Consent to Telehealth

CONSENT TO TELEHEALTH, MDANYWHERE.COM

Last updated: 06/11/22

THIS IS NOT FOR EMERGENCIES!

You should never seek professional services from the providers of Access Medical Associates, PLLC using MDAnywhere.com for a medical emergency. For emergencies, dial 911 or go to an emergency department immediately.

Please make sure you read all of the important information below which covers the following topics:

• Our medical team consists of doctors.
• When our duty of care begins.
• The benefits and risks of using our service.
• The importance of reading all of the information we provide.
• The importance of answering all questions fully and truthfully.
• The risks of accepting a treatment plan.
• Medications which will not be prescribed.
• The risks of electronic health information.

Only use our service if you've read this information and subsequently made an informed decision that our service is right for you. If you have any questions, please send us a message through the MDAnywhere.com website messaging service, email, or call us at 1-800-632-4981.

BACKGROUND INFORMATION

Access Medical Associates, PLLC provides medical services (the “Medical Services”) through the MDAnywhere.com website (the “Website”). Medical Services are provided exclusively by the licensed medical providers of Access Medical Associates, PLLC, a professional corporation consisting of doctors.  Access Medical Associates, PLLC does not make any guarantees with respect to the outcome of the Medical Services and does not guarantee any results.

The medical team is made up only of doctors at this time. They do not provide comprehensive medical care or services other than the listed services.

The doctors can only provide care in states where regulations permit this practice and where they maintain an active medical license. Thus, our services may not be available in all states.

We are not a pharmacy. We do not guarantee that a prescription will be written. If the doctors determine that you can safely be treated online, prescriptions will be sent electronically to the pharmacy of your choosing. You shall be responsible for all payment in connection with prescriptions.  Controlled substances, including but not limited to opioids, benzodiazepines, cannabinoids, amphetamines or any other medications with abuse potential will not be prescribed under any circumstances.

We do not offer an insurance product.

By using our service you have read, understood, and agreed to the Terms of Use, Privacy Policy, Notice of Privacy Practices, Prescription Policy and this Consent to Telehealth:

WHEN OUR DUTY OF CARE BEGINS

I understand that the doctor will take responsibility for my care only after I have answered all the required health questions fully and truthfully, created an account in my legal name, provided any necessary photo(s), made payment, and the doctor has subsequently reviewed my request for treatment, my demographic information, the answers to the health questions that I have completed, any photos, and any other information I have provided, and then subsequently determined that I am a good candidate for telehealth services. I understand that the duty of care does not begin at the point of me answering questions or making payment but at the point at which the doctor accepts the duty of care, as described above.

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 and I should seek medical attention from and in-person health care provider immediately.  I understand that making a request for treatment (by completing a visit in the MDAnywhere.com website and making payment to Access Medical Associates, PLLC) or sending a message through the Website does not create a duty of care or create a doctor-patient relationship.

I understand that there may be a delay until the next business day before a doctor reviews my request for treatment and any messages I send. I understand that it is my responsibility to seek medical care immediately if my condition worsens while waiting for treatment.

I understand that the only content on 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 linked to in such messages by the doctor. I understand that no other content on the Website constitutes professional medical advice. I understand that the information provided in our health questions about who can and cannot be treated does not constitute professional medical advice.

I understand that all other content on the Website does not constitute professional medical advice and is for informational purposes only. I should never disregard or delay seeking professional medical advice because of something I have read on the Website.

I understand that Medical Services obtained utilizing the Website does not replace my relationship with my primary care provider or any other in-person health care providers.

BENEFITS AND RISKS OF USING OUR SERVICE

I understand that by obtaining Medical Services utilizing the Website I am receiving  quick, convenient and affordable care.

I understand that important differences exist between the care offered by Access Medical Associates, PLLC utilizing the Website and traditional healthcare. Specifically, by using the Website in order to obtain medical care from Access Medical Associates, PLLC I accept the responsibility of reading and understanding information throughout the Website about the limitations of this model of care, the risks of seeking care this way, and the risks and benefits of a proposed treatment plan.

I acknowledge that I must read and understand this Consent to Telehealth, the Terms of Use, the Privacy Policy, the Notice of Privacy Practices, the FAQs, the information provided about a service before I answer health questions, the information provided in the health questions themselves, messages I receive from the doctors utilizing the Website, and the care plan sent to me and 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 buttons to view the important information that they contain, and that without clicking on these links and buttons I will not be able to read important information that enables me to give my informed consent to a treatment. This may include my responsibility to click on the link to my discharge information, which contains important information regarding what to expect with my treatment, how to improve my outcome by using certain home remedies and other additional treatments, and important warning signs that I must look out for in order to identify any worsening or complication of my condition.

I understand that by obtaining medical care from the doctors of Access Medical Associates, PLLC utilizing the Website  I accept the responsibility of providing full and truthful answers to all questions and, when requested, unaltered photos of me that are taken at the time of using the service.

I understand that the doctor is unable to authenticate  the information and photos I provide and that the doctor must rely on them in good faith in order to render  a professional judgment.

