Consent to Treatment, Terms of Service and New Patient Agreement
Last updated: March 29, 2022
This summary is not a full and complete recitation of the New Patient Agreement (“Agreement”). It is an attempt to capture in broad terms the nature and scope of the Agreement. This summary has been prepared in an effort to highlight key elements of the Agreement in an abbreviated format, not to replace it. By confirming the Agreement below, you certify that you have read the full Agreement and that you agree to and understand its terms.
- You hereby certify that you are (i) over the age of eighteen (18) or have the legal ability to consent to Medical and/or Counseling Services (as defined below), or (ii) you are the parent or legal guardian of the patient and have the legal authority to consent to Medical and/or Counseling Services on behalf of the patient;
- You are a resident of the state of California;
- Confidentiality of your patient information and privacy is critically important and we encourage you to communicate with us through the IntakeQ (labeled as Remedy) portal to protect your patient information;
- Patients and/or parents or legal guardians of the patient, agree to pay the following fees:
- Adult patients aged 18 and over: a non-refundable initial fee of $179 for the first month, and a monthly subscription fee of $89 per month starting in their second month.
- Patients under the age of 18: a non-refundable initial fee of $199 for the first month, and a monthly subscription fee of $99 per month starting in their second month.
- The monthly subscription fee is subject to increase at any time. Patients may cancel their subscription at any time after the first month upon prior written notice but monthly fees are otherwise nonrefundable once paid;
- We always reserve your appointment times just for you. If the patient fails to attend their appointment or cancels their appointment within 24 business hours of their scheduled appointment, patients shall be charged a cancellation fee in the amount of $179 for an initial appointment for adult patients age 18 and over, and $199 for an initial appointment fee for patients under the age of 18, and $89 per follow-up appointment for adult patients age 18 and over, and $99 per follow-up appointment for patients under the age of 18. Please let us know in advance if you want to cancel or change your appointment;
- If patients require completion of medical paperwork (included but not limited to: state or personal disability forms, emotional support animal letters or forms) Patients agree to, and are billed at $2.50 per minute for completion of these services;
- Remedy Psychiatry is not intended for the provision of a clinical diagnosis requiring an in-person evaluation, and you should not use it if you need any official documentation or approvals for purposes such as, but not limited to, court-ordered evaluations.
- Remedy Psychiatry is not for patients with pain, opiate or substance addiction treatment, clozapine treatment, those needing benzodiazepines prescribed every day, or for patients seeking emergent treatment. If such services are required, Patients should seek alternate treatment.
- Medical team will respond to patient requests within 48 business hours; for life-threatening emergencies, patients should always immediately dial 911 or go to the nearest emergency room.
- You consent to our use of your name, phone number, and email address for the purpose of communicating with you about our services, billing, appointments, and related business interactions between you and us.
The full text of the New Patient Agreement follows:
New Patient Agreement:
This Concierge Patient Membership Agreement (the “Agreement”), effective as of the date of the Member’s digital confirmation of receipt (the “Effective Date”), is made by and between Remedy Psychiatry, Inc. a California professional corporation (the “Practice”), Remedy Psychiatry contractual affiliates (“Affiliates”) and/or associates (“Associates”), and the undersigned patient member (the “Member” or “You”).
You are a patient of the Practice who receives certain physician, nurse and related medical services from the Practice using telehealth technologies (“Medical Services”). You now desire to receive, in exchange for a fee, additional certain nonmedical concierge services (the “Concierge Services“) from the Practice as part of and by virtue of this Agreement. The purpose of this Agreement is to set forth the terms and conditions of how the Medical and Concierge Services will be furnished to You by the Practice. You and the Practice therefore agree as follows.
- “Member” – a person for whom the Practice shall provide Concierge Services, and who is a party to this Agreement.
- “Insurer”- the Medicare or Medicare programs, a private health insurance policy, an individual or group health plan, HMO, PPO, or other similar private health plan or coverage.
- “Non-Member Patients” – patients of the Practice who have not signed a Concierge Patient Membership Agreements.
The Practice will provide You with the Concierge Services set forth in Appendix 1, which may be adjusted for subsequent membership years. The Non-Medical (“Non-Medical”) Concierge Services are intended to supplement the Medical Services you receive from the Practice, but Concierge Services shall not include Medical Services.
To become and remain a Member, after your initial on-boarding appointment, you agree to pay the Practice a monthly fee, which may be adjusted for subsequent membership years. Members will be notified of any pricing changes in advance of implementation. The fee for your initial membership year is subject to individual adjustments, payment plans, and discounts.
Adult patients age 18 and over will be charged a non-refundable $179 monthly fee for the first month of your subscription and $89 per month thereafter. Parents and/or legal guardians of patients under the age of 18 will be charged a non-refundable initial fee of $199 for the first month, and a monthly subscription fee of $99 per month starting in their second month.
In some cases, discounts and alternative pricing may be made available (for example, yearly pricing or a free trial period). This monthly fee is incurred whether or not you have an appointment or communicate with your provider during that month.
If you cancel your initial on-boarding appointment with your doctor within 24 business hours of your appointment time, you will be charged a $179 missed appointment fee if you are age 18 or over and $199 missed appointment fee for patients under the age of 18. If you do not attend your initial Appointment (commonly referred to as a “no show”), you will be charged a $179 missed appointment fee if you are age 18 or over and $199 missed appointment fee for patients under the age of 18. If you cancel your follow-up appointment with your doctor within 24 business hours of your appointment time, you will be charged a $89 missed appointment fee if you are age 18 or over and $99 missed appointment fee for patients under the age of 18. If you do not attend your follow-up appointment (commonly referred to as a “no show”), you will be charged a $89 missed appointment fee if you are age 18 or over and $99 missed appointment fee for patients under the age of 18.
Patients must keep an active credit card on file for all services. If this credit card is expired, or no longer works, patients will be contacted for updated credit card information. If Remedy Psychiatry is unable to obtain appropriate payment information, whether the patient is unable to be reached, or sufficient payment cannot be made, this will be viewed as the patient desiring to seek continued medical and concierge services elsewhere such that the patient will have been determined to desire termination of care with Remedy Psychiatry.
Recurring Billing Policy
Our subscription model is a monthly recurring charge and the billing period begins from the time of registration, as defined by when you enter your payment method. By agreeing to our recurring billing terms, you are agreeing to the following:
You represent and warrant that (i) any credit / debit card information you supplies is true, correct and complete, (ii) charges incurred by you will be honored by your credit/debit card company, (iii) you will pay the charges incurred in the amounts posted, including any applicable taxes, and (iv) you are the person in whose name the credit / debit card was issued and you is authorized to make a purchase or other transaction with the relevant credit / debit card and information.
You agree and authorize the payment method to be billed automatically for the entire subscription length, according to the published pricing on the Remedy Psychiatry, Inc. website, which is subject to change at any time.
You agree and authorize the payment method to be billed beginning on the date of registration and subsequently on a monthly basis regardless of whether the assessment has been completed or services have been rendered (including, but not limited to, provider visits, and medication prescription and delivery).
If Remedy Psychiatry, Inc. is unable to secure funds from your debit / credit card(s) for any reason, including, but not limited to, insufficient funds in the debit / credit card or insufficient or inaccurate information provided by you when submitting electronic payment, Remedy Psychiatry, Inc. may undertake further collection action, including application of fees to the extent permitted by law.
You have the right to revoke this authorization by contacting Remedy Psychiatry, Inc. via email or the patient messaging portal by 9:00AM PT one business day prior to the scheduled payment date. You understand and acknowledge that services may be cancelled or withheld if you revoke this authorization, and that you are still responsible for all charges incurred by you or otherwise owed to Remedy Psychiatry, Inc. This authorization will remain in full force and effect until revoked by you or Remedy Psychiatry, Inc.
