Noteikumi un nosacījumi

Noteikumi un nosacījumi NP in Family Health On Demand 24/7 PLLC

Es saprotu, ka dalība intravenozajā (“IV”) hidratācijā, vitamīnu/piedevu ievadīšanā, medikamentu ievadīšanā, programmās un pakalpojumos, ko piedāvā NP In Family Health On Demand 24/7, PLLC (“IV DRIPS”), ir saistīta ar risku. Riski ietver, bet neaprobežojas ar traumām, asiņošanu, infekciju, iekaisumu/ pietūkumu, zilumiem vai rētām, kas rodas no IV infiltrācijas, ekstravazācijas un ekstravazācijas, nepareizas IV līniju ievietošanas organismā, gaisa emboliju, šķidruma pārslodzi, medikamentu nevēlamu mijiedarbību, nervu bojājumiem, reiboni vai ģīboni. Ciktāl es iepriekš neatklāstu par saviem veselības stāvokļiem, medikamentiem vai narkotiku lietošanu, es atzīstu un piekrītu, ka vienīgais risks par traumām vai kaitējumu, kas jebkādā veidā var rasties, man izvēloties piedalīties šādā režīmā, programmās un pakalpojumos, ir pilnībā jāuzņemas man. Es skaidri apliecinu IV DRIPS, ka man nekad nav diagnosticētas vai ārstētas nekādas slimības, saslimšanas vai stāvokļi, kas var radīt paaugstinātu risku, ja es piedalos IV DRIPS piedāvātajos režīmos, programmās vai pakalpojumos. Turklāt es neizvēlos piedalīties, nepretendējot uz to, ka IV DRIPS pārbaudīs, diagnosticēs, uzraudzīs vai kā citādi nodrošinās šādu slimību aprūpi vai ārstēšanu. Es atzīstu un saprotu, ka IV DRIPS paļaujas uz iepriekš minēto. apliecinājumus, ko es sniedzu IV DRIPS, izvēloties pieņemt mani dalībai tās programmā(-ās) vai pakalpojumā(-os). Es apzinos, ka IV DRIPS nesniedz nekādas garantijas vai garantijas attiecībā uz IV, vitamīnu/piedevu ievadīšanas, zāļu ievadīšanas, programmu vai jebkādu citu IV DRIPS piedāvāto pakalpojumu rezultātiem vai vispārējiem panākumiem, un visi IV DRIPS izteiktie viedokļi par tiem ir viedokļi, uz kuriem nevajadzētu paļauties. Es apzinos, ka, piedaloties IV hidratācijā, vitamīnu/piedevu ievadīšanā, farmaceitisko preparātu ievadīšanā vai jebkurā IV DRIPS piedāvātajā programmā/pakalpojumā, manam īpašumam var rasties papildu kaitējums. Ar šo es uzskatu IV DRIPS par pilnībā nekaitīgu un pilnībā atlīdzināšu IV DRIPS visus šādus zaudējumus.

Es apzinos, ka sniegtos pakalpojumus nav novērtējusi ASV Pārtikas un zāļu pārvalde. Es apzinos, ka šie produkti nav paredzēti nekādas slimības diagnosticēšanai, ārstēšanai vai ārstēšanai. Es nepārprotami apliecinu un garantēju IV DRIPS, ka neesmu nelegālu narkotiku vai kontrolējamu vielu lietotājs un neesmu narkotiku vai kontrolējamu vielu ietekmē vai atveseļojos no narkotikām vai kontrolējamām vielām laikā, kad IV DRIPS sniedz man kādu pakalpojumu. Neatliekamas palīdzības gadījumā es noteikti zvanīšu 911 vai vērsīšos tuvākajā neatliekamās palīdzības nodaļā.

Pateicība: Es apliecinu, ka esmu izlasījis šo veidlapu un pilnībā saprotu tās saturu. Apstiprinu, ka man nav sniegtas nekādas garantijas vai apliecinājumi attiecībā uz rezultātiem, kas paredzēti IV DRIPS piedāvātajās nodarbībās un programmās. Es saprotu nodarbību un programmu būtību un to, ka dalība tajās ir saistīta ar risku. Man ir dota iespēja uzdot jautājumus, un uz visiem maniem jautājumiem ir sniegtas izsmeļošas un mani apmierinošas atbildes. Es uzņemos visus ar savu dalību saistītos riskus.

