BioTel Heart MCOT Patch - Terms and Conditions

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Data Transmission
Bluetooth Radio
USB - USB 2.0
Monitor
General
Display - IPS Capacitive Touchscreen
Operating System - Android
Battery Type - 2500mA-Hr Lithium Ion
Service Life - 3 years
Environmental
IPX Rating - "IP67 Protected from dust and immersion to water between 15cm and 1m."
Operating Temperature - 10°C to +45°C
Non-Operating Temperature - -20°C to +70°C
Operating Humidity - 10% to 95% (non-condensing)
Non-Operating Humidity - 5% to 95% (non-condensing)
Physical
Size - 5.06” x 2.69” x .51”
Weight - 5.94 oz.
Battery Type - 2500mA-Hr Lithium Ion
Data Transmission
Cellular Radios - LTE Cat 3, CDMA 1x EVDO, 1x Advanced
Bluetooth - 4.0 + LE/EDR
Patch / Electrode
General Functional
Number of Electrodes - 4
Environmental
IPX When Sensor is connected to Patch/Electrode - "IPX4 Resistant to water splashes from any direction"
Storage Temperature - +5ºC to +27ºC
Storage Humidity - Up to 93% non-condensing
Operating Temperature - +5ºC to +40ºC
Operating Humidity - 15% to 93% non-condensing
Transportation Temperature - 0ºC to 40ºC
Transportation Humidity - Up to 93% non-condensing
Physical
Service life - single use
Size - 2.17" w x 0.24"h x 5.0" l (without release liner)
Weight (sensor in patch) - 0.78 oz (24g)
CardioNet, LifeWatch, and BioTel Heart are trademarks of BioTelemetry, Inc.
TERMS AND CONDITIONS OF THE BIOTELEMETRY SERVICE AGREEMENT.
PLEASE READ THIS DOCUMENT CAREFULLY BEFORE ACTIVATING THE MONITOR.
To activate your monitor and begin service you will be asked to accept the terms of this Agreement.
Answering “Yes” to the questions on the monitor’s touch screen prior to activation is your acceptance
of the terms listed in this document. If you do not agree with the terms of this document please notify
Customer Service at 1-866-426-4401 immediately.
PRIVACY AND CONFIDENTIALITY.
By signing this document and/or accepting these terms electronically, you acknowledge that you have
received a copy of BioTelemetry’s Notice of Condentiality and Privacy Practices, which is incorporated
in this agreement below. This acknowledgement is required by the Health Insurance Portability and
Accountability Act (HIPAA) to ensure that you have been made aware of your privacy rights. You give
BioTelemetry’s your consent and permission to communicate with other members of your household,
if necessary, with regard to your BioTelemetry service. You also authorize BioTelemetry to provide your
monitoring data to your physician and his /her staff and to Emergency Medical Services by phone, e-mail,
fax or through secure Internet access. You will also be asked to give BioTelemetry permission to use
your monitoring data, without your identity, in clinical research and case studies. This is an option and
not required to continue to receive BioTelemetry monitoring service (“Service”). You consent to receiving
calls from BioTelemetry and its afliates or authorized agents on your landline or cellular telephone
related to the service or payment related to the service. For example, BioTelemetry or its afliate
or authorized agent may contact you in order to obtain the loaned BioTelemetry Monitoring System
(“System”) or seek payment for the value of the System. You understand that such communications
may include the use of prerecorded voice messages and/or automatic telephone dialing systems.
ASSIGNMENT OF BENEFITS
I request that payment of authorized health insurance benets, including Medicare benets, if I am a
Medicare beneciary, to be made on my behalf to CardioNet, LLC. ( a subsidiary of BioTelemetry, Inc.) for
any medical services provided to me by CardioNet. I authorize any holder of medical and/or insurance
information about me to release to CardioNet, my health insurance carrier, or the Centers for Medicare
and Medicaid Services (CMS) any information needed to determine these benets or the benets
payable for related services provided under this agreement. This assignment includes all dates of
services rendered by CardioNet for all insurance plans. A copy of this authorization will be sent to CMS
or my health insurance carrier if requested. The original will be kept on le by CardioNet. I understand
that I am fully responsible to CardioNet for any co-payments, co-insurance, deductibles, payments made
directly to me by my health insurance carrier for CardioNet services, and, when allowed by law, services
not-covered or payable under my health insurance plan. I also understand that by signing this form and/
or accepting these terms electronically, I am accepting nancial responsibility as explained above for all
payment for services received from CardioNet. By signing this document and/or accepting these terms
electronically, I acknowledge that I have received a copy of CardioNet’s Notice of Privacy Practices. This
acknowledgement is required by the Health Insurance Portability and Accountability Act (HIPAA) to
ensure that I have been made aware of my privacy rights.