You acknowledge and agree you will not dispute the payment with the credit / debit card company, provided the transactions correspond to the terms indicated in this authorization form. No refunds.
Good Faith Estimate:
This Good Faith Estimate shows the costs of items and services that are reasonably expected for your health care needs for an item or service. The estimate is based on information known at the time the estimate was created. The Good Faith Estimate does not include any unknown or unexpected costs that may arise during treatment. You could be charged more if complications or special circumstances occur.
You are welcome to request an oral explanation of this Good Faith Estimate by calling us at 747-212-3876. Additionally, the specific list of services, diagnosis code, TIN and NPI numbers can be provided to you upon request. You may contact us to let us know if the billed charges are higher than the Good Faith Estimate. To learn more, go to www.cms.gov/nosurprises.
For adults, age 18 and over, the fees for service(s) with Remedy Psychiatry, Inc. are billed each month, starting the month you initiate care and sign this terms of service, with the initial month of care $179, then $89 per month thereafter, and continued until you submit a request in writing to terminate your membership and care. This monthly fee is incurred even if you did not have an appointment or require use of services during any given month. The estimated cost of care for an adult age 18 and over for the first 12 months is $1158 total [which is ($179 x 1 month for first month of care) + ($89 per month x 11 months remaining in the year)]. If you elect to continue care with Remedy beyond your first year, your annual estimated cost for years two and beyond is $1068 per year [which is ($89 x 12 months)], and you will be notified in advance if this monthly fee is to increase. Additionally, if you do not show up for an appointment or are late for an appointment, you will be charged an additional $89 for each missed appointment, in addition to the above care estimate. The total fees incurred include the above estimated cost of annual care, plus $89 multiplied by the number of appointments you miss per year.
For children, age 17 and younger, the fees for service(s) with Remedy Psychiatry, Inc. are billed each month, starting the month you initiate care and sign this terms of service, with the initial month of care $199, then $99 per month thereafter, and continued until you submit a request in writing to terminate your membership and care. This monthly fee is incurred even if you did not have an appointment or require use of services during any given month. The estimated cost of care for a child under age 18 for the first 12 months is $1288 total [which is ($199 x 1 month for first month of care) + ($99 per month x 11 months remaining in the year)]. If you elect to continue care with Remedy beyond your first year, your annual estimated cost for years two and beyond is $1188 per year [which is ($99 x 12 months)], and you will be notified in advance if this monthly fee is to increase. Additionally, if you do not show up for an appointment or are late for an appointment, you will be charged an additional $89 for each missed appointment, in addition to the above care estimate. The total fees incurred include the above estimated cost of annual care, plus $89 multiplied by the number of appointments you miss per year.
If you require legal medical documentation, the fees for documentation are in addition to the above Good Faith Estimate, and can be reviewed in this document.
If desired, you are welcome to request an invoice that you can submit to your insurer (with the exclusion of Medicare) for possible subscription reimbursement. This invoice, or “superbill” will include the services rendered and relevant service (CPT) code and total fees paid. Clients will need to attend at least one appointment within the billing cycle for their insurer to review the claim.
Telephone and Electronic Communications
You consent to our use of your name, phone number, and email address for the purpose of communicating with you about our services, billing, appointments, and related business interactions between you and us. The Remedy patient portal is the means by which your Protected Health Information will be communicated to you. We encourage you to communicate through this portal. Communication via email may not be encrypted, and if you elect to email, you are aware that your personal information may be compromised. For the purposes of assessment of your symptoms, you will receive a questionnaire or series of questionnaires to your phone number, and email address, using a partner software (‘OutcomeMd’), to collect and track your symptoms. Your use of this software is optional.
Term, Termination, and Cancellation
This Agreement will commence on the Effective Date and will extend for one year thereafter. The Agreement shall be automatically renewed upon the anniversary of the Effective Date and each anniversary thereafter, unless terminated as outlined below. Patients are able to cancel at any point without obligation to continue.
Cancellations. Please email email@example.com or message your provider within the Remedy patient portal by 9am PT the business day before your scheduled billing date to cancel your account. Remedy reserves the right not to refund any prepaid amounts due to cancellations.
If a patient wishes not to renew their annual membership, the patient must notify Remedy Psychiatry 30 days before the membership expires. Please note that patients are allowed to cancel at any point, but are only allowed to rejoin once every 12 calendar months and must pay the initial monthly fee for each time they rejoin.
In some cases, the Remedy Psychiatry medical team, nurse and/or physician may determine that you may require a higher level of care or alternate treatment for your benefit. This may include, but is not limited to: discharge from care at Remedy Psychiatry and referral to in-person care by a local medical team, transfer to specialty care center (such as an addiction treatment center).
You acknowledge that your confirmation of engagement with this Agreement is strictly voluntary. This Agreement does not restrict or limit your ability to receive professional services from other physicians and health care professionals.
Insurance Coverage of Fee
The Practice makes no representations whatsoever that the fees paid under this Agreement are or are not covered by your Insurer. You will have the full and complete responsibility for any such determination and You understand and acknowledge that your Insurer may not pay for or reimburse You for the Concierge Service fee.
Insurance or Other Medical Coverage
This Agreement and the Practice’s provision of Concierge Services are not substitutes for health insurance or other health plan coverage (such as membership in an HMO). You acknowledge that the Practice has advised You to obtain or keep in full force your health insurance policy(ies) or plans in order to cover You and your family members for Medical Services and other healthcare costs. You acknowledge that this Agreement is not a contract that provides health insurance for you, and this Agreement is not intended to replace any insurance coverage provided to You by an Insurer and that Concierge Services are not intended to be billed to or covered by your Insurer. Severability If for any reason any provision of this Agreement shall be deemed, by a court of competent jurisdiction, to be legally invalid or unenforceable in any jurisdiction to which it applies, the validity of the remainder of the Agreement shall not be affected, and that provision shall be deemed modified to the minimum extent necessary to make that provision consistent with applicable law and in its modified form, and that provision shall then be enforceable. Modifications, Termination, Interruption and Disruptions You understand, agree and acknowledge that we may modify, suspend, disrupt or discontinue the Remedy Psychiatry platform, any part of the platform or the use of the platform, whether to all clients or to you specifically, at any time with or without notice to you. You agree and acknowledge that we will not be liable for any of the aforementioned actions or for any losses or damages that are caused by any of the aforementioned actions. The Remedy Psychiatry platform depends on various factors such as software, hardware and tools, either our own or those owned and/or operated by our contractors and suppliers. While we make commercially reasonable efforts to ensure the platform’s reliability and accessibility, you understand and agree that no platform can be 100% reliable and accessible and so we cannot guarantee that access to the platform will be uninterrupted or that it will be accessible, consistent, timely or error-free at all times.
Patient Testimonial Release
You agree to provide Remedy Psychiatry, Inc. the right to distribute and share any and all client testimonials that you provided in relation to the services received by Remedy Psychiatry, Inc. Sharing your client testimonial may include posting the information on the company website, posting the testimonial information on Remedy Psychiatry, Inc.’s social media pages, including your testimonial on printed advertisements and promotions. You agree that you are voluntarily sharing your testimonial about services from Remedy Psychiatry, Inc., and you are receiving no financial remuneration from Remedy Psychiatry, Inc. for providing your testimonial and allowing them to use your protected health information for marketing purposes.