Pacienta atļauja izmantot un izpaust aizsargāto veselības informāciju: Parakstot šo veidlapu, es pilnvaroju IV DRIPS vajadzības gadījumā izmantot vai izpaust noteiktu personas informāciju. IV DRIPS var izpaust (ne tikai) šādu informāciju: pakalpojuma(-u) datums(-i), pakalpojuma(-u) veids(-i), jebkurš datu avots, vecums, dzimums un dzīvības rādītāji. Šī informācija tiks izmantota vai izpausta, lai (i) izpētes dati atspoguļotu izaugsmi un (ii) jebkura veida pakalpojumiem, ko pieprasa IV DRIPS esošie vai potenciālie klienti. Šī atļauja ir derīga vienu gadu no pakalpojuma sniegšanas dienas. IV DRIPS nesaņems samaksu vai citu atlīdzību no trešās personas par šādu pakalpojumu sniegšanu.apmaiņā pret personisko informāciju. Es saprotu, ka man nav pienākuma parakstīt šo pilnvarojumu. Kad mana informācija tiek izmantota vai izpausta saskaņā ar šo pilnvarojumu, saņēmējs to var atkārtoti izpaust, un, ievērojot noteiktu protokolu, uz to var vairs neattiekties HIPAA privātuma noteikumi. Ar šo es dodu IV DRIPS un visiem IV DRIPS darbiniekiem vai aģentiem tiesības un atļauju izmantot vai publicēt jebkādas manis uzņemtas fotogrāfijas mākslas vai reklāmas nolūkos, tostarp, bet ne tikai, reklāmai, publicitātei vai komerciālai/reklāmas izmantošanai. Es arī atļauju publicēt manas fotogrāfijas sociālajos medijos (piemēram, Facebook, Twitter, TikTok), tostarp IV DRIPS tīmekļa vietnē. Ar šo es atbrīvoju un atbrīvoju IV DRIPS un jebkuru ar to saistīto darbinieku/agentu no jebkādām juridiskām vai taisnīguma prasībām, kas radušās, bet neaprobežojas ar (i) attēlu(-u) izpludināšanu, (ii) pārveidošanu, (iii) izkropļošanu vai izmantošanu saliktā veidā, (iv) apmelošanu, (v) privātuma aizskārumu vai (vi) jebkādām prasībām, kuru pamatā ir jebkāda IV DRIPS sniegtā pakalpojuma rezultātā radīta materiāla sagatavošana vai publicēšana. Es piekrītu, ka IV DRIPS var izmantot manu vārdu, attēlu vai citātu jebkādai reklāmai, un saprotu, ka visas īpašumtiesības (piemēram, īpašuma tiesības) pieder IV DRIPS. Es piekrītu izmantot savu vārdu, attēlu vai citātu, kā to nosaka IV DRIPS, bet ne tikai, plašsaziņas līdzekļu saturā (piemēram, tīmekļa vietnē vai citātā).Piekrišana dalībai IV DRIPS lojalitātes programmā; Konvertētos punktus var izmantot tikai iegādājoties pilienus, izņemot bezmaksas pilienus pēc izvēles. Balvu izpirkšanu nevar apvienot ar citām akcijām. NAD+ un ketamīns nav iekļauti 10% un 15% atlaidē. Lojalitātes programmas priekšrocības nav nododamas.

Kredītkartes/debetkartes autorizācija: Parakstot šo veidlapu, es pilnvaroju IV DRIPS debetēt manu kredītkarti par jebkuru produktu/pakalpojumu un saprotu, ka šī atļauja ir derīga.

Es piekrītu iepriekš minētajiem noteikumiem:

Print:____ Sign:____ Date:____

HIPAA Ģimenes veselības aprūpes pēc pieprasījuma diennakts stacionārā PLLC, kas apkalpo IV DRIPS

Šajā Paziņojumā par privātuma praksi ir aprakstīts, kā mēs varam izmantot un izpaust jūsu aizsargāto veselības informāciju, lai veiktu ārstēšanu, apmaksu vai veselības aprūpes darbības, kā arī citiem mērķiem, kas ir atļauti vai pieprasīti ar likumu. Tajā aprakstītas arī jūsu tiesības piekļūt jūsu aizsargātajai veselības informācijai un kontrolēt to. “Aizsargāta veselības informācija” ir informācija par jums, tostarp demogrāfiskā informācija, kas var jūs identificēt un kas attiecas uz jūsu bijušo, esošo vai turpmāko ārsta vai garīgo veselību vai veselības stāvokli un ar to saistītajiem veselības aprūpes pakalpojumiem.

