I hereby consent and authorize Curedose medical providers (which may include Medical doctors, Physician Assistants, Nurse Practitioners, and Medical Assistants) to administer and perform medical evaluation and treatment deemed necessary and release Curedose.com Inc of any legal responsibility incurred by the medical providers.
I understand that electronic communication technology will be used during online consultation, and such a consultation will not be the same as a direct patient-health care provider visit due to the fact that I will not be in the same room as my health care provider.
I understand there are potential risks to this technology, including interruptions, unauthorized access, and technical difficulties.
I understand that my healthcare information may be shared with the Curedose medical providers and pharmacy staff for the purpose of providing appropriate medication and treatment plans. Curedose medical providers will all maintain the confidentiality of the information obtained.
Telemedicine or Telehealth carries the risk of misdiagnosis or delayed diagnosis, which could lead to patients not receiving the proper treatment or even receiving the wrong treatment. I understand these potential risks and am willing to proceed with a consultation with Curedose.
Due to the potential risk of misdiagnosis or delayed diagnosis, I understand and agree to seek immediate medical care if my symptoms do not improve within a timely manner (typically within 48 hours)
I understand that the treatment, therapy or recommendations provided by Curedose medical team is an initial and first-line approach and I agree to follow up with a doctor in-person for a re-evaluation as needed.
I understand that the health care provider or I can discontinue the telemedicine visit if it is felt that the electronic communication technology is not adequate for the situation.
I understand that I have the right to withdraw my consent to the use of telemedicine or telehealth at any time in the course of care. As long as the consent is in force, Curedose medical team may provide health care services to me via telemedicine without the need to sign another consent form.
I understand that I have the right to withdraw my consent to the use of telemedicine or telehealth at any time in the course of care. As long as the consent is in force, Curedose medical team may provide health care services to me via telemedicine without the need to sign another consent form.
I have had the alternatives to a telemedicine or telehealth consultation explained to me, and I'm choosing to participate in a telemedicine or telehealth consultation. I understand that some parts of the exam involving physical tests may be limited due to the fact that I will not be in the same room as my health care provider.
I understand that Curedose.com utilizes both synchronized and asynchronized (store and forward) to deliver care. and I have visited www.Curedose.com to familiarize myself with these types of telemedicine practices, and their scope of practice.
I certify that I must be an adult patient or an adult legal guardian of a minor patient to use the Curedose.com platform.
I understand that services rendered by Curedose are provided on a non-refundable basis.
I understand that my payment to Curedose.com, the consultation fee, may not cover the prescribed medication and I still have to pay for the prescribe medication at the pharmacy.
I understand that the information given on the medical intake form must be complete, accurate and up-to-date to the best of my knowledge.
I understand that my failure to provide a complete, accurate and truthful information on the intake form puts me at a harmful risk of misdiagnosis and incomplete treatment.
I understand that Curedose reserves the right to decline treatment if misleading pieces of information are given by the patient or user.