I understand that I will not receive any other medical services that go beyond the online treatment of:

1. Acne
2. Allergies-Seasonal and Environmental
3. Asthma
4. Athlete's Foot
5. Birth Control
6. Body Lice Prevention
7. Burn Evaluation
8. Cold Sore
9. Cough, Congestion and Bronchitis
10. COVID-19 (SARS-CoV-2) Antibody test
11. Dark Spot Reducer
12. Eczema
13. Epinephrine Autoinjector Refill
14. Erectile dysfunction
15. Eyelash Enhancement (Latisse®)
16. Folliculitis (Razor Bumps)
17. General Skin, Rash, and/or Skin Infection Visit
18. Genital Herpes
19. Hair Loss
20. Influenza (Flu)
21. Influenza (Flu) Prevention
22. Insect Bite/Sting Reaction
23. Lab and Cologuard® testing
24. Laryngitis (Lost or Hoarse Voice)
25. Medication (Prescription) Refill
26. Motion Sickness Prevention
27. Naloxone Opioid Antidote
28. Pertussis (Whooping Cough) Prevention
29. Pink Eye
30. Pinworm Prevention
31. Poison Ivy, Oak and Sumac
32. Respiratory Infection
33. Ringworm
34. Scabies Prevention
35. Shingles
36. Sinus Congestion/Infection
37. Stye
38. Tick Bite-Lyme prevention
39. Toothache
40. Traveler’s diarrhea
41. Unwanted Facial Hair (Vaniqa®)
42. UTI (Urinary Tract Infection)
43. Wrinkle Reducer
44. Yeast Infection
45. Doctor's notes
46. Documentation of Recovery from COVID-19/Travel Clearance

I need to seek other sources of care for my other medical needs.

I understand that by using the Website for a telemedical consultation, I will not have an in-person or live audio or video consultation and/or a complete physical exam which may provide additional information to the examining doctor, facilitating diagnosis and treatment of conditions other than those listed.

I understand that by using the service I will not necessarily speak to or message with a doctor or nurse in real time.

I understand that by registering on the Website to obtain Medical Services, I will gain access to a secure patient portal where any messages from physicians regarding my care, as well as other protected health information (PHI) will be maintained. I understand that I must check my secure MDAnywhere.com portal for messages because this is the only way that the doctor will be able to communicate important information to me. I will not attempt to communicate with the medical team caring for me , by any other means, as communication by any other method is not secure. I understand that if I do not check my portal regularly my care may be delayed.

I understand that if I have any questions relating to my care that are not urgent, I can message the health care team through my portal. I understand that the health care team may not review and respond to my messages until the next business day.

IMPORTANCE OF READING THE INFORMATION WE PROVIDE

I understand that information will be provided by the doctor through the Website which will help me make an informed decision about whether to accept a proposed treatment plan. I understand that the most important information about a treatment plan is in the “Discharge Instructions” link that the doctor will send me when a treatment is prescribed. I understand that this link will include detailed information to help me decide if the benefits of the treatment plan outweigh the risks, given the alternative options available to me, which include the option of not accepting treatment from the doctors through the Website and instead seeking care from a licensed, in-person medical provider.

I understand that this link will also include information about adverse events, including the signs and symptoms of common and potentially serious side effects of medications, or signs and symptoms which indicate my condition is not improving or worsening, and if this is the case I will be instructed to seek immediate medical attention.

IMPORTANCE OF ANSWERING ALL QUESTIONS FULLY AND TRUTHFULLY

I understand that by using MDAnywhere.com I 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 of my answers to health questions. I understand that all photos will be considered to be of me, unaltered, and taken at the time of me using the service.

I understand that if I provide information that is not true and complete, that puts me at greater risk of adverse events from any treatment that the doctor provides and, as a result, my treatment may be unnecessary, inappropriate, or unsafe.

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 will be at greater risk of adverse events from any treatment that a doctor may provide or withhold and I may receive treatment that is unnecessary, inappropriate, or unsafe, or I may be withheld treatment that would otherwise be necessary.

I understand that even if I provide information that is true and complete, I am still at risk of adverse events from any treatment that the doctor prescribes.

I understand that it is important that I do not 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 have received from the medical team. I understand that 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 making.

I understand that by using the Website to obtain medical care I am giving my explicit consent for the doctor to access medication history, when available, from records provided by pharmacy databases via the services of DoseSpot. I understand that, if appropriate, the doctor may take this information into account when making a treatment and prescribing decision but it is still important that I provide full, true and complete information during the visit.

RISKS OF ACCEPTING OUR TREATMENT PLAN

I understand that all the medicines that the doctor may prescribe or recommend for any of our treatments, including over-the-counter medicines and prescription 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. I understand that I must weigh the risks and benefits of the treatment being prescribed, alternative treatment options and the risks and benefits of such alternatives, and the option of not seeking or receiving treatment from the doctors of Access Medical Associates, PLLC but seeking treatment from an in-person medical provider.

I understand the importance of reading the manufacturer's leaflet that comes with a medication, including any over-the-counter or prescription medicine, before I take a medication because this leaflet includes important information about interactions, risks, cautions and warnings.

I understand that adverse events can be caused by a number of factors, 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 remedies (e.g., supplements, herbs, over-the-counter medicines) I am taking, tobacco products, alcohol or recreational drugs.

I understand that even if I answer the questions accurately and the doctors provide a diagnosis and prescribe treatment, it is my responsibility to seek follow up care in person with a licensed medical provider within 3 days (72 hours) to confirm the diagnosis and evaluate for any possible complications. I understand it may also be necessary for me to seek additional care from an in-person doctor or specialist if the treatment is not effective or the doctors consider my condition to be too complicated to manage online. I understand that if I do not follow this recommendation, I may be ignoring a potentially serious underlying medical condition, which may result in hospitalization, permanent disability or death.

