Consent

Citizen Meds Consent

You have asked Citizen Meds to arrange for a licensed physician (“Physician”) to review the health information you provided to Citizen Meds through its online platform thru Blue Drop Health PLLC (the “Providers” or Platform) to determine what, if any, Citizen Meds healthy lifestyle products are medically appropriate for you.  The purpose of this consent form (“Consent”) is to provide you with information about telehealth and to obtain your informed consent for Citizen Meds and Blue Drop Health PLLC to provide you with care.

In this Consent, the words “you” and “yours” means the person using the Citizen Meds website or the Providers, or in the case of a minor between the ages of 13 and 18 years-old (or a higher age of majority under applicable state law) means both the parent or guardian who provides consent to use the Service by minor and the minor for whom consent is being provided.

Please carefully read all of the information below.  By clicking “I Agree” below, by carrying through with the Providers, or by signifying your acceptance of any other component of the form means you understand and agree to all of the following:

  • Telehealth means the use of electronic communication systems and information technology to provide care when the patient and the health care provider are not in the same physical location. Telehealth may be used for diagnosis, treatment, prescribing, patient education, and follow-up care, and can be done through phone, electronic transmission of medical records and health information, or by electronic communication between the patient and the provider by audio, visual, audiovisual, or other data transmission, including messaging or email.

 

  • The use of telehealth may have some or all of the following benefits for you: increase your access to care; increase the efficiency of medical care, allow you to access health care at times and places that are convenient for you.

 

  • The use of telehealth may also present some or all of the following risks to you: the inability of your health care provider to perform an in-person exam may limit the quality, accuracy or effectiveness of the care you receive, and may limit or negatively impact your health care provider’s ability to diagnose your condition and provide you with the care that you need; you may be required to seek alternative sources of medical care; the technology used for telehealth, including the online visit or form, may have errors or bugs that negatively impact the quality and timeliness of care provided, the accurate or timely transmission of health care information, the accuracy or completeness of information used to provide health care, render the technology, including the care inoperable or unavailable, or cause the loss of health information and/or personal data.

 

  • The use of telehealth also involves the risk of possible failures of technology, equipment, electronic systems or security systems and protocols that could result in a loss of your health information or a breach of privacy and unintended disclosure to unauthorized individuals or entities, which may also negatively impact the care you receive by telehealth.

 

  • The health care you receive through use of the Platform will be provided to you using telehealth. By starting or continuing to use the Platform or by requesting or receiving a Physician Review, you consent to the use of telehealth to provide you with care.

 

  • You understand that at any time a Physician using their independent medical judgement may determine that it is not medically appropriate to provide health care to you using telehealth or the Platform. You agree to discontinue using the Platform immediately if the Physician makes such a determination.

 

  • You may withdraw your consent to use telehealth for the provision of health care at any time by providing Citizen Meds with written notice. Your withdrawal of consent is immediately effective upon Citizen Meds receipt of your written notice but will not impact health care provided using telehealth prior to Citizen Meds receipt of your notice of withdrawal of consent. Your withdrawal of consent shall not impact any other terms of this Consent, and you must continue to follow the Consent.  You understand that withdrawal of consent for telehealth means that Citizen Meds and the Physicians will no longer be able to provide you with care using the Platform or otherwise, as neither the Physician nor Citizen Meds provides in-person care.

 

  • The Platform is not designed to provide you with emergency medical or mental health services.

 

  • IF YOU HAVE A MEDICAL EMERGENCY, YOU SHOULD DIAL 911.

 

  • IF YOU ARE HAVING A MENTAL HEALTH EMERGENCY OR ARE THINKING ABOUT SUICIDE, YOU SHOULD DIAL THE SUICIDE AND CRISIS LIFELINE AT 988.

 

  • Citizen Meds and its Physicians use software and network security systems and protocols to safeguard the security and privacy of your health information. Citizen Meds and its Physicians will not release your protected health information to third parties without your consent, except as permitted or required by law.  You may receive phone, email, or other electronic communication from Citizen Meds or a Physician that may contain your protected health information.  You acknowledge that Citizen Meds and the Physicians cannot and do not guarantee the security and privacy of the technology or Platform or equipment you use to receive such communications.

 

  • Neither Citizen Meds nor the Physician makes any guarantee that you will receive a prescription for a Citizen Meds product as a result of using the Platform or receiving a Physician Review.

 

  • Neither Citizen Meds nor the Physician guarantees any specific result if you use the Platform or a Citizen Meds product.

 

  • You agree to provide accurate and complete information about yourself and your health when using the Platform or communicating with a Physician. There are risks to your health and well-being if you give incorrect or incomplete information.  You  certify that all of the information you provide to Citizen Meds and the Physician is true, accurate, and complete.
  • You understand that the information you provide to the Physician when using the Platform or communicating with the Physician might be the only information used by the Physician to provide you with health care. The Physician will not have access to your health information held by other medical professionals.
  • The fees you have paid or will pay to Citizen Meds cover the cost of using the Platform, receiving a Physician Review, and any Citizen Meds products prescribed by the Physician. Citizen Meds and the Physician will not bill your medical insurance company or any other third-party payor for your use of the Platform, the Physician Review, or the Citizen Meds products.

 

  • You are responsible for arranging and paying for any follow-up care you receive after the Physician Review or while or after using the Platform.

 

  • If the Physician prescribes a product for you, the Physician will send the prescription to a Citizen Meds affiliated pharmacies for dispensing. Citizen Meds and the pharmacy will work together to deliver the prescribed products to you at the address you have provided to Citizen Meds.   Please be sure you have provided Citizen Meds with an address where you may safely and securely receive delivery of the Citizen Meds products. You have the right to choose the pharmacy of your choice but Citizen Meds cannot guarantee if the product is available.

 

  • By clicking “I Agree” or utilizing the Service, you are consenting to the Physician’s and Citizen Meds sharing of your protected health information with certain third parties, including the pharmacy, as more fully described in Citizen Meds Notice of Privacy Practices, available on the Citizen Meds website.

 

  • Copies of your medical record associated with your use of the Platform are available in accordance with applicable law by request to Citizen Meds at [email protected].

 

  • If you have a concern or complaint about the Physician, please contact the medical licensing board in your state.

 

  • If you have a concern or complaint about the pharmacy that fills your prescription for a Citizen Meds product, please contact the pharmacy licensing board in your state.