Remote Patient Monitoring (RPM) Consent Policy

Consent Agreement:

By enrolling in the Remote Patient Monitoring (RPM) program (the "Program"), I hereby acknowledge and agree to the following terms and conditions:

1. Personal Use

  • I affirm that I am the sole user of the remote monitoring device (the "Device") provided for my personal health monitoring.

  • I agree to utilize the Device solely for purposes explicitly outlined by the Program.

  • I understand and acknowledge that enrollment in more than one RPM program with a single medical provider concurrently is not permitted.

2. Device Handling

  • I agree not to tamper with, alter, or misuse the Device.

  • I accept responsibility for any fees incurred due to damage or misuse of the Device.

3. Program Purpose

  • I understand that the Device is intended exclusively for use within the scope of the Program and is designed to collect and transmit health data to my healthcare provider’s secure platform.

  • I acknowledge that the Device does not serve as an emergency response system. In the event of a medical emergency, I will contact emergency services by dialing 911.

4. Data Collection & Monitoring

  • I understand that the Device does not have diagnostic capabilities but will transmit data to my healthcare provider for review.

  • I am aware that my data will be reviewed by a qualified health professional on a regular basis; however, I acknowledge that this is not a continuous 24/7 monitoring service.

5. Insurance & Costs

  • I acknowledge that my insurance provider may be billed for RPM services, and I am responsible for any applicable copayments or coinsurance.

6. Data Security & Withdrawal

  • I consent to the secure transmission of my health data to my healthcare provider for review.

  • I reserve the right to withdraw from the Program at any time by returning the Device and discontinuing the use of any associated software.

  • In the event of withdrawal, I agree to return the Device within 14 days, utilizing the prepaid label and instructions provided.

7. Program Participation

  • I agree to make a good faith effort to record my health data daily.

  • I acknowledge that I may be contacted monthly to discuss my progress and results.

  • Should I elect to withdraw from the Program, I agree to return the Device in accordance with the Device Return Policy set forth herein.

Device Return Policy for RPM Program

1. Opt-Out Notification

  • I will provide notification of my intent to opt out of the Program at least 7 days in advance by contacting the program administrator via email at support@empwr.life or the EMPWR app.

2. Device Return Process

  • I agree to return the Device within 14 days of providing opt-out notification to the program administrator.

  • I will adhere to the provided instructions for packaging and returning the Device, utilizing a prepaid return label.

3. Device Condition

  • I agree to return the Device in good working condition, including all accessories.

  • I will ensure that the Device is clean and free of damage upon return.

4. Lost or Damaged Devices

  • I agree to report any lost Device immediately. I understand that a fee may be charged for replacements.

  • I acknowledge that fees may be assessed for Devices returned with significant damage.

5. Non-Return, Damaged, Lost, Stolen, and Mishandled Device Fees

  • I understand that there is a fee for with the Device. I will be provided with instructions on how to remit payment for non-return, damage, loss, or theft of the Device.

  • I acknowledge that if the non-return fee is not paid within 21 days of the due date, Wellness Connection reserves the right to refer the matter to a collection agency.

6. Contact Information

  • For assistance, I may contact the support team via email at support@empwr.life or through the support feature on the Empwr app.

Device: The term "Device" refers to any equipment or software provided as part of the RPM Program.

I agree to receive SMS messages related to my care plan from Wellness Connection. I can reply “STOP” at any time to opt-out. Message and data rates may apply. Message frequency may vary, text HELP to (430) 413-4467 for assistance. For more information, please refer to our privacy policy at https://www.wellnessconnection.care/privacy on our website.

By participating in the RPM Program, I agree to the terms and conditions of this Consent Policy and Device Return Policy. I understand that this consent remains in effect for the duration of my possession of the Device. I acknowledge that these policies are subject to amendment, and I will be notified of any updates accordingly.