Acne

I understand that by requesting treatment for my acne, the doctor’s evaluation depends on honest answers to the questions and good quality photos. I understand that if I do not answer the questions accurately, or if the photos that I send to the doctors are not representative of my condition, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability or death.

I understand that tretinoin is one of the medications that may be used to treat my acne. I understand that the use of this medication during pregnancy is not recommended, as it caused birth defects in animal studies and in some pregnant women. I understand that I should discontinue use if I become pregnant or plan to become pregnant. I understand that it is not known if this medication is present in breast milk, and I should discontinue use if breastfeeding. I understand that I must let the doctors know if I am pregnant or plan to become pregnant.

Allergies-Seasonal and Environmental

I understand that by requesting treatment for environmental allergies, the doctor’s evaluation depends on honest answers to the questions. I understand that if I do not answer the questions accurately, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability or death.

Asthma Inhaler

I understand that by requesting treatment for asthma, the doctor’s evaluation depends on honest answers to the questions. I understand that if I do not answer the questions accurately, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability or death.

Athlete’s foot

I understand that by requesting treatment for athlete’s foot, the doctor’s evaluation depends on honest answers to the questions and good quality photos. I understand that if I do not answer the questions accurately, my condition may be underestimated, and the doctor could miss a serious skin infection, vascular disease, or some other serious medical problem, and my condition could worsen very quickly, leading to hospitalization, permanent disability or death.

Birth Control Refill

I understand that hormonal birth control that contains estrogen, such as combination birth control pills, the birth control patch, and the birth control ring, has a higher risk of serious side effects and adverse events, including blood clots, stroke, permanent disability, and death, than birth control that does not contain estrogen. Progestin-only pills do not contain estrogen and therefore present a lower risk of serious side effects. I understand that there are also birth control methods that do not contain hormones, such as barrier methods like condoms, and abstinence.

I understand that if I request a prescription for a combination pill, birth control patch or birth control ring that contains estrogen, it is important that I provide a recent and accurate blood pressure measurement because I should not take birth control that contains estrogen if I have a history of high blood pressure. I understand that if I take a combination pill, birth control patch or birth control ring without knowing my blood pressure then I am putting myself at significant risk of blood clots, stroke, permanent disability, and death.

I understand that I can request a prescription for many different types of birth control pills, and these pills have different risks of adverse events.

I understand that if I request a prescription for a specific birth control, then I accept any increased risk of adverse events and serious side effects associated with that particular medicine.

I understand that by requesting a refill of my birth control medicine, the doctor’s evaluation depends on honest answers to my questions. I understand that if I do not answer the questions accurately, I put myself at increased risk for permanent disability and death.

I understand that the goal of birth control medication prevents pregnancy and certify that I do not wish to become pregnant at this time. I also understand that I may become pregnant while taking birth control medication, as it is not 100% effective. I also attest that I have had a negative pregnancy test within 7 days of requesting birth control medication, and I have not been pregnant within the last 60 days (2 months).

I understand that while birth control medication reduces the chances of pregnancy, it does not prevent any sexually-transmitted infections (STIs), and that barrier protection and abstinence are the most effective ways  to reduce the chances of STIs.

Body Lice Prevention

I understand that this treatment is to help prevent body lice after an exposure, and that if I have any symptoms right now I should see a licensed medical provider immediately. I understand that even if I take this medication, it is not 100 percent effective and I may still get body lice.

I understand that by requesting treatment for body lice exposure, the doctor’s evaluation depends on honest answers to the questions. I understand that if I do not answer the questions accurately, my condition may be underestimated, and the doctor could miss serious and potentially life-threatening medical conditions, leading to hospitalization, permanent disability and death.

Burn Evaluation

I understand that by requesting treatment for a burn, the doctor’s evaluation depends on honest answers to the questions and good quality photos. I understand that if I do not answer the questions accurately, or if the photos that I send to the doctors are not representative of my condition, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability and death.

Cold Sore (Herpes Labialis)

I understand that by requesting treatment for cold sores, the doctor’s evaluation depends on honest answers to the questions and good quality photos. I understand that if I do not answer the questions accurately, or if the photos that I send to the doctors are not representative of my condition, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability or death.

I understand that the FDA has not specifically approved medicines to be taken on a daily basis or as-needed basis as the doctors prescribe them, and that taking cold sore medications in this way is 'off-label use'. I understand that cold sore medication does not remove the underlying virus that causes cold sores and that I will likely have outbreaks again in the future.

Cough/Chest Congestion/Bronchitis

I understand that by requesting treatment for cough, chest congestion or bronchitis, the doctor’s evaluation depends on honest answers to the questions. I understand that if I do not answer the questions accurately, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability or death.

COVID-19 (SARS-CoV-2) Antibody Test

I understand that by requesting a COVID-19 (SARS-CoV-2) antibody test, the doctor’s evaluation depends on honest answers to the questions. I understand that if I do not answer the questions accurately, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability or death.

I understand that the doctor is only ordering the test, and the cost of the visit does not include laboratory fees which can vary depending on the lab. I understand that the test has not been fully studied and is not 100 percent accurate. I understand that even if I test positive for antibodies to COVID-19 (SARS-CoV-2) there is a chance I am not immune, and I should still practice social distancing and wear a mask as required by public health authorities. I understand that my body may not make antibodies until at least 2 weeks after symptoms of the infection started, and that I should wait 2 weeks before being tested. I understand that if do not wait long enough to be tested, I may get a false-negative result. I understand that if I develop symptoms of COVID-19 I should seek medical attention.

