Telehealth Consent
Diagnostic Orders Direct, a division of Glow Oversight PC, is a patient-facing telehealth platform designed to streamline the process of obtaining necessary diagnostic orders.
Effective Date: 05/01/2026
By requesting, scheduling, or participating in a virtual consultation through Diagnostic Orders Direct, I acknowledge and agree to the following:
Nature of Telehealth
I understand that telehealth involves the use of telephone, video, electronic communications, digital intake forms, and other technology to allow a licensed provider to review my request, communicate with me remotely, and determine whether an imaging, diagnostic, EKG, or laboratory order is medically appropriate.
I understand that the provider may ask questions, review symptoms and history, and recommend a different study than the one I initially requested. I understand that no order is guaranteed.
Scope and Limits of This Service
I understand that this service is limited to a virtual consultation and possible issuance of an order when medically appropriate and medically necessary. I understand that this service is not an emergency service, not an imaging facility, not a laboratory, and not a substitute for ongoing in-person medical care.
I understand that this service does not provide ongoing treatment after results are obtained. I am responsible for follow-up with my primary care provider, specialist, urgent care, or emergency room when directed or indicated.
Potential Benefits
I understand that possible benefits of telehealth may include convenience, faster access, lower cost than some in-person consultations, and the ability to discuss whether diagnostic testing is appropriate without first attending an in-person office visit.
Potential Risks
I understand that telehealth also has limitations and risks, including possible technical failures, interruptions, poor audio or video quality, incomplete information due to the remote setting, delays in communication, and privacy or security risks that may occur with electronic communications even when reasonable safeguards are used.
Contrast Studies and eGFR
I understand that if a requested study may require intravenous contrast, recent renal function information, including eGFR, may be needed to assess suitability. If recent results are not available, additional laboratory testing may need to be ordered before contrast-based imaging can be considered.
Alternatives
I understand that alternatives to telehealth include seeking an in-person evaluation with a primary care provider, specialist, urgent care, or emergency department, depending on the severity and urgency of my condition.
Emergencies
I understand that telehealth is not appropriate for emergencies. If I experience chest pain, severe shortness of breath, stroke symptoms, severe bleeding, loss of consciousness, rapidly worsening symptoms, or another medical emergency, I should call 911 or go to the nearest emergency room.
Privacy and Communications
I understand that my health information may be shared electronically as part of the telehealth process, including scheduling, documentation, communication, and order delivery. I understand that reasonable efforts will be made to protect my privacy, but absolute security cannot be guaranteed.
I understand that the provider may communicate with me by phone, secure message, email, text, portal, or other agreed method for administrative or clinical coordination related to this consultation, subject to applicable law and practice policy.
Facility Choice
I understand that Diagnostic Orders Direct is not affiliated with any one imaging center, laboratory, or diagnostic facility. If an order is issued, I may take it to the facility of my choice unless otherwise restricted by the receiving facility or applicable law.
Accuracy of Information
I certify that the information I provide is true, complete, and accurate to the best of my knowledge. I understand that the provider’s decision depends in part on the information I provide and that incomplete or inaccurate information may affect the provider’s recommendations.
Consent and Right to Withdraw
I understand that I may decline or stop telehealth services at any time before or during the consultation, but I also understand that doing so may prevent the provider from completing the review or issuing any order. I understand that a completed consultation fee may still apply according to posted policy.
By proceeding, I consent to receive telehealth services through Diagnostic Orders Direct and acknowledge that I have had the opportunity to review this consent, ask questions, and decide whether to continue.