Patient Responsibility, Consent and Authorization
The following Statement of Patient Responsibility, Informed Consent, and Authorization outlines the conditions under which TeledocConsults.com, LLC ("TeledocConsults.com") provides you with access to telephonic or electronic consultation services with a US-licensed Physician and other practitioners, and your acceptance of responsibility for your decision to use these services through TeledocConsults.com.
To ensure your compliance with these Terms, we reserve the right, but not the obligation, to monitor your access to and use of the site and the services. TeledocConsults.com may, at its sole discretion, refuse access to the site or services due to actual or potential misuse of the site or services or noncompliance with these Terms. To receive any service requests, you must acknowledge that you have read and understood these conditions, including the Statement of Patient Responsibility
Statement of Patient Responsibility
By submitting my health information (symptoms, conditions, comments, answers to questions, and a fully completed Health Information Form) in connection with my request for services, I attest to the following:
• I am an adult, at least 21 years old.
• I am capable of using the services provided by TeledocConsults.com, and I fully comprehend the material on this website.
• I am voluntarily seeking a physician consultation through TeledocConsults.com.
• I understand that the consulting physician reviewing my Health Information may or may not prescribe treatment based on my responses.
• I am aware that withholding truthful, accurate, and complete information from the consulting physician and other providers could lead to an inappropriate treatment decision that could harm me or be ineffective. Therefore, I have answered each question on the Health Information Form truthfully and accurately and have fully disclosed any and all information about my health and medical history that could be relevant to my current condition and need for treatment and/or medication.
• I understand and agree that this website or the owner(s) affiliated with this website shall not be liable for any acts or omissions of its contracting Prescribing Physicians, Telemed Physicians, the Dispensing Pharmacy and of my Primary Physician in advising me or communicating with me with regard to the prescribed medication. The liability if any, of this website shall extend only up to such amount as may represent the purchase price of any medication and products concerned in any relevant transaction.
• I agree to release this website, it's owner(s), its employees, agents, principals, corporate affiliates and all related parties from any liability arising from my consumption of prescribed medications and for medical, physical or behavioural and other effects of any medication that I may take as a result of my seeking a consultation via the Internet. I hereby release this website and it's owner(s) and clinician from any and all claims that the physician acted below the requisite standard of care on the basis that the Physician did not personally examine me.
• I have been seen by a physician and undergone a physical examination and/or medical history evaluation within one year of requesting services from TeledocConsults.com. I agree to undergo a physical examination every year to ensure that my request for treatment is appropriate, and to inform my personal physician about the products ordered or purchased, as applicable, through TeledocConsults.com.
• I will contact my physician if I have questions, difficulties, or complications with recommended treatment(s).
• I will inform the Consulting Physician of any changes to my medical condition if I return to the site seeking services or products of any kind whatsoever.
• I understand that TeledocConsults.com receives an electronic transmission of my request for a consultation and the reason for said consultation, directs my completed Health Information to a consulting physician for their review and response in accordance with their professional judgment regarding my request.
• I understand that I can contact the Consulting Physician who reviews my Health Information Form through the TeledocConsults.com customer service number posted on the website.
• I understand that I will have the opportunity to ask the consulting physician any questions about any tests, procedures, or medication(s) that may have been prescribed for me.
• I understand that the Consulting Physician is an independent, US-licensed practitioner, is not an employee or principal of TeledocConsults.com, and is not my primary care physician.
• I understand that there are risks and benefits associated with having tests performed or taking any medication.
• If paying by credit or debit card, I am the owner of that credit or debit card or am permitted by law to use such credit card.
Patient Agreement and Acknowledgement
As a customer or potential customer of the services provided by or through this website, I hereby understand, accept, and agree to the following:
To ensure compliance with these Terms, we reserve the right, but not the obligation, to monitor your access to and use of the site and the services. TeledocConsults.com may, at its sole discretion, refuse access to the site or services due to actual or potential misuse of the site, these Services, or for noncompliance with these Terms.
By using the services provided by or through this website, I acknowledge and agree to the following:
TeledocConsults.com reserves the right to monitor my access to and use of the site and the services to ensure compliance with these Terms. TeledocConsults.com may refuse to provide access to the site or services for actual or potential misuse of the site, these services, or for noncompliance with these Terms.
I am voluntarily providing my health and medical information and completing a Health Information Form to receive services through TeledocConsults.com.
The consulting physician will not conduct an in-person physical examination and will rely on the information I provide on my Health Information Form, supplemented by follow-up questions and/or a telephone consultation.
I am using this technology platform to seek medical advice and treatment from a qualified physician and/or other clinician.
I understand that a licensed physician in the United States will review my Health Information, and all online consultations, diagnoses, and treatments will be deemed to have occurred in the state where the consulting physician is licensed to practice medicine.
I am under the care of a personal physician and do not consider the consulting physician to be my primary care physician.
TeledocConsults.com does not practice medicine and is not a healthcare services provider. TeledocConsults.com cannot direct, control, or influence the medical opinions or decisions made by the consulting physician or other assigned clinician with respect to my care.
Any dispute arising out of or related to the provision of services by TeledocConsults.com, the consulting physician or other clinician, or by their affiliates, employees, partners and agents, will be subject to mandatory mediation. If mediation fails, the dispute shall be subject to final and binding arbitration, enforceable in a court, and the parties waive their right to bring suit.
Any mediation, arbitration, or proceedings will be held in Montgomery County, Pennsylvania, and governed by the substantive law of the Commonwealth of Pennsylvania.
I accept all known and unknown risks involved in, arising from, or related to taking medication, products, or treatment. I will not seek indemnification or damages from TeledocConsults.com for negligent, reckless, or intentional acts or omissions, and I hold TeledocConsults.com harmless from any liability relating to or arising out of my request for or receipt of medications from TeledocConsults.com.
I release TeledocConsults.com and the consulting physician and other clinician from any and all claims that the physician acted below the requisite standard of care on the basis that the physician did not personally examine me.
All information and services provided by or through this website are provided "as is" without warranty of any kind, expressed or implied.
If any provision of this agreement is held to be illegal, void, or unenforceable, this agreement may be modified or amended only to the extent necessary to enable the remaining provisions to be of force and effect to the maximum degree.
Patient Authorization for Release of Individually Identifiable Health Information
In connection with providing individually identifiable health information to TeledocConsults.com, I authorize the following:
TeledocConsults.com to use and disclose any of my health information, including all individually identifiable health information contained in the Health Information Form for the purpose of treatment, payment, and health care operations. This authorization includes, but is not limited to, any health information relating to HIV and other sexually transmitted diseases, mental health or disease, drug or alcohol treatments.
TeledocConsults.com's privacy notice provides more detailed information about their privacy policies, and I am encouraged to review it before agreeing to this authorization. I declare under penalty of perjury that the foregoing is true and correct. My agreement to this statement constitutes my signature.