Consent to Telehealth, MISTR
Last updated: November 15, 2018
Make sure you read all the important information below because we cover:
- That our third-party medical team consists of doctors, physicians and nurse practitioners.
- How most states require you to do a video consultation with one of our third-party doctors, physicians or nurse practitioners.
- When our duty of care begins.
- The benefits and risks of using our service.
- The importance of reading all the information we provide.
- The importance of answering all questions fully and truthfully.
- The risks of accepting our treatment plan.
- The risks to electronic health information.
- Promo code programs from an employer, individual, health insurer or other organization.
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 App or Website or call us at 747.322.0060 during business hours, Monday to Friday. Our normal business hours are 9:00am to 5:00pm Pacific Time Monday to Friday.
MISTR, Inc. herein referred to as MISTR, does not provide any medical services. MISTR can store a request for medical services and forward that request to a licensed medical provider in your state, which may include our third-party medical team.
After you make a request through the App or Website, MISTR utilizes the medical services of third-party providers, including, but not limited to, TeleDocs, Inc., registered in Florida. The medical team of TeleDocs, Inc. and others is made up of doctors, physicians and nurse practitioners. Whenever we use the term ‘doctor’ we mean doctors, physicians and nurse practitioners.
Most states require you to do a video consultation with our third-party medical team. The video consultation allows you to ask any questions and allows our third-party medical team to judge your suitability for our online model of care.
MISTR is not a pharmacy. If you request that your medicines be delivered to you in the mail, we’ll arrange for an independent third party US pharmacy to dispense and mail your medicines.
NOT FOR EMERGENCIES
I understand that I should never use MISTR in a medical or psychiatric emergency. I understand that in an emergency, I should dial 911 or go to an emergency department.
WHEN OUR DUTY OF CARE BEGINS
I understand that the doctor will take responsibility for my care only after I have created an account, answered all the required health questions and provided a photo and/or have had a video visit and made payment, and the doctor has subsequently reviewed my request for treatment and the health questions that I have completed and any photos and/or information received from a video visit, reviewed all my information, and then subsequently determined that I am a good candidate for the telehealth services. I understand that the duty of care does not begin at the point of me answering questions or making payment or starting a video visit but at the point at which the doctor accepts the duty of care.
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. I understand that making a request for treatment (by completing a visit in the App or Website and making payment or by starting a video visit) or sending a message through the app does not in and of itself 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 the only content in the App or 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 that the doctor links to in such messages and advice that a doctor provides in a video visit. No other content in the App or Website constitutes professional medical advice. Specifically the information provided in our health questions about who we can and cannot treat does not constitute professional medical advice.
I understand that all other content in the App or Website does not constitute professional medical advice and is instead for information purposes only. Never disregard professional medical advice or delay in seeking it because of something you have read on our App or Website.
LIMITED SERVICE SCOPE
I understand that by using the App or Website I will receive care for a limited scope of services only.
I understand that by using the App or Website I won’t receive any other medical services that go beyond the services offered by MISTR and I need to seek other sources for my other medical needs.
I appoint MISTR as my authorized representative for the purpose of receiving my dispensed prescription from the pharmacy. I understand that the pharmacy may mail the prescription directly to me through a mail order service. If the pharmacy does not offer mail order services, I understand that MISTR, as my authorized representative, shall receive the dispensed prescription on my behalf.
BENEFITS AND RISKS OF USING OUR SERVICE
I understand that by using the service I’m seeking great care that’s convenient and affordable.
I understand that important differences exist between MISTR’s model of care and traditional healthcare. Specifically by using MISTR I accept a far greater responsibility to read and understand information throughout the App and Website about the limitations of MISTR’s model of care, the risks of seeking care this way, and the risks and benefits of a proposed treatment plan.
I understand that to read important information I may need to both click on links and various titles to expand the information that’s visible below, and that without clicking on links and titles I will not be able to read important information that enables me to give my informed consent to a treatment.
I understand that by using MISTR I accept the responsibility to provide full and truthful answers to all questions and, when requested, to provide unaltered photos of me that are taken at the time of using our service.