Dark Spot Reducer

I understand that the medication hydroquinone is an approved treatment to reduce pigmentation of the skin (lighten dark spots). I understand that it may be 12 weeks (3 months) before I see the full effects of this treatment. I understand that this treatment does not always work, and I should stop using the medication if I do not see an improvement after 2-3 months of use. I understand that the use of this medication during pregnancy has not been well-studied, and the effects on the fetus are unknown. I understand that I should discontinue use if I become pregnant or plan to become pregnant. I understand that it is not known if this medication is present in breast milk, and I should discontinue use if breastfeeding.

I understand that by requesting treatment for dark spots, the doctor’s evaluation depends on honest answers to the questions and good quality photos. I understand that if I do not answer the questions accurately, or if the photos that I send to the doctors are not representative of my condition, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability and death.

Eczema

I understand that by requesting treatment for eczema, the doctor’s evaluation depends on honest answers to the questions and good quality photos. I understand that if I do not answer the questions accurately, or if the photos that I send to the doctors are not representative of my condition, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability and death.

Epinephrine Auto-injector Refill

I understand that by requesting a refill of my epinephrine auto-injector, the doctor's evaluation depends on honest answers to the questions. I understand that if I do not answer the questions accurately, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability and death. I understand that this service is for patients with a pre-existing prescription for an epinephrine auto-injector (such as EpiPen, Adrenaclick or Auvi-Q), and that pictures of my current epinephrine auto-injector with my name clearly visible on the label will be required. I understand that this service is not for emergencies, and if I am having any symptoms of an allergic reaction or anaphylaxis, I should call 911 and get to an emergency room immediately.

I understand that some people may be more likely to have a bad reaction to epinephrine:

• Those with heart disease, coronary artery disease or “clogged arteries.”
• Those taking MAOI (monoamine oxidase inhibitor) medications or TCAs (tricyclic antidepressants)
• Those with recent brain surgery, aneurysms, uncontrolled hyperthyroidism, uncontrolled high blood pressure.
• Those using cocaine, methamphetamines or other illicit drugs
• Those taking stimulant medications (amphetamines or methylphenidate) to treat ADHD (attention deficit hyperactivity disorder)

I understand that the risk of death from a severe allergic reaction or anaphylaxis is more important than the risk of one of these bad reactions. If I am unsure about using an epinephrine auto-injector, I will contact primary care doctor or allergy specialist for advice before using this service.

Erectile Dysfunction

I understand that adverse events from taking sildenafil (Viagra), tadalafil (Cialis) or vardenafil (Levitra) include but are not limited to a painful erection lasting more than 4 hours, sudden loss of vision in one or both eyes, sudden decrease or loss of hearing, allergic reaction, permanent disability, and death.

I understand that if I have a condition where sex is not advised then I should not take sildenafil (Viagra), tadalafil (Cialis) or vardenafil (Levitra).

I understand that if I am taking nitroglycerin or other medicines that contain nitrates then I should not take sildenafil (Viagra), tadalafil (Cialis) or vardenafil (Levitra) as this combination can lower blood pressure unexpectedly and could be fatal.

I understand that sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) are prescription medicines and not recreational drugs and certify that I will only use them as prescribed.

I understand that generic sildenafil 20mg pills are not licensed by the FDA for treatment of erectile dysfunction and that the doctors will be prescribing generic sildenafil 20mg pills 'off-label'. I understand that the medicine sildenafil is the active ingredient in Viagra, the brand name erectile dysfunction medicine.

I understand that by requesting treatment for erectile dysfunction, the doctor’s evaluation depends on honest answers to the questions. I understand that if I do not answer the questions accurately, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability or death.  I understand that erectile dysfunction is often the first symptom of other health conditions, including but not limited to cardiovascular disease and diabetes and that it is my responsibility to have a follow-up exam and ongoing care with an in-person health care provider to investigate the cause of my condition.

Eyelash Enhancement with Latisse

I understand that adverse effects from taking medications to enhance my eyelashes include but are not limited to temporary or permanent darkening of the colored portion of my eye (or iris), temporary or permanent eyelid skin darkening, hair growth outside of the treatment area, allergic reaction, permanent disability such as permanent eye injury or blindness and death.

I understand that Latisse, or Bimatoprost ophthalmic, is an approved treatment to grow eyelashes for people with inadequate or too few eyelashes. I understand that it may be 3 to 4 weeks before I see the effects of this treatment.

I understand that by requesting treatment for eyelash enhancement, the doctor’s evaluation depends on honest answers to the questions and good quality photos. I understand that if I do not answer the questions accurately, or if the photos that I send to the doctors are not representative of my condition, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability, including permanent damage to my eyes, blindness and death.

Folliculitis (Razor Bumps)

I understand that by requesting folliculitis treatment, the doctor’s evaluation depends on honest answers to the questions and good quality photos. I understand that if I do not answer the questions accurately, or if the photos that I send to the doctors are not representative of my condition, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability and death.

General Rash/Skin Visit

I understand that by requesting treatment for a rash or skin condition, the doctor’s evaluation depends on honest answers to the questions and good quality photos. I understand that if I do not answer the questions accurately, or if the photos that I send to the doctors are not representative of my condition, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability and death.

