Consent To Telehealth
INFORMED CONSENT TO TELEHEALTH
Last updated: January 4, 2021
Make sure you read all the important information below as we cover:
How our medical team consists of doctors and nurse practitioners.
How many states require you to do a video consultation or have a telephone call with one of our doctors or nurse practitioners.
When our duty of care begins.
The benefits and risks of using our service.
The importance of reading all the information we provide.
The importance of answering all questions fully and truthfully.
The risks of accepting our treatment plan.
The risks to electronic health information.
Only use our service if you have read this information and subsequently made an informed decision that our service is right for you. If you have any questions, please send us a message through the App or Website or call us at 888-514-7003.
Our medical team is made up of doctors and nurse practitioners. Whenever we use the term 'doctor' we mean both our doctors and nurse practitioners.
Some states require you to do a video consultation or to have a telephone call with our medical team. For some services we always do a video consultation or telephone call because we think that's required for us to provide you with good medical care.
If you request that your medicines be delivered to you in the mail, we'll arrange for New Pharmacy Ventures LLC or any pharmacy of your choice to mail your medicines. If you do want us to send your prescription to a local pharmacy in your area, please message or call us and we will do so at no extra charge. We do not send prescriptions to pharmacies based outside the US.
NOT FOR EMERGENCIES
I understand that I should never use AmplixinRx in a medical or psychiatric emergency. I understand that in an emergency, I should dial 911 or go to an emergency department.
WHEN OUR DUTY OF CARE BEGINS
I understand that the doctor or nurse practitioner will take responsibility for my care only after I have created an account, answered all the required health questions and provided a photo and/or have had a video visit and made payment, and the doctor or nurse practitioner has subsequently reviewed my request for treatment and the health questions that I have completed and any photos and/or information received from a video visit, reviewed all my information, and then subsequently determined that I am a good candidate for the telehealth services. I understand that the duty of care does not begin at the point of me answering questions or making payment or starting a video visit but at the point at which the doctor or nurse practitioner accepts the duty of care.
In the case of lab tests, the duty of care is restricted exclusively to the act of ordering and interpreting specific lab tests and only occurs when the doctor or nurse practitioner has ordered the lab test. The duty of care does not extend to your wider health, even if you have told the doctor or nurse practitioner information about your health as part of our intake questionnaire.
I understand that the doctor or nurse practitioner has the right to refuse to take responsibility for my care if the doctor or nurse practitioner makes a professional judgment that I am not a good candidate for this service. I understand that making a request for treatment (by completing a visit in the App or Website and making payment or by starting a video visit) or requesting a lab test or sending a message through the app does not in and of itself create a duty of care or create a doctor-patient relationship.
I understand that there may be a delay of a number of days before a doctor reviews my request for treatment or a lab test and any messages I send.
I understand that the only content in the App or Website that constitutes professional medical advice is the personalized messages the doctor or nurse practitioner sends me (once I have completed the health questions and made payment, and the doctor or nurse practitioner has subsequently taken responsibility for my care) and any content that the doctor or nurse practitioner links to in such messages and advice that a doctor or nurse practitioner provides in a video or telephone consultation. No other content in the App or Website constitutes professional medical advice. Specifically, the information provided in our health questions about who we can and cannot treat does not constitute professional medical advice.
I understand that all other content in the App or Website does not constitute professional medical advice and is instead for information purposes only. Never disregard professional medical advice or delay in seeking it because of something you have read on our App or Website.
BENEFITS AND RISKS OF USING OUR SERVICE
I understand that by using the service I am seeking care that is convenient and affordable.
I understand that important differences exist between AmplixinRx model of care and traditional healthcare. Specifically, by using AmplixinRx I accept a greater responsibility to read and understand information throughout the App and Website about the limitations of AmplixinRx model of care, the risks of seeking care this way, and the risks and benefits of a proposed treatment plan.
I understand that to read important information I may need to both click on links and various titles to expand the information that's visible below, and that without clicking on links and titles I will not be able to read important information that enables me to give my informed consent to a treatment.
I understand that by using AmplixinRx I accept the responsibility to provide full and truthful answers to all questions and, when requested, to provide unaltered photos of me that are taken at the time of using our service.
