Medical Consent

Policy on Changes

The company may modify these terms as needed by law, including adding, removing, or changing provisions in response to legal, business, or competitive circumstances.

Telehealth Consent

Overview

Telehealth enables clients to access health services through audio-video interfaces like videoconferencing. Electronic systems incorporate network and software security protocols to protect client identification and imaging data.

Expected Benefits

• Improved access to weight loss management healthcare across distances
• More efficient medical evaluation and management
• Access to distant specialist expertise
• Maintained connections with established providers in other areas

Possible Risks

• Insufficient information transmission (poor image resolution) affecting medical decision-making
• Treatment delays from equipment deficiencies or failures
• Rare security protocol failures causing privacy breaches
• Adverse drug interactions or allergic reactions from incomplete medical records

Client Understanding and Consent

By consenting, the client understands:

• Privacy laws protecting medical information confidentiality apply to telehealth; personal identifying information won't be disclosed to researchers without consent
• Right to withhold or withdraw telehealth consent without affecting future care
• Right to inspect and receive copies of documented telehealth information for reasonable fees
• Alternative weight loss management methods are available and may be chosen at any time
• Obligation to inform physicians of other healthcare providers involved in their care
• No guarantee of specific results, though anticipated benefits are expected
• Continued service use constitutes acceptance of these terms and authorization for telehealth use

HIPAA Consent

Purpose

HIPAA provides privacy safeguards. This is a friendly summary version; complete text available upon request. Additional info: www.hhs.gov.

Office Policies

Confidentiality: Patient information is confidential except as necessary for service provision. We may share information with healthcare providers, laboratories, and insurance payers. Patient files may be stored in open racks without identifying coding. Records may temporarily be in reception/exam rooms. Clients agree to standard procedures for chart/record handling.

Appointment Reminders: We may contact you via telephone, e-mail, or U.S. mail for appointment reminders and policy/procedure changes.

Vendor Access: Practice vendors may access protected health information (PHI) but must comply with HIPAA confidentiality rules.

Government/Insurance Review: Government agencies and insurance payers may inspect office and review documents containing PHI.

Complaint Process: Direct privacy concerns/complaints to office manager or doctor.

Marketing Restrictions: Confidential information won't be used for marketing or advertising.

Record Access: Practice provides patient record access per state and federal laws.

Policy Modifications: Practice may change, add, delete, or modify provisions.

Patient Rights: Clients may request restrictions on PHI use and policy changes, though practice isn't obligated to alter internal policies.

Consent

My continued use of the services constitutes my understanding and acceptance of the above terms set forth in the HIPAA INFORMATION FORM and any subsequent changes in office policy.

Financial Consent

The client understands and accepts:

• A credit card may be kept on file for payment of remaining service balances
• JoinEm (owned by Modern Metabolic Medicine, Inc.) is authorized to submit medical records or necessary information to process consultation orders
• Fee schedules and service receipts are available upon request
• The company is authorized to make invoice adjustments and debit the account for orders placed, goods received, and services rendered not fully covered by third-party vouchers or credits
• The company is authorized to charge the credit card for any unpaid balances
• All programs auto-renew; automatic charges continue unless explicit cancellation occurs before payment processing
• No refunds or exchanges
• The cardholder certifies authorization to use the credit card and won't dispute payments with their credit card company

Shipping Authorization

All prescription medications are dispensed per state and federal law with pharmacist approval and compliance with applicable Medical Board and State Board of Pharmacy regulations. The customer:

• Disclaims liability for delays or errors during shipping
• Agrees to hold harmless JoinEm and Modern Metabolic Medicine, Inc. for shipping issues
• Understands medication is considered dispensed when signed out for shipping, not upon delivery

Authorization

My continued use of the services constitutes my understanding and acceptance of the above terms and I give permission for JoinEm and Modern Metabolic Medicine, Inc. to ship medication to me at the address provided in my intake form or any other address given by me to the company and agree to all of the conditions listed above.