Mums ir jāievēro šī Paziņojuma par privātuma prakses nosacījumiem. Mēs jebkurā laikā varam mainīt mūsu paziņojuma noteikumus. Jaunais paziņojums stāsies spēkā attiecībā uz visu aizsargāto veselības informāciju, ko mēs tajā laikā glabājam. Pēc jūsu pieprasījuma mēs jums sniegsim pārskatīto Paziņojumu par privātuma prakses pārskatīšanu. Jūs varat pieprasīt pārskatīto versiju, apmeklējot mūsu tīmekļa vietni vai piezvanot uz biroju un pieprasot, lai pārskatīto versiju jums nosūta pa pastu, vai lūdzot to saņemt nākamās vizītes laikā.

  1. Aizsargātas veselības informācijas izmantošana un izpaušana

Jūsu aizsargāto veselības informāciju var izmantot un izpaust jūsu ārsts, mūsu biroja darbinieki un citas personas ārpus mūsu biroja, kas ir iesaistītas jūsu aprūpē un ārstēšanā, lai sniegtu jums veselības aprūpes pakalpojumus. Jūsu aizsargāto veselības informāciju var arī izmantot un izpaust, lai apmaksātu jūsu veselības aprūpes rēķinus un atbalstītu jūsu praktizējošā ārsta prakses darbību.Turpmāk ir sniegti piemēri, kādus jūsu aizsargātās veselības informācijas izmantošanas un izpaušanas veidus ir atļauts veikt jūsu praktizējošam ārstam. Šie piemēri nav izsmeļoši, bet apraksta izmantošanas un izpaušanas veidus, ko var veikt mūsu prakse.

Ārstēšana: Mēs izmantosim un izpaudīsim jūsu aizsargāto veselības informāciju, lai nodrošinātu, koordinētu vai pārvaldītu jūsu veselības aprūpi un jebkādus saistītos pakalpojumus. Tas ietver jūsu veselības aprūpes koordinēšanu vai pārvaldību ar citu pakalpojumu sniedzēju. Piemēram, ja nepieciešams, mēs izpaudīsim jūsu aizsargāto veselības informāciju mājas veselības aprūpes aģentūrai, kas sniedz jums aprūpi. Mēs arī izpaudīsim aizsargāto veselības informāciju citiem ārstiem, kuri var sniegt jums ārstniecisko palīdzību. Piemēram, jūsu aizsargāto veselības informāciju var sniegt ārstam, pie kura esat nosūtīts, lai nodrošinātu, ka ārstam ir nepieciešamā informācija, lai jūs diagnosticētu vai ārstētu. Turklāt mēs laiku pa laikam varam izpaust jūsu aizsargāto veselības informāciju citam pakalpojumu sniedzējam, kurš pēc jūsu ārsta pieprasījuma iesaistās jūsu aprūpē, sniedzot ārstam palīdzību jūsu veselības aprūpes diagnostikā vai ārstēšanā.

Maksājums: Jūsu aizsargātā veselības informācija tiks izmantota un izpausta, ja nepieciešams, lai saņemtu samaksu par mūsu vai cita pakalpojumu sniedzēja sniegtajiem veselības aprūpes pakalpojumiem. Tas var ietvert noteiktas darbības, ko jūsu veselības apdrošināšanas plāns var veikt, pirms tas apstiprina vai apmaksā jums ieteiktos veselības aprūpes pakalpojumus, piemēram: noteikt tiesības uz apdrošināšanas pabalstiem vai to segumu, pārbaudīt jums sniegto pakalpojumu medicīnisko nepieciešamību un veikt izmantošanas pārbaudes darbības.

Veselības aprūpes darbības: Mēs varam izmantot vai izpaust jūsu aizsargāto veselības informāciju, ja nepieciešams, lai atbalstītu prakses uzņēmējdarbību. Šīs darbības ietver, bet neaprobežojas ar kvalitātes novērtēšanas darbībām, darbinieku pārbaudes darbībām, medicīnas studentu apmācību un licencēšanu.

Mēs dalīsimies ar jūsu aizsargāto veselības informāciju ar trešajām personām, “biznesa partneriem”, kas mūsu prakses vajadzībām veic dažādas darbības (piemēram, rēķinu izrakstīšanas vai transkripcijas pakalpojumus). Ja vienošanās starp mūsu biroju un sadarbības partneri ietver jūsu aizsargātās veselības informācijas izmantošanu vai izpaušanu, mēs noslēgsim rakstisku līgumu, kurā būs ietverti noteikumi, kas aizsargās jūsu aizsargātās veselības informācijas konfidencialitāti.Mēs varam izmantot vai izpaust jūsu aizsargāto veselības informāciju, ja nepieciešams, lai sniegtu jums informāciju par ārstēšanas alternatīvām vai citām ar veselību saistītām priekšrocībām un pakalpojumiem, kas jūs varētu interesēt. Jūs varat sazināties ar mūsu privātuma amatpersonu, lai pieprasītu, lai šie materiāli jums netiktu nosūtīti.Citi atļautie un obligātie izmantošanas veidi un izpaušana, kas var tikt veikti bez jūsu atļaujas vai iespējas piekrist vai iebilst.

Mēs varam izmantot vai izpaust jūsu aizsargāto veselības informāciju šādās situācijās bez jūsu atļaujas vai iespējas jums piekrist vai iebilst. Šīs situācijas ietver:

  • Likumā prasīts: Mēs varam izmantot vai izpaust jūsu aizsargāto veselības informāciju, ciktāl to pieprasa likums. Izmantošana vai izpaušana tiks veikta saskaņā ar likumu, un tā būs ierobežota ar attiecīgajām likuma prasībām. Ja to pieprasa likums, jums tiks paziņots par jebkuru šādu izmantošanu vai izpaušanu.
  • Veselības uzraudzība: Mēs varam izpaust aizsargāto veselības informāciju veselības uzraudzības aģentūrai likumā atļautu darbību veikšanai, piemēram, revīzijām, izmeklēšanām un pārbaudēm.
  • Papildu situācijas ietver, bet neaprobežojas ar: ļaunprātīga izmantošana un nolaidība,. Krimināla darbība, Darbinieku kompensācija, Infekcijas slimības, Pētījumi, ko apstiprinājusi IRB, Sabiedrības veselība un tiesvedība.

Cits jūsu aizsargātās veselības informācijas izmantojums un izpaušana tiks veikta tikai ar jūsu rakstisku atļauju, ja vien likumā nav noteikts citādi, kā aprakstīts tālāk. Jūs jebkurā laikā varat atsaukt šo pilnvarojumu rakstiski. Lūdzu, ņemiet vērā, ka mēs nevaram atsaukt ar jūsu atļauju jau veikto informācijas izpaušanu.

Citi atļautie un obligātie izmantošanas veidi un izpaušanas veidi, kuru veikšanai jums ir jādod iespēja piekrist vai iebilst.

Mēs varam izmantot un izpaust jūsu aizsargāto veselības informāciju šādos gadījumos. Jums ir iespēja piekrist vai iebilst pret visas jūsu aizsargātās veselības informācijas vai tās daļas izmantošanu vai izpaušanu. Ja jūs neesat klāt vai nevarat piekrist vai iebilst pret aizsargātās veselības informācijas izmantošanu vai izpaušanu, tad jūsu ārsts, izmantojot profesionālu vērtējumu, var noteikt, vai informācijas izpaušana ir jūsu interesēs.

Others Involved in Your Health Care or Payment for your Care: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.

2. Your Rights

Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected health information about you for so long as we maintain the protected health information. You may obtain your medical record that contains medical and billing records and any other records that your practitioner and the practice uses for making decisions about you. As permitted by federal or state law, we may charge you a reasonable copy fee for a copy of your records. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or health care operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.Your practitioner is not required to agree to a restriction that you may request. If your practitioner does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your practitioner.You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We will not request an explanation from you as to the basis for the request. Please make this request in writing to us. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically. You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. We will not retaliate against you for filing a complaint.

I read, acknowledge and agree to the above.

Subscription Agreement for Telehealth

NP in Family Health on Demand 24/7 PLLC (the “Practice”) is honored to provide you with personalized support and care for the duration of your participation in our telehealth subscription program (the “Program”).