You understand that you have the right to revoke this authorization at any time by providing a written request to the Privacy Officer at Remedy Psychiatry, Inc. You understand that if you choose to revoke this authorization, it will become effective on the day of the revocation of the authorization. Any prior uses and disclosures of your testimonial with your protected health information will not be subject to the revocation of the authorization. You understand that Remedy Psychiatry, Inc. will make its best effort to remove your testimonial and protected health information from the Remedy Psychiatry, Inc.’s website and other social media pages.
You understand that the client testimonial for Remedy Psychiatry, Inc. will only include the language contained in the testimonial itself, and no information about you, including your name, medical information, or any other private or protected health information. You understand that all other protected health information that Remedy Psychiatry, Inc. creates and maintains for purposes of your care will not be used in your testimonial or for marketing purposes without prior authorization per privacy regulations of the state and Health Insurance Portability and Accountability Act (HIPAA).
The release in this Section will expire 12 months after the date of the digital confirmation of receipt. After the expiration, you understand that Remedy Psychiatry, Inc. will not be allowed to use your testimonial for any future marketing purposes. It does not require Remedy Psychiatry, Inc. to remove your testimonial from the website or other social media pages unless you specifically request a revocation of this authorization.
Amendment and updates to the Terms
We may modify these Terms regarding the Concierge and Medical Services from time to time. We will notify you of material changes by posting the amended terms on our Remedy Psychiatry platform and/or website. If we have your email on file, we will also notify you of material changes to the Terms by email by or before the effective date of the changes. Please make sure we have your current email address so that you will receive notice of any material changes. If you do not agree with the proposed changes, you should discontinue your use of the Services before the effective date of the changes. If you continue using the Services after the effective date, you will be bound by the updated Terms.
Unless otherwise specified by us, all modifications shall be effective upon posting. Therefore, you are encouraged to check the terms of this Agreement frequently. By using the Remedy Psychiatry platform and the Concierge Services after the changes become effective, you agree to be bound by such changes to the Agreement. If you do not agree to the changes, you must terminate your access to the Remedy Psychiatry platform and participation in the Concierge Services. Moreover, if federal, state, or local law or regulation (“Applicable Law”) requires this Agreement to contain provisions that are not expressly set forth in this Agreement, then, to the extent necessary, such provisions shall be incorporated by reference into this Agreement and shall be deemed a part of this Agreement as though they had been expressly set forth in this Agreement.
This Agreement, and any rights You may have under it, may not be assigned or transferred by You. This Agreement, and any rights the Practice may have under it, may not be assigned or transferred to its heirs, successors, or assignees. The Practice may freely transfer or assign this Agreement and/or any of its obligations hereunder.
Relationship of Parties
You and the Practice intend and agree that the Practice, in performing the Medical and Concierge Services under this Agreement, is an independent contractor, as defined by the guidelines promulgated by the United States Internal Revenue Service and/or the United States Department of Labor, and the Practice shall have exclusive control of its work and the manner in which it is performed.
You acknowledge that this Agreement is a legal document and creates certain rights and responsibilities. You also acknowledge that You have had a reasonable time to seek legal advice regarding the Agreement and have either chosen not to do so or have done so and are satisfied with the terms and conditions of the Agreement.
All written notices are deemed served when sent if sent to the e-mail address of the party appearing in Appendix 2 by email.
This Agreement shall be governed and construed under the laws of California. This Agreement shall be construed without regard to any presumptions or rules requiring construction against the party causing the instrument to be drafted.
Captions in this Agreement are used for convenience only and shall not limit, broaden, or qualify the text.
This Agreement contains the entire agreement between the parties regarding the subject matter of this Agreement, and supersedes all prior oral and written understandings and agreements regarding the subject matter of this Agreement. If any provision of this Agreement is held by a court of competent jurisdiction to be illegal, invalid, unenforceable, or otherwise contrary to law, the remaining provisions of this Agreement will remain in full force and effect.
APPENDIX 1: CONCIERGE SERVICE
Concierge Services are Non-Medical Services. Under the Agreement, you are entitled to receive the following Concierge Services in exchange for the fee listed below:
- Connection to same Nurse Practitioner via video chat, phone, text chat application for questions.
- Patient shall have access to the same Nurse each visit via messaging, phone and video chat. The communication will be enabled by the Remedy Psychiatry third party applications.
- Same Day/Next Day Appointments.
- When Patient requests to schedule an appointment, a reasonable effort shall be made to schedule an appointment with the same Nurse on the same day or within 24 hours.
- Patients will receive direct care and communicate only with their psychiatric mental health nurse practitioner. The medical doctor will not communicate directly with patients but instead will serve a supervisory role in reviewing the patient treatment plans as created by the nurse practitioner.
- Electronic Medical Record (called Remedy Patient Portal, or IntakeQ or Onpatient) for communication and monitoring for health data.
- Remedy Psychiatry will provide information obtained via their platform ( Drchrono, and IntakeQ) to provide data and protected communication with the medical team in a comprehensive manner regarding the patient ’s health status and communications.
Concierge Services Patient Warning. Patient understands and agrees that email and the internet should never be used to access medical care in the event of an emergency, or any situation that Patient could reasonably expect may develop into an emergency. Patient agrees that in such situations, when a Patient cannot speak to Nurse immediately in person or by telephone, that Patient shall call 911 or the nearest emergency medical assistance provider and follow the directions of emergency medical personnel.
Background on Telemedicine
Telemedicine involves the use of electronic communications technologies to enable the transfer of medical/health and other information between a health care provider and patient who are in different locations. Telemedicine technologies may include interactive two-way audio and video, interactive audio, remote monitoring, patient medical records, medical images, e-mail, output data from medical devices, and sound and video files. Information conveyed using telemedicine may be used for the diagnosis, treatment, follow-up and/or education of patients.
Electronic systems incorporate network and software security protocols to protect your confidentiality and the confidentiality of your data. Our system also includes measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption.
Expected Benefits of Receiving Medical Services via Telemedicine
- Improved access to medical care by enabling you to consult with your physician remotely.
- More efficient medical evaluation and management.
- Obtaining the expertise of a distant specialist.
Possible Risks of Receiving Medical Services via Telemedicine
As with any medical procedure, there are potential risks associated with the use of telemedicine. These risks include, but may not be limited to:
- In rare cases, information transmitted may not be sufficient (e.g. poor resolution of images) to allow for appropriate medical decision making by the physician.
- Delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment.
- In very rare instances, security protocols could fail, causing a breach of privacy of personal medical information.
- In rare cases, a lack of access to complete medical records may result in adverse drug interactions or allergic reactions or other judgment errors.
- There may be other risks that are currently not known.
Medication and Prescribing Controlled Substances
During the course of your care, if a medication is suggested to you by your provider, you will be orally informed of the risks, benefits, side effects and alternatives to that medication.
Given that your provider is licensed to practice medicine, prescribe and treat patients in California, medications will be prescribed to that state. If you are to travel to another state or country, you are responsible for planning ahead to request that your medication be sent to your California pharmacy for early fill so as to have sufficient medication during your travel. If you run out of medication, or it is lost or stolen, your Remedy provider may not be able to send a prescription for a medication refill in another state or country. In this case, it is recommended that you seek local care through an urgent care or emergency room to obtain your medication.
California Business and Professions Code Section 2242 prohibits a medical professional from prescribing a controlled substance without an in-person medical evaluation. However, due to the COVID-19 pandemic, as of January 31, 2020, the Drug Enforcement Administration (“DEA”) announced that it will allow DEA registered practitioners to issue prescriptions for controlled substances to patients for who they have not conducted an in-person medical evaluation, so long as certain conditions are met. This temporary change to the law shall remain in effect for the duration of the public health emergency. As such, it is possible that this allowance will be reversed and patients that have initiated care with Remedy may need arrange an in-person appointment with a local medical team in order to continue their medications.
