WeHeal, Inc. is committed to providing outstanding client support and is based on a collaborative model which integrates different levels of support into the care environment. In addition to its Professional Staff (defined as the individuals retained on WeHeal, Inc.'s behalf who are qualified in healthcare-related professions and whose primary responsibilities, including delivering healthcare services to clients, require the exercise of medical judgment and discretion) who provide medical diagnosis, treatment and advice to clients, WeHeal, Inc. provides additional support to its patients by offering mentor Services (as defined herein) (collectively, the "Practice").
WeHeal, Inc. is based on a collaborative model. WeHeal, Inc. expects that a mentor will (as needed): (1) help clients articulate agendas for upcoming visits with the Professional Staff (as defined herein), (2) review Professional Staff recommendations to ensure client comprehension, (3) assess whether clients accept their health plans, (4) support clients' efforts in adopting healthy behaviors, and (5) function as a cultural bridge, point of access, and support for clients, and undertake any other action within their scope, to support client support ("Services"). WeHeal, Inc. defines "Professional Staff" as the individuals retained on WeHeal, Inc.'s behalf who are qualified in healthcare-related professions and whose primary responsibilities, including delivering healthcare services to clients, require the exercise of medical judgment and discretion.
WeHeal, Inc. also expects that a mentor will (as needed): provide client coaching, which involves direct and personal conversations conducted via scheduled face-to-face, video, or phone appointments, which may include, but is not limited to, one or more of the following: creation/development of personal, professional, emotional, spiritual, mental, physical and lifestyle goals; methods to carry out a strategy/plan for achieving those goals; identification and addressing of specific personal struggles, professional issues or general physiological conditions; value clarification, brainstorming, identification of plans of action, examining modes of operation in life, asking clarifying questions and making empowering requests or suggestions for action (collectively, "Coaching").
WeHeal mentors may NOT exercise independent medical judgment or discretion or provide medical advice, diagnosis, or treatment recommendations and may only perform non-clinical tasks. Examples of non-clinical tasks include, but are not limited to, education & coaching, empathy & companionship support, transcribing notes, taking information from the client and/or communicating such information to the Professional Staff, and bringing to the attention and/or discussing with the Professional Staff any items of concern that have been disclosed to the mentor by the client.
I understand that the Services and Coaching I will be receiving under this agreement are not offered as a substitute for mental health care and are not psychological or medical care services. I also understand that my mentor is not acting as a mental health practitioner, licensed healthcare professional, dietician or nutritionist and does not purport to offer such care, and nothing communicated to me by the mentor shall constitute the practice of such fields. If my mentor believes that medical care services may be helpful, my mentor may provide a referral.
I am fully responsible for my well-being during my sessions with my mentor, and subsequently, including my choices and decisions.
All comments and ideas offered by my mentor are solely for the purpose of educating me and aiding me in achieving my defined goals. I am entering into this agreement knowingly and voluntarily, and hereby give my consent to my mentor to assist me in achieving such goals.
My mentor will endeavor to maintain the confidentiality of our communications to the extent allowed by law.
I understand that the sharing of any of my confidential information outside of WeHeal, whether made at my request or not, is done at my own risk.
I, the undersigned, do hereby request and consent to Services and Coaching provided by a mentor. I understand any questions I may have regarding diagnosis, treatment or advice will be directed to a Professional Staff member during my evaluation and course of treatment. I request and consent to be transported by the Practice and/or emergency medical services to a hospital or emergency medical facility in the event of a medical emergency during my treatment at the Practice. I intend this consent to cover the entire course of treatment.
I have read this WeHeal, Inc. Patient Consent to mentor Services and Coaching in its entirety and agree to be bound by all of its terms and conditions as described above. I acknowledge and agree that I have been given the opportunity to ask any questions and have either (i) declined the opportunity to do so or (ii) had all my questions answered to my satisfaction.