I understand that the doctor or nurse practitioner is unable independently to verify the information and photos I provide and that the doctor or nurse practitioner will make a professional judgment based on the information and photos I provide.
I understand that I won't receive any other medical services that go beyond the diagnosis and treatment of dermatological treatments and advice that the doctor or nurse practitioner thinks is appropriate to give online.
I understand that by using the service for a telemedical consultation, I won't have an in person consultation and in person physical exam that might identify a medical condition that needs further investigation or immediate treatment.
I understand that by using the service I won't necessarily speak or message with a doctor or nurse in real time.
I understand that I must check the App or Website for messages because this is the way that the doctor or nurse practitioner will communicate important information to me. I understand that if I don't check the App or Website regularly, then my care may be delayed.
I understand that if I have any questions relating to my care that aren't urgent, I can message the doctor or nurse practitioner through the App or Website. I understand that the doctor or nurse practitioner may not review and respond to my messages until the next business day.
IMPORTANCE OF READING ALL THE INFORMATION WE PROVIDE
I understand that AmplixinRx will provide detailed information in the App and Website to help me make an informed decision about whether to accept a proposed treatment plan. The most important information about a treatment plan is in the link that the doctor or nurse practitioner will send me when the doctor or nurse practitioner prescribes a treatment. This information includes detailed information to help me decide if the benefits of the treatment plan outweigh the risks, given the alternative options available to me, which includes the option of not taking any treatment.
I understand the importance of reading the information the doctor or nurse practitioner provides about adverse events, including the signs and symptoms of serious side effects and common side effects from taking a medicine, as this will ensure that I seek appropriate medical attention in a timely manner.
IMPORTANCE OF ANSWERING ALL QUESTIONS FULLY AND TRUTHFULLY
I understand that by using AmplixinRx I seek to enter into a relationship where the doctor or nurse practitioner relies exclusively upon information and photos that I provide to decide whether or not treatment is safe and appropriate.
I understand that the doctor or nurse practitioner has no way of verifying the information and photos that I provide and that the doctor or nurse practitioner will consider information to be accurate, true and complete, including my age, gender and all my answers to health questions, and the photos to be of me, taken at the time of me using the service, and unaltered.
I understand that if I provide information that isn't true and complete, then I'll be at greater risk of adverse events from any treatment that the doctor or nurse practitioner prescribes and I may take a treatment that isn't necessary, appropriate, or safe.
I understand that if I provide photos that are altered, not of me or not taken at the time of me using the service, then I'll be at greater risk of adverse events from any treatment that the doctor or nurse practitioner prescribes and I may take a treatment that isn't necessary, appropriate, or safe.
I understand that even if I provide information that is true and complete, I'm still at risk of adverse events from any treatment that the doctor or nurse practitioner prescribes.
I understand that even if I provide photos that are unaltered, of me and taken at the time of using the service, I'm still at risk of adverse events from my treatment that the doctor or nurse practitioner prescribes.
I understand that it is important that I don't create more than one account. Creating more than one account makes it impossible for the doctor or nurse practitioner to see the full history of care that I've received from AmplixinRx. This increases the chances that the doctor or nurse practitioner will not have access to important information and photos in my medical record that could influence the doctor or nurse practitioner's clinical decision.
I understand that by using AmplixinRx I'm giving my explicit consent for the doctor or nurse practitioner to access medication history, where it's available, from records provided by pharmacy databases via the services of Surescripts. I understand that, if appropriate, the doctor or nurse practitioner may take this information into account when making a treatment and prescribing decision but this doesn't change how important it is that I provide full, true and complete information during the AmplixinRx visit.
RISKS OF ACCEPTING OUR TREATMENT PLAN
I understand that all the medicines that the doctor or nurse practitioner may prescribe or recommend, including over-the-counter medicines and ‘behind-the-counter' medicines, can cause serious side effects and adverse events that include severe allergic reaction, permanent disability, and death.
I understand that it is my responsibility to make an informed decision whether to accept a treatment plan that the doctor or nurse practitioner proposes after weighing the risks and benefits of the medicine being prescribed, alternative treatment options and the risks and benefits of such alternatives, and the option of not seeking any treatment.
