I agree and understand that I should not use ClickeMD for Medical or Psychiatric emergencies. I agree and understand that in an emergency, I should dial 911 or go to a hospital emergency room.
Using our Telemedicine service involves the sharing and use of electronic communications to enable healthcare providers at different locations, to share individual patient medical information for the purpose of improving patient care. Providers may include primary care practitioners and/or specialists or sub-specialties, psychologists, mental health counselors, nurse practitioners and support staff. The information we gather may be used for medical advice and/or treatment, e-prescribing, diagnosis, online therapy, follow-up and/or education, and may include any of the following information:
The electronic systems we use will incorporate and use network and software security protocols, encryption and HIPAA secure servers to protect the confidentiality of patient medical information, identification, laboratory testing results and imaging data and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional “hacking” or corruption. You agree that by using the ClickeMD portal and website that the ultimate responsibility for patient care should remain with the patient’s local provider or clinician, if applicable, as does the patient’s medical record. Use of the services on this website is with the permission of ClickeMD, which we may revoke at any time, for any reason, in ClickeMD’s sole discretion.
You agree that use of our Website will allow you access to some expected benefits:
As with any medical procedure, there are potential risks associated with the use of our Telemedicine Website and Services. These risks are rare but may include, and not be limited to:
This Informed Consent is an electronic form and agreement that sets out to notify you of the risks associated with the use of the ClickeMD Website, Services and systems. This Consent may be modified by ClickeMD from time to time, and such modifications will be effective upon posting by ClickeMD on Our Website.
Permission to Treat: By completing this informed consent thru Our website you give permission to the Providers to provide you with medical care. You may withdraw this consent at any time by no longer seeking care from ClickeMD, or by providing notice to ClickeMD of such withdrawal in writing. We reserve the right to exclude or cancel service to any person at any time, for any reason, or for no reason at all.
Scheduling: You agree that ClickeMD does not guarantee appointment times, or that a Provider will be available at the time you select and confirm. If you are a no show to a properly scheduled appointment on our Website, we reserve the right to charge a no show fee, which will be less than the actual fee you paid for the telemedicine consult.
Mandatory reporting requirements: You agree to enter all information regarding your medical history in a truthful way, and to disclose all relevant medical information asked of you by providers accurately. You agree to hold ClickeMD and the provider harmless from any liability as a result of injury, errors or death as a result of inaccurate medical information provided by you prior to or during the actual telemedicine encounter with the provider.
Billing arrangement: You agree that charges for all services are due in full prior to completion and confirmation of an appointment with a provider on the ClickeMD website. ClickeMD does not guarantee results of any kind in regard to the treatment you receive from the provider, and you agree to hold us harmless from any and all damages you may suffer as a result of using this service, or the ClickeMD site and providers.
Credentials of Providers using our site: Providers using our site are licensed in the state in which you are a resident. You agree to accurately inform us of the state that you legally reside in. Providers are credentialed and screened by us or one of our third party staffing agencies, and these records are retained by us. We make no guarantee as to the suitability of a particular provider for the condition or health problem, which you may have while using our site. By completing your registration on our site through our process, you give permission to the Providers to provide you with Medical Care.
Prescribing policies: ClickeMD Providers do not issue prescriptions for substances controlled by the DEA, non-therapeutic, and/or certain other drugs which may be harmful because of their potential for abuse. You agree that ClickeMD and Providers shall not be liable to you or to any third party for any modification, suspension or discontinuance of the service.
Our Services: You agree that this service is not a replacement for your primary care physician, and should not be viewed as such by you. Our service is not an online pharmacy. Our providers do not prescribe elective medications or narcotic pain relievers. You agree that any prescription you receive from the Provider will be used for the purpose it was intended for by the Provider. You agree that ClickeMD does not guarantee that a specific medication will be prescribed if requested, and that you will NOT seek a charge back from your credit card company in retaliation for not receiving a prescription that you may expect, after registering and seeing the Provider. You agree that a completed online consultation attended by you and the Provider is sufficient, and satisfies all your requirements and expectations for the online consultation, and the dollar amount charged to you by our service. You agree that not receiving the prescription/s you want is not a legitimate reason to request a charge back from your credit card company and in some cases may constitute doctor shopping, which is illegal. You certify that you are physically present in the state in which you seek services from that state’s licensed provider.
Errors Omissions on the Site: You agree that ClickeMD is not responsible for any incorrect or inaccurate content that is posted on the Website, whether caused by Users of the website, Providers using the website, or by any of the website program coding or equipment used by the service. You agree that ClickeMD is not responsible for the conduct either online or offline, social media of any User or Provider of the website. You agree that ClickeMD assumes no responsibility for any error, omission, interruption, delays, mistakes, defects or inadvertent deletions in our operations, destruction, theft, unauthorized access, technical malfunctions, server failures, software failures, technical problems. ClickeMD does not guarantee any particular result from use of the Website or providers.
Liability: ClickeMD, to the extent permitted by law, in no event be liable to You or any third party or person for any consequential, indirect, incidental, exemplary, special or punitive damages arising from your use of the ClickeMD website and service. ClickeMD’s liability to you for any cause whatsoever, and regardless of the action, will at all times be limited to the amount paid, if any, by you to ClickeMD for the service during the entire term of your use.
Arbitration: You agree that any dispute arising out of use of the website or providers by you for medical malpractice in regard to medical services rendered to you by provider as to unnecessary or unauthorized or negligently or incompetently rendered, will be determined by submission to arbitration as provided by Florida law, and not by a lawsuit or court process except as Florida law provides for. Both parties to this informed consent, by entering into it and agreeing to it electronically, are giving up their constitutional right to have the dispute decided in a court of law before a jury, and instead are accepting the use of arbitration. This arbitration binds you and anyone else who may have a claim arising out of or related to all treatment or services provided by ClickeMD, including the following parties, spouses, heirs, children and includes all monetary damages exceeding small claims court limits and without limitation, wrongful death, emotional distress, suicide, loss of employment and permanent disability and class action proceedings. There are no third party beneficiaries to this informed consent. This consent is governed by the laws of the county of Pasco and the state of Florida.
Electronic Signature: You agree and certify that you have read, accept and hereby grant and consent to the terms of this ClickeMD Informed Consent agreement, and your acceptance of these terms constitutes your electronic signature to this agreement.
1. Treatment, Payment and Health Care Operations.
The following section describes different ways that we use and disclose health information for treatment, payment and health care operations. For each of those categories, we explain what we mean and give one or more examples. Not every use or disclosure will be noted and there may be incidental disclosures that are a byproduct of the listed uses and disclosures. The ways we use and disclose health information will fall within one of the categories.
A. For Treatment. We may use your health information to provide you with medical or psychiatric and/or psychological treatment or services. We may disclose your health information to staff physicians, psychiatrists, psychologists, clinical social workers, nurse practitioners, physicians assistants, medical assistants and other personnel involved in your health care. We may also disclose your health information to administrative personnel who, as a part of CEMD (and while supervised by physicians or clinicians), are involved in your care. Treatment includes (a) activities performed by physicians, nurses, office staff, hospital staff, technicians and other types of health care professionals providing care to you or coordinating or managing your care with third parties, (b) consultations with and between CEMD website providers and other health care providers, and (c) activities of non-CEMD providers or other providers covering an CEMD practice by HIPAA compliant Video, email or telephone or serving as the covering provider.
B. For Payment. We may use and disclose your health information so that we may bill and collect payment from you, an insurance company, or someone else for health care services you receive from CEMD. We may also tell your health plan about a treatment you are going to receive to obtain prior approval, or to determine whether your plan will pay for the treatment.
C. For Health Care Operations. We may use and disclose your health information in order to run the necessary administrative, quality assurance and business functions at CEMD. For example, we may use your health information to evaluate the performance of our website administrative. We may also use health information about patients to help us decide what additional services we should offer, how we can improve efficiency, or whether certain treatments are effective. Or we may give health information to doctors, nurses for review, analysis and other co-treating or referral purposes.
2. Investment Activities. As a part of CEMD’s healthcare operations, we may use and disclose a limited amount of your health information internally, or to CEMD third party business associates as defined by federal law fo the purposes of developing internal email, call center and promotional material to allow us to send you promotional emails, SMS or other offerings. The health information released for these purposes can include your name, address, other contact information, gender, age, date of birth, dates on which you received service, health insurance status, the outcome of your treatment at the CEMD website and your treating physician’s name and contact information on the CEMD website. Any communications you receive from CEMD or its advertisers will include information on how you can elect not to receive any further communications from CEMD.
3. Uses and Disclosures You Can Limit
a. CEMD Provider Directory. Unless you notify us that you object, we may include certain information about you in the CEMD online Provider directory in order to respond to inquiries.
b. Family and Friends. Unless you notify us that you object, we may provide your health information to individuals, such as family and friends, who are involved in your care or who help pay for your care. We may do this if you tell us we can do so, or if you know we are sharing your health information with these people and you don’t stop us from doing so. There may also be circumstances when we can assume, based on our professional judgment, that you would not object. For example, we may assume you agree to our disclosure of your information to your spouse if your spouse is with you during an online video consultation.
Also, if you are not able to approve or object to disclosures, we may make disclosures to a particular individual (such as a family member or friend), that we feel are in your best interest and that relate to that person’s involvement in your care. For example, we may tell someone who is present during the video consultation that you suffered from high blood pressure and provide updates on your condition. We may also make similar professional judgments about your best interests that allow another person to pick up such things as filled prescriptions, medical supplies and X-rays.
We may use or disclose your health information without your permission in the following circumstances, subject to all applicable legal requirements and limitations:
Other than for those purposes identified above in Sections B and C, we will not use or disclose your health information for any purpose unless you give us your specific written authorization to do so. Special circumstances that require an authorization include most uses and disclosures of your medical and/or psychotherapy notes, certain disclosures of your test results for the human immunodeficiency virus or HIV, uses and disclosures of your health information for marketing purposes that encourage you to purchase a product or service, and for sale of your health information with some exceptions. If you give us authorization, you can withdraw this written authorization at any time. To withdraw your authorization, deliver or fax a written revocation to CEMD 8224 Washington Street Port Richey FL. 34668. If you revoke your authorization, we will no longer use or disclose your health information as allowed by your written authorization, except to the extent that we have already relied on your authorization.