BY CLICKING ACCEPT, I ACKNOWLEDGE THAT I UNDERSTAND AND AGREE WITH THE FOLLOWING:
- I give my informed consent to receive medical services including telemedicine from Remedy Psychiatry, Inc., Affiliates, and/or Associates, and its physicians (including primary care practitioners and specialists) for myself or for whom I am the parent or legal guardian. This medical care may include services related to my health (or the identified person) and may include (but not limited to) preventative care, diagnostic testing, therapeutic treatments, rehabilitative care, health maintenance, palliative care, counseling, assessment or review of physical or mental status/function of the body. This consent includes contact and discussion with other health care professionals for care and treatment.
- I have been given an opportunity to review the credentials of Remedy Psychiatry, Inc., its Affiliates’, and/or Associates’ physicians and to select a physician from Remedy Psychiatry, Inc. prior to any initial consultation.
- It is up to the Remedy Psychiatry, Inc., Affiliates, and/or Associates physician or Nurse to determine whether or not my needs are appropriate for a telemedicine encounter.
- There is no guarantee that I will receive a prescription for any medication.
- A variety of alternative methods of medical care may be available to me, and that I may choose one or more of these at any time. My Nurse has explained the alternatives to my satisfaction.
- Telemedicine may involve electronic communication of my personal medical information to Remedy Psychiatry, Inc. physicians or other healthcare providers who may be located in other areas, including in other states.
- It is my duty to inform my Remedy Psychiatry, Inc., Affiliates, and/or Associates physician or Nurse of interactions regarding my care that I may have with other healthcare providers to ensure my Remedy Psychiatry, Inc., Affiliates, and/or Associates physician has a full clinical picture when making treatment decisions.
- Some parts of the services involving physical tests may be conducted by individuals at my location, or at a testing facility, at the direction of my Remedy Psychiatry, Inc., Affiliates, and/or Associates physician or Nurse.
- I have the right to withhold or withdraw my consent to the use of telemedicine in the course of my care at any time.
- I may suspend or terminate access to telemedicine services at any time for any reason or for no reason.
- I understand that if I am experiencing a medical emergency, that I will be directed to dial 9-1-1 immediately and that neither Remedy Psychiatry, Inc., Affiliates, and/or Associates nor Remedy Psychiatry, Inc. service specialists will be able to connect me directly to any local emergency services.
- I have the right to inspect all information obtained and recorded in the course of a telemedicine interaction, including my medical record, and may receive copies of this information for a reasonable fee.
- I understand that my healthcare information may be shared with other individuals for scheduling and billing purposes. Persons may be present during the consultation other than the Remedy Psychiatry, Inc., Affiliates, and/or Associates physician in order to operate the telemedicine technologies. I further understand that I will be informed of their presence in the consultation and thus will have the right to request the following: (1) omit specific details of my medical history/examination that are personally sensitive to me; (2) ask non-medical personnel to leave the telemedicine examination; and/or (3) terminate the consultation at any time.
- The laws that protect privacy and the confidentiality of medical information also apply to telemedicine, and that no information obtained in the use of telemedicine that identifies me will be disclosed to researchers or other entities without my consent.
- I may expect the anticipated benefits from the use of telemedicine in my care, but that no results can be guaranteed or assured.
- There is a risk of technical failures during the telemedicine encounter beyond the control of Remedy Psychiatry, Inc., Affiliates, and/or Associates. I agree to hold harmless Remedy Psychiatry, Inc., Affiliates, and/or Associates for delays in evaluation or for information lost due to such technical failures.
- In the event of any problem with the website or related services, I agree that my sole remedy is to cease using the website or terminate access to the service. Under no circumstances will Remedy Psychiatry, Inc., its Affiliates, and/or Associates or any Remedy Psychiatry subsidiary or affiliate be liable in any way for the use of the telemedicine services, including but not limited to, any errors or omissions in content or infringement by any content on the website of any intellectual property rights or other rights of third parties, or for any losses or damages of any kind arising directly or indirectly out of the use of, inability to use, or the results of use of the website, and any website linked to the website, or the materials or information contained on any or all such websites. I agree that I will not hold Remedy Psychiatry, its subsidiaries or affiliates liable for any punitive, exemplary, consequential, incidental, indirect or special damages (including, without limitation, any personal injury, lost profits, business interruption, loss of programs or other data on my computer or otherwise) arising from or in connection with your use of the website whether under a theory of breach of contract, negligence, strict liability, malpractice or otherwise, even if we or they have been advised of the possibility of such damages.
- Remedy Psychiatry makes no representation that materials on this website are appropriate or available for use in any other location. I understand that if I access these services from a location outside of the United States, that I do so at my own risk and initiative and that I am ultimately responsible for compliance with any laws or regulations associated with my use.
- I am aware that I have a right to, and can request a copy of this consent form.
- Before the commencement of my initial consultation with Remedy Psychiatry, Inc., Affiliates, and/or Associates, I had an opportunity to discuss the above with my practitioner and all of my questions have been answered to my satisfaction.
All physicians and nurses on Remedy Psychiatry hold professional licenses issued by the professional licensing boards in the states where they practice. You can report a complaint relating to services provided by a Treating Provider by contacting the professional licensing board in the state where the services were received. In a professional relationship, sexual intimacy is never appropriate and should be reported to the board that licenses, registers, or certifies the licensee.
You can find the contact information for each of the state professional licensing boards governing medicine on the Federation of State Medical Boards website at:
Any clinical records created as a result of your use of the Site will be securely maintained by Remedy Psychiatry on behalf of your Treating Provider(s) for a period that is no less than the minimum number of years such records are required to be maintained under state and federal law, and which is typically at least six years.
Please report any violations of these New Patient Agreement and Informed Consent to firstname.lastname@example.org
Notice of Privacy Practices
Our Privacy Obligations
The law requires us to maintain the privacy of certain health information called “Protected Health Information” (“PHI”). Protected Health Information is the information that you provide us or that we create or receive about your health care. The law also requires us to provide you with this Notice of our legal duties and privacy practices. When we use or disclose (share) your Protected Health Information, we are required to follow the terms of this Notice or other notice in effect at the time we use or share the PHI. Finally, the law provides you with certain rights described in this Notice. Furthermore, we are required to notify you following a breach of unsecured PHI.
Please note that if you choose to communicate with Remedy Psychiatry, your Nurse or Doctor, outside of the Remedy Psychiatry provided HIPAA encrypted platforms ofIntakeQ, Drchrono, Doxy, iplum or the telehealth video platform, such as but not limited to: by texting, phone call, FaceTime or other means, your health information will not be protected and may be subject to interception.
Ways We Can Use and Share Your PHI Without Your Written Permission (Authorization)
In many situations, we can use and share your PHI for activities that are common in many hospitals and clinics. In certain other situations, which we will describe in Section 4 below, we must have your written permission (authorization) to use and/or share your PHI. We do not need any type of permission from you for the following uses and disclosures:
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND SHARED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice describes the privacy practices of Remedy Psychiatry, Inc., Affiliates, and/or Associates. It applies to the health services you receive from Remedy Psychiatry, Inc., Affiliates, and/or Associates. For purposes of this Notice, Remedy Psychiatry, Inc., Affiliates, and/or Associates will be referred to herein as “we” or “us.” We will share your health information among ourselves to carry out our treatment, payment, and health care operations.
Uses and Disclosures for Treatment, Payment and Health Care Operations
We may use and share your PHI to provide “Treatment,” obtain “Payment” for your Treatment, and perform our “Health Care Operations.” These three terms are defined as:
- Treatment. We use and share your PHI to provide care and other services to you–for example, to diagnose and treat your injury or illness. In addition, we may contact you to provide appointment reminders or information about treatment options. We may tell you about other health-related benefits and services that might interest you. We may also share PHI with other doctors, nurses, and others involved in your care. We share your PHI with the pharmacy in order to prescribe medication to you.
- Payment. We may use and share your PHI to receive payment for services that we provide to you. For example, we may share your PHI to request payment and receive payment, or coverage of your prescribed medications,from Medicare, Medicaid, your health insurer, HMO, or other company or program that arranges or pays the cost of some or all of your health care (“Your Payor”) and to confirm that Your Payor will pay for health care, or your prescription medication. As another example, we may share your PHI with the person who you told us is primarily responsible for paying for your Treatment, such as your spouse or parent.
- Health Care Operations. We may use and share your PHI for our health care operations, which include management, planning, and activities that improve the quality and lower the cost of the care that we deliver. For example, we may use PHI to review the quality and skill of our physicians, nurses, and other health care providers. However, you have the right to restrict disclosure to a health plan for healthcare services for which you pay in full out of pocket (excluding a deductible).
- Business Associates. In addition, we may share PHI with certain others who help us with our activities, including those we hire to perform services.
Your Other Health Care Providers
We may also share PHI with your doctor and other health care providers when they need it to provide Treatment to you, to obtain Payment for the care they give to you, to perform certain Health Care Operations, such as reviewing the quality and skill of health care professionals, or to review their actions in following the law.
Disclosure to Relatives, Close Friends and Your Other Caregivers
We may share your PHI with your family member/relative, a close personal friend, or another person who you identify if we: (1) first provide you with the chance to object to the disclosure and you do not object; (2) reasonably infer that you do not object to the disclosure; or (3) obtain your agreement to share your PHI with these individuals. If you are not present at the time we share your PHI, or you are not able to agree or disagree to our sharing your PHI because you are not capable or there is an emergency circumstance, we may use our professional judgment to decide that sharing the PHI is in your best interest. We may also use or share your PHI to notify (or assist in notifying) these individuals about your location and general condition.
Public Health Activities
We are required or are permitted by law to report PHI to certain government agencies and others. For example, we may share your PHI for the following:
- to report health information to public health authorities for the purpose of preventing or controlling disease, injury, or disability;
- to report abuse and neglect to government authorities, including a social service or protective services agency, that are legally permitted to receive the reports;
- to report information about products and services to the U.S. Food and Drug Administration;
- to alert a person who may have been exposed to a communicable disease or may otherwise be at risk of developing or spreading a disease or condition;
- to report information to your employer as required under laws addressing work-related illnesses and injuries or workplace medical surveillance; and
- to prevent or lessen a serious and imminent threat to a person for the public’s health or safety, or to certain government agencies with special functions such as the State Department.
Health Oversight Activities
We may share your PHI with a health oversight agency that oversees the health care system and ensures the rules of government health programs, such as Medicare or Medicaid, are being followed.
Judicial and Administrative Proceedings
We may share your PHI in the course of a judicial or administrative proceeding in response to a legal order or other lawful process.
Law Enforcement Purposes
We may share your PHI with the police or other law enforcement officials as required or permitted by law or in compliance with a court order or a subpoena.
We may share PHI with a coroner or medical examiner as authorized by law. We may share your PHI with a family member who was involved in your care or payment for your care prior to death, unless such disclosure would be inconsistent with any prior expression you have communicated to us. Under federal, the privacy rights described herein will expire fifty years after your death.
Organ and Tissue Procurement
We may share your PHI with organizations that facilitate organ, eye, or tissue procurement, banking, or transplantation.
We may use or share your PHI if the group that oversees our research, the Institutional Review Board/ Privacy Board, approves a waiver of permission (authorization) for disclosure or for a researcher to begin the research process.
We may share your PHI as permitted by or required by state law relating to workers’ compensation or other similar programs.
We may share your PHI to a public or private entity authorized by law or by its charter to assist in disaster relief efforts.
As required by law
We may use and share your PHI when required to do so by any other law not already referred to above.
USES AND DISCLOSURES REQUIRING YOUR WRITTEN PERMISSION (AUTHORIZATION)
Use or Disclosure with Your Permission (Authorization)
For any purpose other than the ones described above in Section 2, we may only use or share your PHI when you grant us your written permission (authorization). For example, you will need to give us your permission before we send your PHI to your life insurance company or disability insurance company.
We must also obtain your written permission (authorization) prior to using your PHI to send you any marketing materials paid for by a third party. However, we may communicate with you by email, face to face about products or services related to your treatment, case management, care coordination, or alternative treatments, therapies, health care providers, or care settings. You are welcome to ‘opt-out’ of Remedy marketing, educational and promotional emails at any point in time by unsubscribing to the emails, while staying subscribed to the Remedy care subscription.
We may not sell your PHI without your written authorization.
Uses and Disclosures of Your Highly Confidential Information
Federal and state law requires special privacy protections for certain highly confidential information about you (“Highly Confidential Information”), including: (1) any portion of your PHI that is kept in psychotherapy notes; (2) about mental health and developmental disabilities services; (3) about alcohol and drug abuse prevention, treatment and referral; (4) about HIV/AIDS testing, diagnosis or treatment; (5) about sexually transmitted disease(s); (6) about genetic testing; (7) about child abuse and neglect; (8) about domestic abuse of an adult with a disability; (9) about sexual assault; or (10) In Vitro Fertilization (IVF). Before we share your Highly Confidential Information for a purpose other than those permitted by law, we must obtain your written permission.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
For Further Information; Complaints
If you want more information about your privacy rights, are concerned that we have violated your privacy rights, or disagree with a decision that we made about access to your PHI, you may contact our HIPAA Privacy Officer. You may also file written complaints with the Office for Civil Rights (“OCR”) of the U.S. Department of Health and Human Services by sending a letter to 200 Independence Avenue, S.W., Washington D.C. 20201, calling 1-877-796-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints. We will not take any action against you if you file a complaint with us or with the OCR.
Right to Receive Confidential Communications
You may ask us to send PHI to a different location than the address that you gave us, or in a special way, or to contact you at a different phone number. You will need to ask us in writing. For example, you may ask us to send a copy of your medical records to a different address than your home address. We will accept all reasonable requests.
Right to Revoke Your Written Permission (Authorization)
You may change your mind about your authorization or any written permission regarding your PHI by giving or sending a written “revocation statement” to the HIPAA Privacy Officer at the address below. The revocation will not apply to the extent that we have already taken action where we relied on your permission.
Right to Inspect and Copy Your Health Information
You may request copies (for a reasonable fee) and/or access to your medical record file, billing records, and other records. You have a right to a copy of your records if your provider deems that it is in your best interest and would not contribute to worsening of your mental health, if part of a “designated record set” in electronic format, as reasonably available. You can review your medical records and/or ask for hard copies. Under limited circumstances, we may deny you access to a portion of your records. This denial is used if it is determined by your medical team, that reading your medical record may incur further mental health distress. In this case, you may elect to have a summary of your record, or entire record, sent to a new medical treatment team or physician to continue your care with. If you want to access your records, you may obtain a record request form from Remedy Psychiatry, Inc., Affiliates, and/or Associates Return the completed form to the Privacy Officer.
