Informed Consent


For Services provided by ClickeMD, Inc., (“ClickeMD”, “We”, “Our” “Us”)


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.

You agree to the following while using the ClickeMD Website and Services:

  1. Services provided on this Website are provided at the sole discretion of the Providers.
  2. Service is limited to the diagnosis and treatment recommendations of uncomplicated Non-Emergency medical conditions that are appropriate for diagnosis and treatment using HIPAA compliant video, email or telephone.
  3. Accessing this Website and Services from a state other than a state which ClickeMD or providers operate in is prohibited.
  4. You confirm here that you are physically located in a state which ClickeMD operates in when you request to use the service.
  5. Any and all services provided by ClickeMD on this Website are not reimbursable by Medicare, Medicaid or any other governmental health care program, and you agree to hold ClickeMD harmless if you should use our services that are or might be reimbursable by such programs.
  6. The services may not be reimbursable by commercial insurers, managed care organizations, preferred provider organizations or other health insurance payors.
  7. You are 18 years of age or older.

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.




CLICKEMD, INC. WWW.CLICKEMD.COM


Privacy Policy


THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.


A. PURPOSE OF THIS NOTICE.

CLICKEMD, Inc. (“CEMD”) is committed to preserving the privacy of your health information. In fact, we are required by law to do so for any health information created or received by us. CLICKEMD is required to provide this Notice of Privacy Policy (“Notice”) to you. The Notice tells you how we can and cannot use and disclose the health information that you have given to us or that we have learned about you when you were a patient in our Online Telemedicine system. It also tells you about your rights and our legal duties concerning your health information.
CEMD is required to abide by this Notice and any future changes to the Notice that we are required or authorized by law to make at all CEMD locations, including any medical facilities open to the public that CEMD may operate both in Florida and in other states, any primary care and specialty clinics; psychiatric medical facilities or facilities offering psychological counseling services, and community service and outreach programs. This Notice applies to the practices of: