PATIENT CONSENT TO TELEHEALTH SERVICES

WHEN OUR DUTY OF CARE BEGINS

I understand that a doctor will take responsibility for my care only after I have created an account, truthfully answered all the required health questions on the patient questionnaire and provided a photo and/or have had a video visit and made payment, and after the doctor has reviewed my request for treatment, the health questions that I have completed on the patient questionnaire 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 doctor’s 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 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 has ordered the lab test. The duty of care does not extend to your wider health, even if you have told the doctor information about your health as part of our intake questionnaire.

I understand that the doctor has the right to refuse to take responsibility for my care if the doctor makes a professional judgment that I am not a good candidate for this service. I understand that making a request for treatment or requesting a lab test 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 Website that constitutes professional medical advice is the personalized messages the doctor sends me (once I have completed the health questions and made payment, and the doctor has subsequently taken responsibility for my care) and any content that the doctor links to in such messages and advice that a doctor provides in a video or telephone consultation. No other content on the 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 on the Website does not constitute professional medical advice and is instead for information purposes only. I understand that I should never disregard professional medical advice or delay in seeking it because of something I have read on the Website.

BENEFITS AND RISKS OF USING OUR SERVICE

I understand that by using the service I'm seeking care that's convenient and affordable.

I understand that important differences exist between Cleared's model of care and traditional healthcare. Specifically, by using Cleared I accept a greater responsibility to read and understand information throughout the Website about the limitations of Cleared's model of care, the risks of seeking care this way, and the risks and benefits of a proposed treatment plan.

I understand that I must read and understand the Consent to Telehealth, the Terms of Use, the Privacy Policy, the FAQs, the information provided in the health questions themselves, messages I receive from Cleared, and, very importantly, content provided via links in the message that the doctor sends me after the doctor has reviewed all my information and recommended a treatment plan and, when appropriate, prescribed a medicine.

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 Cleared 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 is unable independently to verify the information and photos I provide and that the doctor 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 allergies and other treatments and advice that the doctor thinks is appropriate to give online.

I understand that by using Cleared for a telehealth 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 Website for messages because this is the way that the doctor will communicate important information to me. I understand that if I don't check the 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 through the Website. I understand that the doctor may not review and respond to my messages until the next business day.

IMPORTANCE OF READING ALL THE INFORMATION WE PROVIDE

I understand that Cleared will provide detailed information on the 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 will send me when the doctor 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 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 Cleared I seek to enter into a relationship where the doctor relies exclusively upon information and photos that I provide to decide whether or not treatment is safe and appropriate.

I understand that the doctor has no way of verifying the information and photos that I provide and that the doctor 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 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 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 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 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 to see the full history of care that I've received from Cleared. This increases the chances that the doctor will not have access to important information and photos in my medical record that could influence the doctor's clinical decision.

I understand that by using Cleared I'm giving my explicit consent for the doctor to access medication history, where it's available, from records provided by pharmacy databases via the services of Surescripts and/or DoseSpot. I understand that, if appropriate, the doctor 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 Cleared visit.

RISKS OF ACCEPTING OUR TREATMENT PLAN

I understand that all the medicines that the doctor 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 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 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.