Right to Amend Your Records
You have the right to request that we amend PHI maintained in medical record files, billing records, and other records used to make decisions about your Treatment and payment for your Treatment. If you want to amend your records, you may obtain an amendment request form from the HIPAA Privacy Officer. After which, you can return the completed form to the HIPAA Privacy Officer. We will comply with your request unless we believe that the information that would be amended is correct and complete or that other circumstances apply. In the case of a requested amendment concerning information about the Treatment of a mental illness or developmental disability, you have the right to appeal to a state court our decision not to amend your PHI.
Right to Receive an Accounting of Disclosures
You may ask for an accounting of certain disclosures of your PHI made by us. These disclosures must have occurred before the time of your request, and we will not go back more than six (6) years before the date of your request. If you request an accounting more than once during a twelve (12) month period, we will charge you based on the rate sheet. Direct your request for an accounting to the HIPAA Privacy Officer.
Right to Request Restrictions
You have the right to ask us to restrict or limit the PHI we use or disclose about you for treatment, payment, or health care operations. With one exception, we are not required to agree to your request. If we do agree, we will comply unless the information is needed to provide emergency treatment. Your request for restrictions must be made in writing and submitted to the HIPAA Privacy Officer at the address below. We must grant your request to a restriction on disclosure of your PHI to a health plan if you have paid for the health care item in full out of pocket.
Right to Receive a Copy of this Notice
If you ask, you may obtain a copy of this Notice, even if you have agreed to receive the notice electronically.
This Notice is effective as of December 3, 2020.
Right to Change Terms of this Notice
We may change the terms of this Notice at any time. If we change this Notice, we may make the new notice terms effective for all Protected Health Information that we maintain, including any information created or received prior to issuing the new notice. If we change this Notice, we will post the new notice in common areas throughout our facility, and on our Internet site at www.Remedy Psychiatry.com. You also may obtain any new notice by contacting the Privacy Officer.
Federal & State Law
Federal and state laws require Remedy Psychiatry, Inc., Affiliates, and/or Associates to protect your medical information and federal law requires Remedy Psychiatry, Inc., Affiliates, and/or Associates to describe to you how we handle that information. When federal and state privacy laws differ, and the state law is more protective of your information or provides you with greater access to your information, then state law will override federal law.
Questions or Concerns
You may contact the Privacy Officer for additional information:
Address: (Mailing address only)
200 S. Barrington Ave, PO Box 492124
Los Angeles CA 90049-9998
PATIENT BILL OF RIGHTS
Many states have adopted a patient bill of rights applicable to patients of physicians and/or hospitals and other health care facilities. Some of those states require that physicians provide a copy of the bill of rights to their patients. The portion of the bill of rights that is relevant to the Service is provided to you here on behalf of Remedy Psychiatry, Inc., Affiliates, and/or Associates. Please note that it includes patient responsibilities as well.
- A patient has the right to be treated with courtesy and respect, with appreciation of his or her individual dignity, and with protection of his or her need for privacy.
- A patient has the right to a prompt and reasonable response to questions and requests within the context of the Service.
- A patient has the right to know who is providing medical services and who is responsible for his or her care.
- A patient has the right to know what patient support services are available, including whether an interpreter is available if he or she does not speak English.
- A patient has the right to know what rules and regulations apply to his or her conduct.
- A patient has the right to be given information by the health care provider concerning diagnosis, planned course of treatment, alternatives, risks, and prognosis.
- A patient has the right to refuse any treatment provided via the Service unless otherwise required by law.
- A patient has the right to receive a copy of a reasonably clear and understandable, itemized bill and/or receipt and, upon request, to have the charges explained.
- A patient has the right to impartial access to medical treatment or accommodations, regardless of race, national origin, religion, handicap, or source of payment, subject to the technical limitations of the Service.
- A patient has the right to express grievances regarding any violation of his or her rights, as stated in state law, through the grievance procedure of the health care provider which served him or her and to the appropriate state licensing agency.
- A patient is responsible for providing to the Provider, to the best of his or her knowledge, accurate and complete information about present complaints, past illnesses, hospitalizations, medications, and other matters relating to his or her health.
- A patient is responsible for reporting unexpected changes in his or her condition to the Provider.
- A patient is responsible for reporting to the Provider whether he or she comprehends a contemplated course of action and what is expected of him or her.
- A patient is responsible for following the treatment plan recommended by the Provider.
- A patient is responsible for his or her actions if he or she refuses treatment or does not follow the Provider’s instructions.
STATE SPECIFIC NOTIFICATIONS (SEE BELOW FOR STATE SPECIFIC MENTAL HEALTH NOTIFICATIONS)
Remedy Psychiatry’s services are only offered in California at this time. You agree that you are domiciled in and physically present in California, and agree to receive care by Remedy Psychiatry within the state of California. You understand that your practitioner is licensed in the state of California, and if you move or seek temporary or permanent residence in another state or country, your Remedy Psychiatry nurse or physician may not be licensed in that state and you may need to obtain alternative and ongoing care, and medication-prescribing services, outside of Remedy Psychiatry.
FOR CALIFORNIA RESIDENTS
- You or your legal representative retains the option to withhold or withdraw consent to receive health care services via the Service at any time without affecting your right to future care or treatment nor risking the loss or withdrawal of any benefits to which you or your legal representative would otherwise be entitled.
- All existing confidentiality protections apply.
- All existing laws regarding patient access to medical information and copies of medical records apply.
- Dissemination of any of any of your identifiable images or information from the telemedicine interaction to researchers or other entities shall not occur without your consent.
- All provisions herein, including your informed consent to receive services via the Service are for the benefit of the treating provider as well as for your benefit.
- Medical doctors are licensed and regulated by the Medical Board of California, (800) 632-2322, www.mbc.ca.gov
STATE SPECIFIC DIRECT PRIMARY CARE (“DPC”) REQUIREMENTS)
FOR CALIFORNIA RESIDENTS
- While you are obligated to pay a flat monthly fee for general concierge non-medical access (not care), Remedy Psychiatry shall charge the monthly fee of $179 for your first month if you are an adult age of 18 or older, or $199 for your first month for patients under the age of 18, and $89 per month starting in your second month if you are an adult age 18 or older, or $99 starting in your second month if you are under the age of 18. Your flat monthly fee is the maximum amount you will pay, excluding billing for no-show appointments, late cancellation appointments, or fees billed for completing documentation. All text messages and telephone calls will be considered as follow-up to the initial and subsequent face-to-face video chat appointments. Your credit card will be charged $179 for your first month if you are an adult age of 18 or older, or $199 for your first month for patients under the age of 18, and $89 per month starting in your second month and every month after if you are an adult age 18 or older, or $99 starting in your second month if you are under the age of 18. This Agreement is not a health benefit plan as otherwise described by law as it only pertains to a limited set of services provided through Remedy Psychiatry. This Agreement does not satisfy minimum essential coverage standards for health insurance under state or under the federal Patient Protection and Affordable Care Act, as currently enacted or hereafter amended, 26 U.S.C. 5000a, and there may be tax consequences for those who do not have not qualified comprehensive health coverage in addition to this Agreement. If this Agreement terminates for any reason, and you have not already purchased health care insurance coverage that will satisfy state and federal minimum coverage standards, you will not be able to purchase new individual health insurance until the next health insurance open enrollment period has begun. Remedy Psychiatry and its providers are not affiliated with any health insurance plan, and none of the medical services provided hereunder will be covered by your health insurance. Remedy Psychiatry only covers those services specifically identified in this Agreement when delivered or arranged by Remedy Psychiatry providers according to the terms of this Agreement. Remedy Psychiatry providers may refer a patient to a non-Remedy Psychiatry provider for medical services, prescription drugs or supplies, but in that circumstance, you will need to contact your health insurance provider and follow the health plan’s managed care procedures in order to obtain coverage for the referred services, prescription drugs or supplies under the health plan’s benefits. Certain services identified in this Agreement may already be covered under your health plan at no additional cost when provided by non-Remedy Psychiatry providers. You will need to contact your health plan to understand the benefits and limitations of your health insurance plan and any overlap between the services offered under this Agreement and the coverage under your health insurance plan.