  1. Informed Consent for Telehealth Services. You agree to receive telehealth services for the duration of your participation in the Program. Telehealth involves the use of audio, video, or other electronic communications to interact with you, consult with your service provider, and/or review your medical information for the purpose of diagnosis, therapy, follow-up, coaching and/or education; telehealth may be provided as synchronous (in real time) or asynchronous (not in real time, such as by sending a chat or a photo and later receiving a response). During your telehealth consultation with the Practice, details of your medical history and personal health information may be collected and such information may be disclosed and/or discussed with other health professionals involved in your care and treatment through the use of interactive video, audio, and telecommunications technology. The benefits of telehealth include having access to specialists and additional medical information and education without having to travel outside of your home or local health care community. A potential risk of telehealth is that because of your specific medical condition or due to technical problems, a face-to-face consultation may still be necessary after the telehealth appointment. You agree that the Practice shall determine whether or not the condition being diagnosed and/or treated is appropriate for a telehealth encounter. Additionally, while the Practice shall comply with all administrative, physical and technical safeguards set forth in the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations, in rare circumstances, security protocols could fail, causing a breach of patient privacy. The Practice shall hold you harmless for any information lost due to technical failures. The alternative to receiving telehealth services is to not receive them. You understand the risks, benefits, and alternatives of receiving telehealth services. You may ask your provider any questions you may have regarding telehealth services. You may be asked to sign additional consents or provide additional information before receiving telehealth services if you reside in a state where additional documentation or additional information is required prior to receiving telehealth services.Our services should not be used for emergency care or services. If you’re experiencing a medical emergency, please call 911 immediately, or go to the nearest emergency room. ‍
  2. Program Details. The Program is intended to provide telehealth services on demand. You will make an appointment with the Practice to set up a video conference with a licensed nurse practitioner (“Nurse Practitioner”). A Nurse Practitioner will examine you and prescribe medication if need be. The Nurse Practitioner will only provide treatment in accordance with your medical needs. The Nurse Practitioner has the right to request additional information regarding your medical history and may refer to your primary care physician or a specialist for further treatment if the Nurse Practitioner deems it necessary. Please note that under the Program, Nurse Practitioner cannot prescribe any controlled substances, weight loss medication or any medication that requires ongoing monitoring.
  3. Plans. The Program offers three levels of service. Subscribers can choose from: (1) The Silver Plan, which includes one telehealth consultation per month and up to a three consultation roll over if a consultation is not used in any given month. Additional telehealth consultations shall be at an added cost. (2) The Gold Plan which includes unlimited telehealth consultations and blood work. (3) The Platinum Family Plan which offers the same benefits as the Gold Plan but for up to four family members over the age of 18.
  4. Subscription, Payment and Cancellation. The Program is a subscription-based program that charges a monthly fee for services (“Subscription”).
    • Your payment device will be automatically charged on a monthly basis until you cancel your Subscription in accordance with the terms herein.
    • To the extent permitted by law, Subscription fees are final and non-refundable expressly stated otherwise.
    • The Practice reserves the right to cancel your Subscription for non-payment, for breaching these terms, or for any act of aggression or violence towards Practice staff or contractors (as shall solely be determined by the Practice). In the event of such cancellation, you shall not be refunded any payment made for that Billing Cycle (as hereinafter defined).
    • You acknowledge and agree that your Subscription will automatically renew on a monthly basis on the monthly anniversary of you joining the Program (“Billing Cycle”) unless you cancel it in accordance with these terms.
    • Subscriptions automatically renew at the end of each Billing Cycle. To terminate this agreement prior to any renewal, you must email [email protected] no less than two (2) business days prior to the end of your Billing Cycle.
    • You understand and agree that the cancellation or termination of your Subscription pursuant to the terms of this Agreement is your sole remedy with respect to any dispute with the Practice.
    • Upon the cancellation or termination of your Subscription, we may immediately deactivate your access to our services. Your access to telehealth will be suspended as of the date your participation in the Program ends.
    • Plan accordingly to ensure that your access to any prescription medication is not interrupted as a result of any cancellation.
  5. Subscription Products. Prescription drugs of any sort prescribed by the Practice are additional out of pocket expenses and are not included in the Program. You are fully responsible for any costs associated with filling prescriptions prescribed by the Practice at the pharmacy of your choice.
  6. Confidentiality and Compliance. We will take appropriate precautions to keep your health information confidential and not disclose it without your consent. You are also protected under the provisions of the federal Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and any other applicable federal and state laws related to the protection of patient information and how we will use and disclose your protected health information.
  7. Consent to Call, Email, Text, and Application Messaging. You expressly consent to allow our agents and us to communicate with you by telephone call, email, text message, and/or other forms of unencrypted electronic messaging (“Electronic Messages”) using any telephone numbers or email addresses that you provide us or that we obtain lawfully. You expressly agree to receive prerecorded or automated Electronic Messages from us.You understand the risks associated with communicating through Electronic Messages, including, without limitation, that Electronic Messages can easily be misaddressed to or forwarded to unintended recipients, that Electronic Messages can be stored, that backup copies of Electronic Messages may exist even after the Electronic Messages are deleted, that Electronic Messages may not be secure and thus may be used or forwarded without your permission or knowledge, that Electronic Messages may be inspected by your telephone carrier, and that Electronic Messages may be used as evidence in court. You understand that we are not liable for any breaches of confidentiality caused by you or a third party. You understand that Electronic Messages may be filed in your medical record. You may opt out of automated Electronic Messages, including SMS and/or email, at any time by sending a request via email to [email protected]. You acknowledge and agree to receive a final message confirming your choice to opt out. Unless you revoke your consent to communicate with us via Electronic Messages, your consent will last for the duration of your participation in the Program.In exchange for the services provided by us, you release us from all claims, causes of action, lawsuits, damages, losses, liabilities, or other harms relating to any Electronic Messages you exchange with us. You release us from all claims, causes of action, or lawsuits based on any alleged violations of any laws, including the Telephone Consumer Protection Act, the Truth in Caller ID Act, the CAN-SPAM Act, the Fair Debt Collection Practices Act, the Fair Credit Reporting Act, HIPAA, any similar state and local acts or statutes, and any federal or state tort or consumer protection laws.
  8. Notice Regarding Your Financial Responsibility for Services. Neither the Practice nor any of its Providers are enrolled with or a participating provider with any federal or state healthcare programs (i.e., Medicare, Medicaid) for the provision of any healthcare services or supplies and, as such, you acknowledge and agree that (1) you have sole financial responsibility for all Subscription services or products you purchase, and (2) neither you, nor the Practice may submit a claim for reimbursement to any federal or state healthcare program for the costs of the services and products provided to you.
  9. Indemnification. You agree to defend, indemnify and hold the Practice, its officers, directors, managers, partners, employees, agents, and suppliers harmless from and against all third-party claims, demands, damages, liabilities, costs and expenses including reasonable attorneys’ fees against or incurred by the Practice arising out of your: (1) breach of these terms; (2) violation by you of any and all applicable laws, regulations or rules; or (3) your use of the Program’s materials or features in an unauthorized manner.
  10. Arbitration Agreement. You agree that any dispute between you and the Practice shall be resolved by binding, individual arbitration conducted before one commercial arbitrator from the American Arbitration Association (“AAA”), and you knowingly waive your rights to a jury trial and to participate in a class action lawsuit or class-wide arbitration.   The arbitration will be governed by the AAA’s commercial arbitration rules and payment of arbitration costs will be governed by the AAA’s fee schedule.
  11. Disclaimer.
    • The Services are not intended for individuals under the age of eighteen (18), and individuals under the age of eighteen (18) are prohibited from participating in the Program.
    • Your compliance with all the terms described herein, as well as all applicable laws and regulations, is a condition of your participation in the Program.
    • Your interactions with the Practice and participation in the Program is not intended to take the place of your relationship with your regular health care practitioners.
    • The Practice does not guarantee any specific outcomes associated with your participation in the Program.
    • You agree that the Practice shall not be liable for any damages, losses, or liabilities arising from the use of or reliance on the Program.
  12. Acknowledgment. You have read and understand the information provided above and understand and agree to the terms in this Agreement, including the services, payment methods, and cancellation policy.