Genital Herpes

I understand that if this treatment is for recurrent (repeat) genital herpes infections, and that if this is my first infection, I should immediately seek care from a licensed in-person medical provider so that I may have a thorough exam and testing to make sure I do not have other sexually transmitted diseases which are often caught at the same time as herpes.

I understand that by requesting treatment for a genital herpes infection, the doctor’s evaluation depends on honest answers to the questions. I understand that if I do not answer the questions accurately, my condition may be underestimated or get worse very quickly, leading to permanent disability and death.

I understand that there are many other conditions that may cause genital pain and/or rashes, including but not limited to sexually transmitted infections (STIs) such as chlamydia, gonorrhea, syphilis, and trichomonas, and if I am sexually active, I should have a follow-up exam and testing by an in-person licensed medical provider within 72 hours.

Hair Loss 

I understand that adverse events from taking finasteride to treat male pattern baldness include but are not limited to breast cancer, prolonged sexual dysfunction, high-grade prostate cancer, allergic reaction, permanent disability, and death.

I understand that by requesting treatment for male pattern baldness, the doctor will not be able to carry out a 'hair-pull' test that could assist in the diagnosis of male pattern baldness.

I understand that by requesting treatment for hair loss, the doctor’s evaluation depends on honest answers to the questions and good quality photos. I understand that if I do not answer the questions accurately, or if the photos that I send to the doctors are not representative of my condition, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability and death.

Influenza (Flu)

I understand that by requesting treatment for the flu, the doctor’s evaluation depends on honest answers to the questions. I understand that if I do not answer the questions accurately, the doctor may underestimate or misdiagnose my condition, which could lead to hospitalization, permanent disability or death.

I understand that as in any in-person evaluation for flu-like symptoms, there is a risk that the doctor misdiagnoses the cause of my symptoms as the flu and not some other cause. I understand that if this happens then I will be taking an antiviral medication unnecessarily, exposing myself to the risks of taking that medication. I understand that there are many other illnesses, some potentially serious or life-threatening, that can have symptoms very similar to the flu.

I understand that if my flu symptoms have not improved after 3 days (72 hours) of taking the antiviral medicine or if my condition worsens, I should go to an emergency room or immediately see a licensed medical provider in person.

Influenza (Flu) Prevention 

I understand that taking medication to prevent the flu can lower my chance of getting the flu after an exposure. I understand that the medication is not 100 percent effective, and I can still get the flu. I understand that by requesting this treatment, I have no symptoms at all, and if I believe I have symptoms of the flu, I should immediately seek treatment for the flu either online through MDAnywhere.com or from a licensed medical provider in person. I understand that I should also be re-evaluated immediately if I develop any symptoms while taking medication to prevent the flu.

I also understand that I should consult my primary doctor or other licensed medical provider before or early in the flu season regarding flu vaccination and other measures to help prevent flu infection.

I understand that the doctor’s evaluation depends on honest answers to the questions. I understand that if I do not answer the questions accurately, I am putting myself at risk for permanent disability and death.

Insect Bite/Sting Reaction

I understand that by requesting treatment for an insect bite or sting, the doctor’s evaluation depends on honest answers to the questions and good quality photos. I understand that if I do not answer the questions accurately, or if the photos that I send to the doctors are not representative of my condition, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability and death.

Lab Testing

I understand that lab testing services are for screening only. I understand that if I am feeling ill, I should select one of your treatments if appropriate or visit an emergency room, urgent care, or other local health care provider immediately for evaluation.

I understand that lab testing ordered through MDAnywhere/Access Medical Associates is not meant to replace routine healthcare by my primary care provider. I understand that I should have ongoing care with my primary care doctor for my routine healthcare needs.

I understand that I may bring the test order to the laboratory of my choice. I understand that additional lab-related fees may apply. I understand that the fee charged by Access Medical Associates covers the physician assessment, the test order, delivery of results, and physician guidance only.

Laryngitis (Lost or Hoarse Voice)

I understand that by requesting treatment for laryngitis (lost or hoarse voice), the doctor’s evaluation depends on honest answers to the questions. I understand that if I do not answer the questions accurately, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability and death.

Medication Refill

I understand that a 1-month supply of medication will be prescribed for most medication renewal/refill requests, and that longer refills may be given at the doctor's discretion. I understand that only certain medications can be renewed safely without an exam, and I acknowledge that I will seek care from a licensed medical provider as soon as possible for any additional refills. I acknowledge that by requesting a medication renewal/refill, I currently have no symptoms of illness.

I understand that the doctors will not refill any controlled substances, including but not limited to opioids, benzodiazepines, cannabinoids, or amphetamines, or any medications they believe may have abuse potential. I understand that the doctors will not prescribe any medications used to treat psychiatric conditions.

I understand that by requesting a prescription refill from the doctors of Access Medical Associates, PLLC, the doctor’s evaluation depends on honest answers to the questions. I understand that if I do not answer the questions accurately, I am putting myself at risk for permanent disability and death.

Motion Sickness Prevention

I understand that in order to receive medications to prevent motion sickness, I acknowledge that I have had motion sickness in the past, and that I am currently not having symptoms of motion sickness, vertigo or dizziness. I understand that I should NOT operate any vehicle or heavy machinery, or perform any activity that requires my being alert and fully coordinated, as the medications prescribed might make me less alert (sleepy) and less coordinated (clumsy), resulting in serious injury, permanent disability or death if I choose to perform such activities while taking the prescribed medication(s).

