoring a medical problem.
Unfortunately, Medicare will not cover monitoring of a “Perfectly healthy 65 yo who is not
overweight but just wants to be healthier.
Remote Patient Monitoring (RPM) involves the use of electronic communications and devices that automatically record data to enable healthcare providers at different locations to monitor physiologic metrics and share individual patient medical information for the purpose of managing patient care. In providing RPM services Kirk G. Voelker, M.D., P.A. (“Group”) and Group’s physicians (“Physician”) will the monitor a variety of physiologic metrics and track general health trends over days, weeks or months. Our program includes a variety of applications and services using remote patient monitoring devices including, without limitation, blood pressure, blood glucose, oxygen levels, weight, heart rate and/or activity (steps). Our staff may communicate with you using the text/phone/video functions of the MiHealth app.
OUR PROGRAM IS NOT DESIGNED TO MANAGE YOUR MEDICAL CARE AND WE DEFER MEDICAL DECISIONS TO YOUR DOCTORS.
MiHEALTH IS NOT AN EMERGENCY RESPONSE UNIT AND IS NOT MONITORED 24/7. CALL 911 for EMERGENT SERVICES
The information from your devices is available to MiHealth only after it is uploaded from the device to our system and therefore is not considered “real time” monitoring.
The MiHealth Remote Patient Monitoring Team will view this information Monday to Friday between 8 a.m. and 5PM, not including statutory holidays
The electronic monitoring systems we use will incorporate network and software security protocols to protect the confidentiality of patient identification and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption.
These RPM services are an addition to, and not a replacement for, your primary care physician. Responsibility for your overall medical care should remain with your primary care doctor, if you have one, and we strongly encourage you to locate one if you do not.
OUR PHYSICIANS DO NOT ADDRESS MEDICAL EMERGENCIES. IF YOU BELIEVE YOU ARE EXPERIENCING A MEDICAL EMERGENCY, YOU SHOULD DIAL 9-1-1 AND/OR GO TO THE NEAREST EMERGENCY ROOM. PLEASE DO NOT ATTEMPT TO CONTACT GROUP, OR A GROUP PHYSICIAN FOR EMERGENCY CARE.
By checking the box associated with "INFORMED CONSENT", you acknowledge that you understand and agree with the following:
I have read this document carefully, and understand the risks and benefits of the RPM services and have had my questions regarding the services explained and I hereby give my informed consent to participate in the RPM services program.
By checking this Box, I
acknowledge that I have carefully read, understand, and agree to the terms.
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
We are required by law to maintain the privacy of your protected health information, to notify you of our legal duties and privacy practices with respect to your health information, and to notify affected individuals following a breach of unsecured health information. This Notice summarizes our duties and your rights concerning your information. Our duties and your rights are set forth more fully in 45 CFR
1. Uses And Disclosures We May Make Without Written Authorization. We may use or disclose your health information for certain purposes without your written authorization, including the following:
2. Disclosures We May Make Unless You Object. Unless you instruct us otherwise, we may disclose your information as described below. To a member of your family, relative, friend, or other person who is involved in your healthcare or payment for your healthcare. We will limit the disclosure to the information relevant to that person’s involvement in your healthcare or payment.
3. Uses and Disclosures with Your Written Authorization. Other uses and disclosures not described in this Notice will be made only with your written authorization, including most uses or disclosures of psychotherapy notes; for most marketing purposes; or if we seek to sell your information. You may revoke your authorization by submitting a written notice to the Privacy Contact identified below. The revocation will not be effective to the extent we have already taken action in reliance on the authorization.
4. Your Rights Concerning Your Protected Health Information. You have the following rights concerning your health information. To exercise any of these rights, you must submit a written request to the Privacy Officer identified below.
You may request additional restrictions on the use or disclosure of information for treatment, payment, or healthcare operations. We are not required to agree to the requested restriction except in the limited situation in which you or someone on your behalf pays for an item or service, and you request that information concerning such item or service not be disclosed to a health insurer. We normally contact you by telephone or mail at your home address. You may request that we contact you by alternative means or at alternative locations. We will accommodate reasonable requests. You may inspect and obtain a copy of records that are used to make decisions about your care or payment for your care, including an electronic copy. We may charge you a reasonable cost-based fee for providing the records. We may deny your request under limited circumstances, e.g., if we determine that disclosure may result in harm to you or others. You may request that your protected health information be amended. We may deny your request for certain reasons, e.g., if we did not create the record of if we determine that the record is accurate and complete. You may receive an accounting of certain disclosures we have made of your protected health information. You may receive the first accounting within a 12-month period free of charge. We may charge a reasonable cost-based fee for all subsequent requests during that 12-month period. You may obtain a paper copy of this Notice upon request. You have this right even if you have agreed to receive the Notice electronically
5. Changes To This Notice. We reserve the right to change the terms of this Notice at any time, and to make the new Notice effective for all protected health information that we maintain. If we materially change our privacy practices, we will post a copy of the current Notice in our reception area and on our website. You may obtain a copy of the operative Notice from our receptionist or Privacy Officer.
6. Complaints. You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated. You may file a complaint with us by notifying our Privacy Officer. All complaints must be in writing. We will not retaliate against you for filing a complaint.
7. Contact Information. If you have any questions about this Notice, or if you want to object toor complain about any use or disclosure or exercise any right as explained above, pleasecontact:
Compliance & Privacy Officer:Kirk G. Voelker MDPhone: (833) 200-2777Address: 15 Paradise Plaza, Ste 184Sarasota, FL 34239E-mail: firstname.lastname@example.org
I acknowledge that
I have reviewed this office’s Notice of Privacy Practices and agree to the terms stated within.
I understand I am
required by my insurance company for follow-up testing and office visits.
I request that
payment of authorized
benefits be made on my behalf to Kirk G. Voelker MD for any services furnished by the entity. I
authorize any holder of medical information to release to the Health Care Financing
Administration and its agent any information necessary to determine these benefits or the
benefits payable for related services.
I understand that the remote patient monitoring services are separate services for which Kirk G Voelker MD,PA will bill my insurance payers, including Medicare or
I understand that my payer, such as Medicare, may not cover all of the billed amount. I understand I am responsible for paying Medical Group for any and all of such amounts not paid by my insurance payer, including non-covered charges and all copayments and deductibles.
By checking the Box for this
MONITORING CONSENT TOCO- PAYMENT" I hereby state that I have read, understood, and agree to
terms of this document.