Consent to Receive Remote ECG Services

Last Updated: September 15, 2020

QT Medical, Inc. offers a digital, wireless electrocardiogram (“ECG”) system that syncs with mobile devices (both iOS and Android) via Bluetooth technology. QT Medical, Inc. contracts with EKG360, P.C. to offer full 12-lead ECG remote monitoring and interpretation (the “Service”). The portable ECG device receives signals from the one-time use electrode strip applied to the body and then transits that data to a connected mobile device where the ECG reading is displayed. The ECG reading can be shared by the patient with third parties, including the treating clinician. The ECG readings are also stored on QT Medical’s secure cloud server for later access and analysis. Before you give your consent to request the Service, please be aware of how receiving remote ECG monitoring through the QT Medical mobile application (the “App”) differs from an in-person conventional ECG procedure. If you have any questions, please send an e-mail to service@qtmedical.com or use the “Support” button in the App.

You understand that the Service ONLY collects remote ECG readings but does not provide any medical treatment or other interventions. Also, the Service does not send alerts, either to you or to any third parties. You understand that by using the Service, you will not have an in-person physical exam that might identify a potentially serious medical condition. DO NOT use the Service in a medical emergency, in a medical emergency you should dial 911 or visit an emergency room.

You agree that it is your choice to or not to use the Service. You can stop receiving the Service at any time.

You understand that you will need to pay for the Service received through the App yourself and that any insurance you have may not pay for it. You understand that by using the Service, you are freely electing to pay out of pocket and that you may be foregoing discounts or insurance coverage that would otherwise be available to you if you sought care in-person. You understand that it is your responsibility to arrange and pay for any follow-up care.

You understand that if you are using the App, you are responsible for having the latest version of the App on your mobile telephone or device and for having sufficient internet access or wireless connection to use the App. You understand that you are responsible for accepting and implementing any software patches or updates pushed out through the App.

You further understand that the electronic nature of the Service may cause greater risk to the privacy of your electronic health information. By using the Service, you are consenting to QT Medical’s sharing of your Protected Health Information (“PHI”) with certain third parties as more fully described in our Privacy Policy. In addition to the information you share with us through the App, it will also collect your device identifier and your geolocation.

PHI is need when assigning your ECG reading to a medical professional licensed in your state. You understand and expressly consent QT Medical to obtain, use, store, and disseminate your information to third parties for providing the Service. Because the Service transmits data over the Internet, it is inherently subject to loss, theft, or corruption. The portable ECG device and the App itself may be vulnerable to viruses, malware, and malfunction. You further understand that records of the Service provided to you through the App may be lost due to technical failures. When experiencing technical difficulties, you may either send a message via the App or contact QT Medical at service@qtmedical.com. You hereby release and hold harmless QT Medical from any damage and/or liability for loss of data or information due to technical failures hereof.

When using the Service, you have the option to have your physician interpret the results of your ECG or to request an interpretation from our contracted cardiologists engaged through EKG360, P.C. Your physician may also request EKG360, P.C. to perform your interpretation. If your physician interprets the results, a routine ECG reading is typically reviewed within two (2) weeks. If you’d like to receive your ECG interpretation earlier, please contact your physician during office hours. You may also request a faster interpretation through EKG360, P.C. via the Website or App. If you select EKG360, P.C. for your interpretation, you will be provided with the name, credentials, and qualifications of the licensed clinician providing the ECG interpretation.

If you’d like to have the records relating to the Service (“Records”) sending to your primary care provider, please contact QT Medical through the App or the Website to request the transfer. If you allow QT Medical to provide the Records through the App, please provide your primary care physician’s information when setting up your account. You may also obtain the Records by contacting us through the App or the Website.

You understand that the Service is not intended to provide a diagnosis and shall not be used in isolation to make a diagnosis of heart disease. It is your treating physician’s responsibility to make a diagnosis after full consideration of the clinical record.

By purchasing the Service, you hereby acknowledge your understanding and agreement to the content hereof and that this informed consent will become part of your medical record. If you have any questions or concerns about the Service, please contact us at service@qtmedical.com.