I understand that by requesting a prescription to prevent motion sickness, the doctor’s evaluation depends on honest answers to the questions. I understand that if I do not answer the questions accurately, my condition may be underestimated or get worse very quickly, leading to permanent disability and death.

Naloxone Opioid Antidote

I acknowledge that by obtaining a prescription for naloxone nasal spray, I have read the package insert and understand how to use the medication. I understand that when this medication is used on myself or another person, the person who administers the drug should call 911 immediately so that the person who has possibly overdosed can be transported to the nearest emergency room for further evaluation. I understand that even if the overdosing person awakens after the application of naloxone, the effects of naloxone are temporary and the overdosing person may again become unresponsive, leading to permanent disability or death if not treated immediately by an in-person licensed medical provider.

Pertussis (Whooping Cough) Prevention

I understand that this treatment is to help prevent pertussis after an exposure, and that if I have any symptoms I should see a licensed medical provider immediately. I understand that even if I take this medication, it is not 100 percent effective and I may still get pertussis.

I understand that by requesting treatment for a pertussis exposure, the doctor’s evaluation depends on honest answers to the questions. I understand that if I do not answer the questions accurately, I am putting myself at risk for permanent disability and death.

Pink Eye (Conjunctivitis)

I understand that adverse effects from taking medications to treat conjunctivitis include but are not limited to allergic reaction, permanent disability including blindness, and death.

I understand that by requesting treatment for conjunctivitis, the doctor’s evaluation depends on honest answers to the questions and good quality photos. I understand that if I do not answer the questions accurately, or if the photos that I send to the doctors are not representative of my condition, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability, including permanent damage to my eyes, blindness and death.

I also understand that in all cases, the medical team will recommend that I follow up with a licensed medical provider within 72 hours (3 days) for an eye examination. I understand that if I do not follow this recommendation, I am putting myself at risk for permanent disability including hospitalization, permanent damage to my eyes, blindness and death.

Pinworm Prevention

I understand that this treatment helps prevent a pinworm infection after an exposure, and that if I have any symptoms I should see a licensed medical provider immediately. I understand that even if I take this medication, it is not 100 percent effective and I may still get pinworms.

I understand that by requesting treatment for pinworm exposure, the doctor’s evaluation depends on honest answers to the questions. I understand that if I do not answer the questions accurately, my condition may be underestimated or get worse very quickly, leading to permanent disability and death.

Poison Ivy/Poison Oak/Poison Sumac

I understand that by requesting treatment for a poison ivy, poison oak, or poison sumac rash, the doctor’s evaluation depends on honest answers to the questions and good quality photos. I understand that if I do not answer the questions accurately, or if the photos that I send to the doctors are not representative of my condition, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability and death.

Respiratory Infection

I understand that by requesting treatment for a respiratory infection, the doctor’s evaluation depends on honest answers to the questions. I understand that if I do not answer the questions accurately, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability or death.

Ringworm

I understand that by requesting treatment for ringworm, the doctor’s evaluation depends on honest answers to the questions and good quality photos. I understand that if I do not answer the questions accurately, or if the photos that I send to the doctors are not representative of my condition, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability and death.

Scabies Prevention

I understand that by requesting treatment to prevent scabies after an exposure, I do not have any symptoms of scabies. I understand that if I have any symptoms I should see a licensed medical provider immediately. I understand that even if I take this medication, it is not 100 percent effective and I may still get scabies.

I understand that by requesting treatment for scabies exposure, the doctor’s evaluation depends on honest answers to the questions. I understand that if I do not answer the questions accurately, my condition may be underestimated or get worse very quickly, leading to permanent disability and death.

Shingles

I understand that I am requesting treatment for a recurrent (repeat) shingles (varicella, zoster) infection. I understand that if this is the first time I have had shingles, I should immediately seek care from a licensed in-person medical provider so that I may have a thorough exam and testing to make sure I do not have some other serious disease.

I understand that by requesting treatment for shingles, the doctor’s evaluation depends on honest answers to the questions and good quality photos. I understand that if I do not answer the questions accurately, or if the photos that I send to the doctors are not representative of my condition, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability and death.

Sinus Congestion

I understand that by requesting treatment for a possible bacterial sinus infection, as in any in-person medical evaluation, there is a risk that my sinus symptoms are due to a viral infection or an allergy and not a bacterial infection, and if this is the case I will take an antibiotic that I do not need and expose myself to the risks of taking that antibiotic.

I understand that by requesting treatment for a sinus infection, the doctor’s evaluation depends on honest answers to the questions and good quality photos. I understand that if I do not answer the questions accurately, or if the photos that I send to the doctors are not representative of my condition, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability and death.

I understand that if my symptoms have not improved after 3 days (72 hours) of treatment, I must immediately visit a licensed medical provider in person.

Stye

I understand that by requesting stye treatment, the doctor’s evaluation depends on honest answers to the questions and good quality photos. I understand that if I do not answer the questions accurately, or if the photos that I send to the doctors are not representative of my condition, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability including but not limited to permanent damage to my eyes or blindness, and death.

Tick Bite/Lyme Disease Prevention

I understand that this treatment helps prevent Lyme disease after a tick bite and that if I have any symptoms at all, I should be evaluated by a licensed medical provider immediately. I understand that this treatment is for a single dose of doxycycline, and is not a full treatment for Lyme disease, which requires a longer course of antibiotics.