I understand the importance of reading the manufacturer's leaflet that comes with a medicine, including an over-the-counter or behind-the-counter medicine, before I take a medicine because this leaflet includes important information about risks and warnings.
I understand that adverse events can be caused by a number of things, including an allergic reaction, side effects, or interactions between a medicine that the doctor or nurse practitioner prescribes and any medical conditions I may have, other prescription medicines or other things (e.g., supplements, herbs, over-the-counter medicines, or recreational drugs) I'm taking, and lifestyle choices such as smoking tobacco products or drinking alcohol.
I understand that by using AmplixinRx to diagnose and treat dermatological conditions, the doctor or nurse practitioner won't have the opportunity to conduct a detailed physical examination that would be possible if I were to see a doctor or nurse practitioner in person. Because AmplixinRx doctors or nurse practitioners cannot do a detailed physical examination there is a risk that they may not identify potential physical causes of my condition that they would be able to identify and investigate further if I were to see them in person.
I understand that AmplixinRx doctors or nurse practitioners can order a set of investigative tests, help me understand the tests results and advise me on next steps. I understand that it's my responsibility to seek follow-up care and ongoing care from a doctor or nurse practitioner in person and that it's unlikely that AmplixinRx doctors or nurse practitioners will be able to provide follow-up care and ongoing care for any potential health conditions highlighted by the tests.
PROMO CODE PROGRAMS
I understand that if I received a promo code for AmplixinRx services from a third party such as my employer, health insurer, or other organization ('Promo-Code-Provider'), I assume all risks associated with my use of the promo code. I understand and agree to fully release, waive, and forever discharge the Promo-Code-Provider from any and all losses, rights, liabilities, claims, demands, legal actions or right of action that I may have now or in the future, known or unknown, for any damages or personal injury that may occur during my use of a promo code for AmplixinRx. I understand that by consenting to these terms and using the AmplixinRx service, I forfeit any and all right to bring a suit against the Promo-Code-Provider arising from my use of the coupon. This release applies even if the injury or damage is caused in whole or in part by the negligence or fault of the Promo-Code-Provider, however, I understand that the forgoing release does not apply to gross negligence or willful misconduct by the Promo-Code-Provider.
I understand that in the event that AmplixinRx, or any of its affiliates (including business associates and vendors) unintentionally discloses or disseminates my personal health information, my only recourse is against AmplixinRx and its affiliates, and not against Promo-Code-Provider.
PACKAGING IS NOT CHILD PROOF
The pharmacies we work with may mail your medicine in topical application tubes or pumps. Topical application tubes and pumps are not child proof.
RISKS TO ELECTRONIC HEALTH INFORMATION
I understand that although AmplixinRx implements a wide range of administrative, physical, and technical safeguards to protect my health information. AmplixinRx cannot guarantee the privacy and confidentiality of my health information.
I understand that Direct2MD clinicians or staff may send me messages. These messages may contain information that is important to my health and medical care. It is my responsibility to monitor these messages. By entering my valid and functional e-mail address and mobile phone number, I have enabled Direct2MD to notify me of messages sent to my Direct2MD Inbox. I will update my e-mail address on Direct2MD platform as needed. I agree not to hold Direct2MD or its authorized vendors and agents liable for any loss, injury or claims of any kind resulting from Direct2MD messages that I fail to read in a timely manner. I understand that contents of any message may be stored in my permanent health record. I agree that all communication will be in regard to my own health condition(s). I understand that asking for advice on behalf of another person could potentially be harmful and is a violation of the Direct2MD Terms and Conditions. Direct2MD and its clinicians do not assume any responsibility for health information or services used by persons other than the primary account holder.
Direct2MD Terms and Conditions
These Terms and Conditions define the obligations of Direct2MD, LLC (Direct2MD) its Business Associates New Pharmacy Ventures, LLC (New Pharmacy Ventures) and its authorized agents and the Service Subscriber. The purpose of these definitions is to establish the basic rules of safe and fair use of Direct2MD Services. Direct2MD its Business Associates, and its authorized agents reserve the right to immediately and without advance notice terminate the service and deny access to individuals who do not abide by the Terms and Conditions.
