As part of your care plan, your provider may recommend remote patient monitoring (“RPM”) and/or Sleep Coaching services provided by Gem Health Specialty Sleep Services, P.A., its affiliated providers and/or staff (“GEM SLEEP”).
I understand that:
· I hereby request and consent to the performance of RPM and/or Sleep Coaching by GEM SLEEP. The services will provide information and guidance about health factors within my own control to managing the symptoms of sleep apnea. I understand GEM SLEEP’s sleep coaches are not medical providers - do not dispense medical advice, nor diagnose or treat any medical condition, but will provide guidance and motivation, train and assist me in using the device properly and help successfully manage sleep apnea.
· While RPM and Sleep Coaching support can complement my medical care, I understand these services are not a substitute for medical care.
· Methods of ongoing RPM and Sleep Coaching evaluation or testing are intended as a guide to developing an appropriate health-supportive program for me and to monitor my progress in achieving my goals.
· I am the only person who should be using the RPM device(s) provided to me, including my personal CPAP device.
· I agree to use the equipment as instructed and will not use the device(s) for any reason other than my own personal health use.
· I understand that if I participate in this program offered by GEM SLEEP, I may not participate in any similar program offered by any other provider at the same time.
· The device is meant to collect clinical data and send information to my Electronic Medical Record or other cloud-based software. It is NOT AN EMERGENCY RESPONSE UNIT AND IS NOT MONITORED 24/7. I will call 911 for immediate medical emergencies.
· I understand that my data will be electronically transmitted from the device to the device’s cloud software in a safe and secure manner.
· I understand that I can withdraw my consent to participate in this program at any time by contacting GEM SLEEP and signing the RPM and Sleep Coaching withdrawal form.
· GEM SLEEP will securely and confidentially store my collected data into my Electronic Medical Record.
· I will do my best to collect my data every day, as instructed.
· I understand that a sleep coach will only view my readings periodically, and that this program is NOT a 24/7 clinical monitoring service. I will be contacted periodically, by phone or other preferred contact method, to review and discuss my results and progress.