Although our physicians follow the CDC recommendations for prevention of Lyme disease by treatment with doxycycline after a tick bite, I understand that this treatment is not 100 percent effective in preventing Lyme disease or any other tick-related infection, and that I still may get Lyme disease or another tick disease even after taking this medication, sometimes without having symptoms.

I understand that identifying the tick that bit me or the exact time it bit me is sometimes difficult, and this may either result in getting Lyme disease despite taking this antibiotic or taking this antibiotic unnecessarily, and I accept the risks of taking this antibiotic.

I understand that requesting antibiotics to help prevent Lyme disease, the doctor’s evaluation depends on honest answers to the questions and good quality photos. I understand that if I do not answer the questions accurately, or if the photos that I send to the doctors are not representative of my condition, I may take an antibiotic that will not cure Lyme disease or another tick disease I may already have, or my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability, and death.

I understand that it is very important to follow up with a licensed medical provider who will determine if I need blood tests to look for tick diseases. I understand that I may need to be tested 4-6 weeks after the tick bite to check for Lyme disease and other possible tick-related infections.

Toothache

I understand that the medications prescribed by the doctors are not a cure or permanent solution to my tooth/dental pain, and are only meant to help temporarily reduce pain and start treating a possible dental infection.

I understand that after getting treated for a toothache, I should seek treatment by a dentist, either in an emergency room or dental clinic, within 72 hours (3 days).

I understand that by requesting treatment for a toothache, the doctor’s evaluation depends on honest answers to the questions and good quality photos. I understand that if I do not answer the questions accurately, or if the photos that I send to the doctors are not representative of my condition, my condition may be underestimated or could get worse very quickly, leading to hospitalization, severe illness including but not limited to a severe infection in my face or eyes leading to permanent disfigurement, permanent eye injury and/or blindness, severe blood infection (sepsis), brain infection (meningitis), permanent disability and death.

Traveler’s Diarrhea

I understand that by requesting an antibiotic prescription for traveler’s diarrhea, the doctor’s evaluation depends on honest answers to the questions. I understand that if I do not answer the questions accurately, I may take an antibiotic unnecessarily, I may take an antibiotic that will not cure my diarrhea, or my condition may be underestimated or could get worse very quickly, leading to severe illness including but not limited to severe dehydration, kidney failure or severe blood infection (sepsis), hospitalization, permanent disability and death.

I understand that this prescription is only one part of a thorough evaluation prior to traveling to another country. I understand that I should schedule an appointment with my primary care doctor, travel specialist, or other qualified medical provider for a thorough pre-travel assessment. I understand that I may require other treatments or vaccinations including but not limited to: hepatitis A and B, typhoid fever, yellow fever, cholera, rabies, influenza, measles/mumps/rubella, diphtheria/tetanus/pertussis, chicken pox, or polio. I understand that I may also need other prophylactic medications including but not limited to anti-malaria drugs depending on the country I am traveling to. I understand that these other illnesses are not prevented or treated by the antibiotic prescribed for traveler’s diarrhea and can cause severe infections, hospitalization, permanent disability and even death. I understand that this antibiotic should not be considered a substitute for a proper pre-travel assessment.

Unwanted Facial Hair (Vaniqa)

I understand that Vaniqa (eflornithine) is an approved treatment to reduce unwanted facial hair in females from the face and areas under the chin. I understand that it may be 4-8 weeks before I see the effects of this treatment, and it may last for 8 weeks or longer after stopping treatment. I understand that the use of this medication during pregnancy has not been well-studied, and the effects on the fetus unknown. I understand that I should discontinue use if I become pregnant or plan to become pregnant. I understand that it is not known if this medication is present in breast milk, and I should discontinue use if breastfeeding.

I understand that by requesting treatment for unwanted facial hair, the doctor’s evaluation depends on honest answers to the questions and good quality photos. I understand that if I do not answer the questions accurately, or if the photos that I send to the doctors are not representative of my condition, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability and death.

Urinary Tract Infection (UTI)

I understand that by requesting treatment for a possible UTI, the doctor’s evaluation depends on honest answers to the questions. I understand that if I do not answer the questions accurately, I may take an antibiotic unnecessarily, I may take an antibiotic that will not cure my UTI, or my condition may be underestimated or could get worse very quickly, leading to severe illness including but not limited to severe dehydration, kidney infection, kidney failure or severe blood infection (sepsis), hospitalization, permanent disability and death. I understand that the doctor will not perform a urinalysis or culture. By relying only  on my answers to the interview questions, the doctor will correctly diagnose approximately 90% of patients who have a UTI and 90% of patients who don't have a UTI. Approximately 10% of patients who actually have a UTI may not receive treatment and 10% of patients who do not actually have a UTI may receive treatment without these additional tests.

I understand that if my symptoms have not disappeared after 3 days (72 hours) of taking the antibiotic treatment, I must visit a licensed medical provider immediately for an evaluation.

Wrinkle Reducer

I understand that tretinoin is an approved treatment to reduce fine wrinkles, dark spots, rough patches, and other signs of skin aging. I understand that it may be 6-8 weeks before I see the effects of this treatment. I understand that the use of this medication during pregnancy is not recommended, as it caused birth defects in animal studies and in some pregnant women. I understand that I should discontinue use if I become pregnant or plan to become pregnant. I understand that it is not known if this medication is present in breast milk, and I should discontinue use if breastfeeding.