By using the Direct2MD telemedicine service, I indicate my acceptance of Direct2MD Terms and Conditions. If I do not accept the Direct2MD services Terms and Conditions I should not use this Service. If Direct2MD, it Business Associates, or authorized agents require a change to these Terms and Conditions they will post those changes prominently. My continued use of the Services following the posting of changes to these terms indicates my acceptance of those changes. Changes to the Terms and Conditions will become effective immediately upon posting on Service Website and shall supersede all prior versions of the Terms and Conditions and unless otherwise noted.
Privacy and Security
Direct2MD considers the privacy of patient health information to be a critically important element of the subscriber/Direct2MD Service relationship. It is Direct2MD's responsibility to maintain the confidentiality of health information. Pursuant to Health Insurance Portability and Accountability Act of 1996 (HIPAA), I acknowledge that I have received a copy of the Facility's Notice of Privacy Practices. I hereby consent to disclosure of my protected information, including information generated through use of virtual health or telemedicine services, as described in the Notice of Privacy Practices. This will include all of my protected health information generated during utilization of Services.
I understand that it is extremely important that I keep my login credentials for the Service completely confidential. If at any time I feel that the confidentiality of my password has been compromised, I will change it by contacting AmplixinRX.
I understand that Direct2MD or their authorized vendors and agents take no responsibility for and disclaim any and all liability or damages arising from a breach of health record confidentiality resulting from my sharing or losing my password. If Direct2MD or their authorized vendors and agents discovers that I have inappropriately shared my password with another person, or that I have misused or abused my online access privileges in any way, my access to the Service will be discontinued without prior notice.
Use of Direct2MD for Health Care Services
My registration for Direct2MD and its Business Associate (New Pharmacy Ventures) authorizes my utilization of services as provided in this agreement. It is my duty to be truthful and accurate with all the information I provide verbally, by text massage, or that I enter or upload to the Service Website, including but not limited to my physical condition, chief complaint, and the documented location of my permanent residence upon accessing the Service. I acknowledge that my ability to access and use the Direct2MD service is conditioned upon the truthfulness of this certification and that the providers of the Service rely on the certification of this information in order to interact with me. In the event that my certification is inaccurate, I agree to indemnify Direct2MD and the providers I interact with from any resulting damages, costs or claims.
The law requires that every medical diagnostic or treatment encounter be documented. The documentation of consultation encounters with Direct2MD is maintained in an electronic health record (EHR). While my account with Direct2MD and its Business Associate (New Pharmacy Ventures) is active and in good standing, I will have unlimited access to my medical information stored in my EHR.
Direct2MD's telemedicine consults are provided by clinicians dedicated to the safe and effective, evidence-based practice of telemedicine. By agreeing to the Service, I agree to enter into a clinician-patient relationship with Direct2MD's providers. I agree to have my medical history and other diagnostic and medical documentation reviewed by one of Direct2MD's clinicians. I acknowledge that Direct2MD's clinicians may choose not to treat my condition or prescribe a medication for my condition. Direct2MD's clinicians do not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. Direct2MD's clinicians reserve the right to deny care for potential misuse of services. I understand that the health care services rendered by Direct2MD's clinicians are subject to their discretion and professional judgment. I understand that Direct2MD operates subject to state regulations and the visits will be conducted based upon the direction of these regulations, that may vary from state to state.
My consultation report will be made available to review to ensure that relevant signs and symptoms of my presenting complaint and treatment decision and instructions issued by the Direct2MD health care provider are correct. I am advised to immediately contact Direct2MD if I disagree with or do not understand the contents of the consultation report or the instructions issued by the treating Direct2MD health care provider.
I understand that Direct2MD should never be used for urgent matters. Therefore, for all urgent matters that I believe may immediately affect my health or well-being, I will, without delay, go to the emergency department of a local hospital, and/or dial 911.
Patient Consent to the Use of Telemedicine
I understand that Direct2MD, its Business Associates, and authorized agents take no responsibility for and disclaim any and all liability arising from any inaccuracies or defects in software, communication lines, the virtual private network, the Internet or my Internet Service Provider (ISP), access system, computer hardware or software, or any other service or device that I use to access my account