By accessing or using the services, clicking “I agree”, checking a related box to signify your acceptance, or using any other acceptance protocol presented through the platform, you acknowledge that you have read, understood, and agreed to be legally bound by and comply with these terms. If you do not or cannot agree to any part of these terms, you may not participate in the Program.

Subscription Agreement for Weight Loss Program

NP in Family Health on Demand 24/7 PLLC (the “Practice”) is honored to provide you with personalized support and care for the duration of your participation in our Hosch Wellness weight loss program (the “Program”) via telehealth.

  1. Informed Consent for Telehealth Services. You agree to receive telehealth services for the duration of your participation in the Program. Telehealth involves the use of audio, video, or other electronic communications to interact with you, consult with your service provider, and/or review your medical information for the purpose of diagnosis, therapy, follow-up, coaching and/or education; telehealth may be provided as synchronous (in real time) or asynchronous (not in real time, such as by sending a chat or a photo and later receiving a response). During your telehealth consultation with the Practice, details of your medical history and personal health information may be collected and such information may be disclosed and/or discussed with other health professionals involved in your care and treatment through the use of interactive video, audio, and telecommunications technology. The benefits of telehealth include having access to specialists and additional medical information and education without having to travel outside of your home or local health care community. A potential risk of telehealth is that because of your specific medical condition or due to technical problems, a face-to-face consultation may still be necessary after the telehealth appointment. You agree that the Practice shall determine whether or not the condition being diagnosed and/or treated is appropriate for a telehealth encounter. Additionally, while the Practice shall comply with all administrative, physical and technical safeguards set forth in the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations, in rare circumstances, security protocols could fail, causing a breach of patient privacy. The Practice shall hold you harmless for any information lost due to technical failures. The alternative to receiving telehealth services is to not receive them. You understand the risks, benefits, and alternatives of receiving telehealth services. You may ask your provider any questions you may have regarding telehealth services. You may be asked to sign additional consents or provide additional information before receiving telehealth services if you reside in a state where additional documentation or additional information is required prior to receiving telehealth services.Our services should not be used for emergency care or services. If you’re experiencing a medical emergency, please call 911 immediately, or go to the nearest emergency room.
  2. Program Details. The Program is a program to help you lose weight. Once you join, you will receive an initial telehealth consultation and blood test to determine eligibility for the Program. If you are deemed eligible, you will receive a personalized weight loss plan with customized medicated treatment to help you lose weight. You will also receive a dedicated nurse practitioner who you can check in with every three weeks to monitor your progress and provide any necessary ongoing medical treatment and/or prescription drugs. If you are not deemed eligible you will be refunded your enrollment fee.
  3. Subscription, Payment and Cancellation.The Program is a subscription-based program that offers terms of six months and twelve months (“Subscription”).
    • Your payment device will be automatically charged on a monthly basis until you cancel your Subscription in accordance with the terms herein.
    • To the extent permitted by law, Subscription fees are final, non-refundable and subject to an early termination fee unless expressly stated otherwise.
    • The Practice reserves the right to cancel your Subscription for non-payment, for breaching these terms, or for any act of aggression or violence towards Practice staff or contractors (as shall solely be determined by the Practice). In the event of such cancellation, you shall be liable to any applicable early termination fee.
    • You acknowledge and agree that your Subscription will automatically renew at the end of any term unless you cancel it in accordance with these terms.
    • Cancelling your Subscription prior to the end of any term shall be subject to a fee equal to three (3) months’ worth of the Subscription cost.
    • Subscriptions automatically renew at the end of each term. To terminate this agreement prior to any renewal, you must email [email protected] no less than thirty (30) days prior to the end of any then-current term.
    • You understand and agree that the cancellation or termination of your Subscription pursuant to the terms of this Agreement is your sole remedy with respect to any dispute with the Practice.
    • Upon cancellation or termination of your Subscription, we may immediately deactivate your access to our services. Your access to telehealth will be suspended as of the date of cancellation.
    • Plan accordingly to ensure that your access to any prescription medication is not interrupted as a result of the cancellation.
  4. Subscription Products. Prescription drugs of any sort prescribed by the Practice are additional out of pocket expenses and are not included in the Program. You are fully responsible for any costs associated with filling prescriptions prescribed by the Practice at the pharmacy of your choice.