I understand that by requesting treatment for wrinkle reduction, the doctor’s evaluation depends on honest answers to the questions and good quality photos. I understand that if I do not answer the questions accurately, or if the photos that I send to the doctors are not representative of my condition, my condition may be underestimated or could get worse very quickly, leading to hospitalization, permanent disability and death.

Yeast Infection

I understand that if this is my first yeast infection, I should seek medical attention from a licensed medical provider immediately.

I understand that over 50% of women with vaginal itching do not have a yeast infection, that I may be taking this antifungal medication unnecessarily, and that my condition may not improve. I understand that there are many other conditions that may cause vaginal itching, including but not limited to sexually transmitted infections (STIs) such as chlamydia, gonorrhea, trichomoniasis, herpes and bacterial vaginosis (BV), and I should have a follow-up exam with a licensed in-person provider within 72 hours (3 days) of treatment.

I understand that by requesting treatment from the doctors of Access Medical Associates, PLLC for my yeast infection, the doctor’s evaluation depends on honest answers to the questions. I understand that if I do not answer the questions accurately, I may be taking a medication that will not improve my symptoms, my condition may be underestimated or could get worse very quickly, leading to a severe infection in my pelvis, infertility, severe blood infection (sepsis), hospitalization, permanent disability and death.

Doctor's Notes

I understand that by requesting treatment and/or a doctor's note, the doctor’s evaluation depends on honest answers to the questions. I understand that if I do not answer the questions accurately, I may be prescribed unnecessary treatment, my condition may be underestimated or could get worse very quickly, leading to severe illness, hospitalization, permanent disability and death. I understand that the doctor's note is issued for my use only, is applicable for only the dates listed on the note, and is intended as an initial precaution for your condition or illness. You are expected to follow up with your primary doctor or another in-person visit within 3 days to have your condition reevaluated. Any unauthorized use or reproduction of the doctor's note is explicitly not permitted. In such instances where an employer contacts our medical team regarding the veracity of a doctor's note, our medical team will provide confirmation of the authenticity of the note.

Documentation of Recovery from COVID-19/Travel Clearance Letter

I understand that in order to be evaluated, I must be 18 years of age or older and I must physically be in a US state where the doctors are licensed to practice medicine at the time of service. I understand that the test result used must be performed in a US-based lab or be a proctored (observed) test, and must include my full name, date of birth, test sample collection date, and positive result.

I understand that by requesting Documentation of Recovery from COVID-19, the doctor’s evaluation depends on honest answers to the questions. I understand that it is my responsibility to upload results showing that I tested POSITIVE for COVID-19, that this test result must not be altered or falsified in any way, and that falsifying test results or providing an inaccurate date of first symptoms puts myself and others at risk of becoming infected with the COVID-19 virus, which could result in serious illness, disability or death. I understand that the Documentation of COVID-19 Recovery letter is based solely on the information and dates which I submit. I understand that it is my responsibility to carefully review my letter for any errors and notify your staff immediately so that they can correct them. I understand that the letter is based on either the date of my first COVID-19 positive test result or the date my symptoms began, whichever is earlier. I understand that this service is only to verify clearance to travel and not an evaluation of my illness, and if I develop any new or worsening symptoms at all, I will not travel and I will see a doctor in-person immediately. I understand that if I have any ongoing symptoms, I must have them checked by a doctor in person. 

I understand that IT IS MY RESPONSIBILITY TO CHECK THE STATE DEPARTMENT WEBSITE FOR COUNTRY-SPECIFIC REQUIREMENTS PRIOR TO TRAVEL, AND THAT  REGIONS VARY IN THEIR REQUIREMENTS FOR A RECOVERY PERIOD. I UNDERSTAND THAT SOME COUNTRIES MAY STILL REQUIRE A NEGATIVE COVID-19 TEST, ADDITIONAL DOCUMENTATION OR EVEN QUARANTINE ON ARRIVAL DESPITE HAVING A RECOVERY LETTER.

I understand that certain third party vendors such as “Verifly” do not accept documents originating in the US. I understand that I must demonstrate my recovery document at the airport during the check-in process.

I understand that the requirements for Documentation of Recovery from COVID-19 are constantly changing. I understand that while the medical team attempts to remain up to date with the current CDC guidelines and US travel requirements, these requirements may change at any moment. I understand that foreign countries have their own requirements and may or may not require a recovery letter. I understand that if a Documentation of Recovery letter was required at the time of my visit, once the doctor has reviewed and completed my visit and provided the Documentation of Recovery letter that was requested, refunds for this service are not permitted.

 

RISKS OF ELECTRONIC HEALTH INFORMATION

I understand that although Access Medical Associates, PLLC implements many safeguards to protect my health information and comply with HIPAA, they cannot guarantee the privacy and confidentiality of my health information. I understand that if I consent to allow notifications to be sent to my email address, I am giving you permission to send private medical information to that address, including but not limited to my name, notification that my treatment is complete, and notification that I have a secure message in my patient portal. I understand that it is solely my responsibility to make sure that my email is secure and I am the only person with access to that email address.

For more details about how the providers of Access Medical Associates protect and use my health information and comply with HIPAA, I will read the Privacy Policy and Notice of Privacy Practices and will not use the Website to request treatment unless I fully understand these policies. I understand I have the opportunity to ask questions about these policies before seeking treatment by contacting Access Medical Associates, PLLC at 800-632-4981.