OUTSIDE PROFESSIONALS ON THE PLATFORM
- From time to time, outside medical professionals (doctors, nutritionist, dietitians for example) & organizations may contract with Remedy Psychiatry, Inc., Affiliates, and/or Associates Physician Group (and affiliated physician groups) in order to use our technology to communicate with our patients). In this regard, Remedy Psychiatry, Inc., Affiliates, and/or Associates Inc. operates a technology service provider for those professionals under a separate agreement, and it’s the responsibility of the partner to enter into a separate agreement with those patients they interact with on the Remedy Psychiatry, Inc., Affiliates, and/or Associates platform.
IntakeQ and Drchrono, Terms and Conditions
The following are the IntakeQ and Drchrono (and Onpatient) Terms and Conditions (the “Agreement”) which govern your access and use of our online platform through which medical treatment and counseling may be provided (collectively, the “Platform”). The Platform may be provided or be accessible via multiple websites or applications whether owned and/or operated by us or by third parties, including, without limitation, the website https://www.Remedy Psychiatry.com and its related apps.
By accessing or using the Platform, you are entering into this Agreement. You should read this Agreement carefully before starting to use the Platform. If you do not agree to be bound to any term of this Agreement, you must not access the Platform.
When the terms “we”, “us”, “our” or similar are used in this Agreement, they refer to any company that is affiliated with, and/or owns and operates the Platform, including but not limited to Remedy Psychiatry, Inc., P.C., and Remedy Psychiatry, Inc. (the “Company”).
You hereby certify that you are (i) over the age of eighteen (18) or have the legal ability to consent to Medical and/or Counseling Services (as defined below) or are the Parent/Guardian of the patient and you have the legal authority to consent to Medical Services on behalf of the patient, and (ii) physically located or are a resident of the State or Country you have chosen as your current residency when creating your account. You agree to provide “Contact Information” (your personal contact and/or a close family member/relation) to your Counselor (as defined below) to act as an information source to be used in case of a mental health crisis or other emergency where knowledge of your location is crucial. You are presumed to be rendering care with your physical location static, and at the address and location specified on your initial submission of your contact form, unless you tell your provider otherwise at the time of your appointment. You agree to not have appointments while driving. You acknowledge that your ability to access and use the Platform is conditioned upon the truthfulness of the information you provide regarding your age, residence and Contact Information and that the Counselors you access are relying upon this certification in order to interact with you and provide the Counseling Services.
The Nurses, Physicians, Counselors and Counselor Services
The Platform may be used to connect you with a medical provider who will provide services to you through the Platform (“Medical Services”).
We require every Nurse or physician providing Services on the Platform to be an accredited, trained, and experienced nurse practitioner or similar applicable recognized professional certification based on their state and/or jurisdiction. The nurses are independent providers who are neither our employees nor agents nor representatives. The Platform’s role is limited to enabling the medical Services while the medical and/or counseling Services themselves are the responsibility of the nurse or physician who provides them. While we hope the medical Services are beneficial to you, you understand, agree and acknowledge that they may not be the appropriate solution for everyone’s needs and that they may not be appropriate for every particular situation and/or may not be a complete substitute for a face-to-face examination and/or care in every particular situation.
DO NOT USE THIS SERVICE FOR EMERGENCY MEDICAL NEEDS. IF YOU EXPERIENCE A MEDICAL EMERGENCY, CALL 911 IMMEDIATELY.
IF YOU ARE THINKING ABOUT SUICIDE OR IF YOU ARE CONSIDERING TAKING ACTIONS THAT MAY CAUSE HARM TO YOU OR TO OTHERS OR IF YOU FEEL THAT YOU OR ANY OTHER PERSON MAY BE IN ANY DANGER OR IF YOU HAVE ANY MEDICAL EMERGENCY, YOU MUST IMMEDIATELY CALL THE EMERGENCY SERVICE NUMBER (911 IN THE US) AND NOTIFY THE RELEVANT AUTHORITIES.
THE PLATFORM IS NOT INTENDED FOR THE PROVISION OF A CLINICAL DIAGNOSIS REQUIRING AN IN- PERSON EVALUATION AND YOU SHOULD NOT USE IT IF YOU NEED ANY OFFICIAL DOCUMENTATION OR APPROVALS FOR PURPOSES SUCH AS, BUT NOT LIMITED TO, COURT-ORDERED COUNSELING. IT IS ALSO NOT INTENDED FOR ANY INFORMATION REGARDING WHICH DRUGS OR MEDICAL TREATMENT MAY BE APPROPRIATE FOR YOU, AND YOU SHOULD DISREGARD ANY SUCH ADVICE IF DELIVERED THROUGH THE PLATFORM.
DO NOT DISREGARD, AVOID, OR DELAY IN OBTAINING IN-PERSON CARE FROM YOUR DOCTOR OR OTHER QUALIFIED PROFESSIONAL BECAUSE OF INFORMATION OR ADVICE YOU RECEIVED THROUGH THE PLATFORM.
Privacy and Security
Protecting and safeguarding any information that you provide through the Platform is extremely important to us. Information about our privacy and security practices can be found within our New Patient Agreement.
All relevant information and materials provided by you with respect to your treatment and the content shared between you and your Nurse while providing the Medical Services will be held confidential unless you request in writing to have all or portions of such content released to a specifically named person/persons. Limitations of the aforementioned privilege of confidentiality are itemized below:
- If you threaten or attempt to commit suicide or otherwise conduct yourself in a manner in which there is a substantial risk of incurring serious bodily harm.
- If you threaten grave bodily harm or death to another person.
- If the Nurse or medical professional has a reasonable suspicion that you or another named victim is the perpetrator, observer of, or actual victim of physical, emotional or sexual abuse of children under the age of 18 years.
- Suspicions as stated above in the case of an elderly person who may be subjected to these abuses.
- Domestic violence when children are present on the premises
- Suspected neglect of the parties named in items #3 and # 4.
- If a court of law issues a legitimate subpoena for information stated on the subpoena.
- If a client is in therapy or being treated by order of a court of law, or if information is obtained for the purpose of rendering an expert’s report to an attorney.
Occasionally, Nurses, physicians or other professionals of Remedy Psychiatry may need to consult with other professionals in their areas of expertise in order to provide the best treatment for you. Information about you may be shared in this context.
Limitation of Liability and Disclaimer of Warranty
TO THE EXTENT PERMITTED BY APPLICABLE LAWS, YOU HEREBY RELEASE US AND AGREE TO HOLD US HARMLESS FROM ANY AND ALL CAUSES OF ACTION AND CLAIMS OF ANY NATURE RESULTING FROM THE COUNSELOR SERVICES OR YOUR ACCESS OR USE OF THE PLATFORM, YOUR USE OR SOMEONE ELSE’S USE OF AND/OR ACCESS TO YOUR ACCOUNT, ANY VIOLATIONS BY YOU OF THIS AGREEMENT, ANY COLLECTION EFFORTS IN NON-PAYMENT OF THE COUNSELING SERVICES, YOUR VIOLATION OF ANY THIRD PARTY RIGHTS INCLUDING (WITHOUT LIMITATION) ANY INTELLECTUAL PROPERTY RIGHTS, PUBLICITY, CONFIDENTIALITY, OR PRIVACY RIGHTS, AND/OR INCLUDING (WITHOUT LIMITATION) ANY ACT, OMISSION, OPINION, RESPONSE, ADVICE, SUGGESTION, INFORMATION AND/OR SERVICE OF ANY COUNSELOR AND/OR ANY OTHER CONTENT OR INFORMATION ACCESSIBLE THROUGH THE PLATFORM.