  5. Confidentiality and Compliance. We will take appropriate precautions to keep your health information confidential and not disclose it without your consent. You are also protected under the provisions of the federal Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and any other applicable federal and state laws related to the protection of patient information and how we will use and disclose your protected health information.
  6. Consent to Call, Email, Text, and Application Messaging. You expressly consent to allow our agents and us to communicate with you by telephone call, email, text message, and/or other forms of unencrypted electronic messaging (“Electronic Messages”) using any telephone numbers or email addresses that you provide us or that we obtain lawfully. You expressly agree to receive prerecorded or automated Electronic Messages from us.You understand the risks associated with communicating through Electronic Messages, including, without limitation, that Electronic Messages can easily be misaddressed to or forwarded to unintended recipients, that Electronic Messages can be stored, that backup copies of Electronic Messages may exist even after the Electronic Messages are deleted, that Electronic Messages may not be secure and thus may be used or forwarded without your permission or knowledge, that Electronic Messages may be inspected by your telephone carrier, and that Electronic Messages may be used as evidence in court. You understand that we are not liable for any breaches of confidentiality caused by you or a third party. You understand that Electronic Messages may be filed in your medical record. You may opt out of automated Electronic Messages, including SMS and/or email, at any time by sending a request via email to [email protected]. You acknowledge and agree to receive a final message confirming your choice to opt out. Unless you revoke your consent to communicate with us via Electronic Messages, your consent will last for the duration of your participation in the Program.In exchange for the services provided by us, you release us from all claims, causes of action, lawsuits, damages, losses, liabilities, or other harms relating to any Electronic Messages you exchange with us. You release us from all claims, causes of action, or lawsuits based on any alleged violations of any laws, including the Telephone Consumer Protection Act, the Truth in Caller ID Act, the CAN-SPAM Act, the Fair Debt Collection Practices Act, the Fair Credit Reporting Act, HIPAA, any similar state and local acts or statutes, and any federal or state tort or consumer protection laws.
  7. Notice Regarding Your Financial Responsibility for Services. Neither the Practice nor any of its Providers are enrolled with or a participating provider with any federal or state healthcare programs (i.e., Medicare, Medicaid) for the provision of any healthcare services or supplies and, as such, you acknowledge and agree that (1) you have sole financial responsibility for all Subscription services or products you purchase, and (2) neither you, nor the Practice may submit a claim for reimbursement to any federal or state healthcare program for the costs of the services and products provided to you.
  8. Indemnification. You agree to defend, indemnify and hold the Practice, its officers, directors, managers, partners, employees, agents, and suppliers harmless from and against all third-party claims, demands, damages, liabilities, costs and expenses including reasonable attorneys’ fees against or incurred by the Practice arising out of your: (1) breach of these terms; (2) violation by you of any and all applicable laws, regulations or rules; or (3) your use of the Program’s materials or features in an unauthorized manner.
  9. Arbitration Agreement. You agree that any dispute between you and the Practice shall be resolved by binding, individual arbitration conducted before one commercial arbitrator from the American Arbitration Association (“AAA”), and you knowingly waive your rights to a jury trial and to participate in a class action lawsuit or class-wide arbitration. The arbitration will be governed by the AAA’s commercial arbitration rules and payment of arbitration costs will be governed by the AAA’s fee schedule.
  10. Disclaimer.
    • The Services are not intended for individuals under the age of eighteen (18), and individuals under the age of eighteen (18) are prohibited from participating in the Program.
    • Your compliance with all the terms described herein, as well as all applicable laws and regulations, is a condition of your participation in the Program.
    • Your interactions with the Practice and participation in the Program is not intended to take the place of your relationship with your regular health care practitioners.
    • The Program is not approved by the FDA and is considered off label use.
    • The Practice does not guarantee any specific results or outcomes associated with your participation in the Program.
    • Individual results may vary, and the effectiveness of the Program may depend on various factors, including but not limited to each individual’s health condition, adherence to recommended guidelines, and other personal circumstances.
    • You agree that the Practice shall not be liable for any damages, losses, or liabilities arising from the use of or reliance on the Program.
  11. Acknowledgment. You have read and understand the information provided above and understand and agree to the terms in this Agreement, including the services, payment methods, and cancellation policy.

By accessing or using the services, clicking “I agree”, checking a related box to signify your acceptance, or using any other acceptance protocol presented through the platform, you acknowledge that you have read, understood, and agreed to be legally bound by and comply with these terms. If you do not or cannot agree to any part of these terms, you may not participate in the Program.