TO THE EXTENT PERMITTED BY APPLICABLE LAWS, YOU UNDERSTAND, AGREE AND ACKNOWLEDGE THAT WE SHALL NOT BE LIABLE TO YOU OR TO ANY THIRD PARTY FOR ANY INDIRECT, INCIDENTAL, CONSEQUENTIAL, SPECIAL, PUNITIVE OR EXEMPLARY DAMAGES.
TO THE EXTENT PERMITTED BY APPLICABLE LAWS, YOU UNDERSTAND, AGREE AND ACKNOWLEDGE THAT OUR AGGREGATE LIABILITY FOR DAMAGES ARISING WITH RESPECT TO THIS AGREEMENT AND ANY AND ALL USE OF THE PLATFORM WILL NOT EXCEED THE TOTAL AMOUNT OF MONEY PAID BY YOU THROUGH THE PLATFORM IN THE 3 MONTHS PERIOD PRIOR TO THE DATE OF THE CLAIM.
If the applicable law does not allow the limitation of liability as set forth above, the limitation will be deemed modified solely to the extent necessary to comply with applicable law.
This section (limitation of liability) shall survive the termination or expiration of this Agreement.
YOU UNDERSTAND, AGREE AND ACKNOWLEDGE THAT THE PLATFORM IS PROVIDED “AS IS” WITHOUT ANY EXPRESS OR IMPLIED WARRANTIES OF ANY KIND, INCLUDING BUT NOT LIMITED TO MERCHANTABILITY, NON-INFRINGEMENT, SECURITY, FITNESS FOR A PARTICULAR PURPOSE OR ACCURACY. THE USE OF THE PLATFORM IS AT YOUR OWN RISK. TO THE FULLEST EXTENT OF THE LAW, WE EXPRESSLY DISCLAIM ALL WARRANTIES OF ANY KIND, WHETHER EXPRESSED OR IMPLIED.
Your Account, Representations, Conduct and Commitments
You hereby confirm that you are at least 18 years old of age or you are the parent or legal guardian of the patient and have the legal authority to consent to Medical and/or Counseling Services on behalf of the patient.
You hereby confirm that you are legally able to enter into this Agreement.
You hereby confirm and agree that all the information that you provided in or through the Platform, and the information that you will provide in or through the Platform in the future, is accurate, true, current and complete. Furthermore, you agree that during the term of this Agreement you will make sure to maintain and update this information so it will continue to be accurate, current and complete.
You agree, confirm and acknowledge that you are responsible for maintaining the confidentiality of your password and any other security information related to your account (collectively “Account Access”). We advise you to change your password frequently and to take extra care in safeguarding your password.
You agree to notify us immediately of any unauthorized use of your Account Access or any other concern for breach of your account security.
You agree, confirm and acknowledge that we will not be liable for any loss or damage that incurred as a result of someone else using your account, either with or without your consent and/or knowledge.
You agree, confirm and acknowledge that you are solely and fully liable and responsible for all activities performed using your Account Access. You further acknowledge and agree that we will hold you liable and responsible for any damage or loss incurred as a result of the use of your Account Access by any person whether authorized by you or not, and you agree to indemnify us for any such damage or loss.
You agree and commit not to use the account or Account Access of any other person for any reason.
You agree and confirm that your use of the Platform, including the Medical and Concierge Services, are for your own personal use only and that you are not using the Platform or the Counselor Services for or behalf of any other person or organization.
You agree and commit not to interfere with or disrupt, or attempt to interfere with or disrupt, any of our systems, services, servers, networks or infrastructure, or any of the Platform’s systems, services, servers, networks or infrastructure, including without limitation obtaining unauthorized access to the aforementioned.
You agree and commit not to make any use of the Platform for the posting, sending or delivering of either of the following: (a) unsolicited email and/or advertisement or promotion of goods and services; (b) malicious software or code; (c) unlawful, harassing, privacy invading, abusive, threatening, vulgar, obscene, racist or potentially harmful content; (d) any content that infringes a third party right including intellectual property rights; (e) any content that may cause damage to a third party; (f) any content which may constitute, cause or encourage a criminal action or violate any applicable law.
You agree and commit not to violate any applicable local, state, national or international law, statute, ordinance, rule, regulation or ethical code in relation to your use of the Platform and your relationship with the Counselors and us.
If you receive any file from us or from a Counselor, whether through the Platform or not, you agree to check and scan this file for any virus or malicious software prior to opening or using this file.
You confirm and agree to use only credit cards or other payment means (collectively “Payment Means”) which you are duly and fully authorized to use, and that all payment related information that you provided and will provide in the future, to or through the Platform, is accurate, current and correct and will continue to be accurate, current and correct.
You agree to pay all fees and charges associated with your account on a timely basis and according to the fees schedule, the terms and the rates as published in the Platform. By providing us with your Payment Means you authorize us to bill and charge you through that Payment Means and you agree to maintain valid Payment Means information in your account information.
If you have any concerns about a bill or a payment, please contact us immediately by sending an email to email@example.com We will evaluate your issue on a case by case basis and, at our discretion, take steps to resolve any issue.
Modifications, Termination, Interruption and Disruptions to the Platform
You understand, agree and acknowledge that we may modify, suspend, disrupt or discontinue the Platform, any part of the Platform or the use of the Platform, whether to all clients or to you specifically, at any time with or without notice to you. You agree and acknowledge that we will not be liable for any of the aforementioned actions or for any losses or damages that are caused by any of the aforementioned actions.
The Platform depends on various factors such as software, hardware and tools, either our own or those owned and/or operated by our contractors and suppliers. While we make commercially reasonable efforts to ensure the Platform’s reliability and accessibility, you understand and agree that no platform can be 100% reliable and accessible and so we cannot guarantee that access to the Platform will be uninterrupted or that it will be accessible, consistent, timely or error-free at all times.
This Agreement and our relationship with you shall be governed and construed in accordance with the laws of the State of California, This Agreement shall be construed without regard to any presumptions or rules requiring construction against the party causing the instrument to be drafted.
This Agreement contains the entire agreement between the parties regarding the subject matter of this Agreement, and supersedes all prior oral and written understandings and agreements regarding the subject matter of this Agreement.
We may change this Agreement by posting modifications on the Platform. Unless otherwise specified by us, all modifications shall be effective upon posting. Therefore, you are encouraged to check the terms of this Agreement frequently. The last update to this Agreement is posted at the bottom of this Agreement. By using the Platform after the changes become effective, you agree to be bound by such changes to the Agreement. If you do not agree to the changes, you must terminate your access to the Platform and participation in the Counseling Services.
We may freely transfer or assign this Agreement and/or any of its obligations hereunder.
The headings in this Agreement are used for convenience only and shall not limit, broaden, or qualify the text, and shall not be applied in the interpretation of this Agreement.
If any provision of this Agreement is held by a court of competent jurisdiction to be illegal, invalid, unenforceable, or otherwise contrary to law, the remaining provisions of this Agreement will remain in full force and effect.
We look forward to seeing you soon!
Your Remedy Team