I understand that the doctor is unable independently to verify the information and photos I provide and that the doctor will make a professional judgment based on the information and photos I provide.
I understand that I won’t receive any other medical services that go beyond the diagnosis and treatment of PrEP, the diagnosis and treatment of erectile dysfunction the diagnosis and treatment of chlamydia, and the diagnosis of gonorrhea, Hepatitis B, Hepatitis C, HIV and Syphilis. I need to seek other sources of care for my other medical needs.
I understand that by using the service for a telemedical consultation, I won’t have an in person consultation and physical exam that might identify a medical condition that needs further investigation or immediate treatment.
I understand that by using the service I won’t necessarily speak or message with a doctor or nurse in real time. The only exception to this is patients who will have a video visit with a doctor.
I understand that I must check the App or Website for messages because this is the way that the doctor will communicate important information to me. I understand that if I don’t check the App or Website regularly, then my care may be delayed.
I understand that if I have any questions relating to my care that aren’t urgent, I can message the doctor through the App or Website. I understand that the doctor may not review and respond to my messages until the next business day.
IMPORTANCE OF READING ALL THE INFORMATION WE PROVIDE
I understand that MISTR will provide detailed information in the App and Website to help me make an informed decision about whether to accept a proposed treatment plan. The most important information about a treatment plan is in the link that the doctor will send me when the doctor prescribes a treatment. This information includes detailed information to help me decide if the benefits of the treatment plan outweigh the risks, given the alternative options available to me, which includes the option of not taking any treatment.
I understand the importance of reading the information the doctor provides about adverse events, including the signs and symptoms of serious side effects and common side effects from taking a medicine, as this will ensure that I seek appropriate medical attention in a timely manner.
IMPORTANCE OF ANSWERING ALL QUESTIONS FULLY AND TRUTHFULLY
I understand that by using MISTR I seek to 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 my answers to health questions, and the photos to be of me, taken at the time of me using the service, and unaltered.
I understand that if I provide information that isn’t true and complete, then I’ll be at greater risk of adverse events from any treatment that the doctor prescribes and I may take a treatment that isn’t necessary, appropriate, or safe.
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’ll be at greater risk of adverse events from any treatment that the doctor prescribes and I may take a treatment that isn’t necessary, appropriate, or safe.
I understand that even if I provide information that is true and complete, I’m still at risk of adverse events from any treatment that the doctor prescribes.
I understand that even if I provide photos that are unaltered, of me and taken at the time of using the service, I’m still at risk of adverse events from my treatment that the doctor prescribes.
I understand that it is important that I don’t 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’ve received from MISTR. 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.
I understand that by using MISTR I’m giving my explicit consent for the doctor to access medication history, where it’s available, from records provided by pharmacy databases via the services of including, but not limited to Surescripts. I understand that, if appropriate, the doctor may take this information into account when making a treatment and prescribing decision but this doesn’t change how important it is that I provide full, true and complete information during the MISTR visit.
RISKS OF ACCEPTING OUR TREATMENT PLAN
I understand that all the medicines that the doctor may prescribe or recommend, including over-the-counter medicines and ‘behind-the-counter’ 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 after weighing the risks and benefits of the medicine being prescribed, alternative treatment options and the risks and benefits of such alternatives, and the option of not seeking any treatment.
I understand the importance of reading the manufacturer’s leaflet that comes with a medicine, including an over-the-counter or behind-the-counter medicine, before I take a medicine because this leaflet includes important information about risks and warnings.
I understand that adverse events can be caused by a number of things, 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 things (e.g., supplements, herbs, over-the-counter medicines, or recreational drugs) I’m taking, and lifestyle choices such as smoking tobacco products or drinking alcohol.
I understand that adverse events from taking sildenafil (Viagra), tadalafil (Cialis) or vardenafil (Levitra) include but aren’t 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.
I understand that generic sildenafil 20mg pills are not licensed by the FDA for treatment of erectile dysfunction and that MISTR doctors will be prescribing generic sildenafil 20mg pills ‘off-label’. The medicine sildenafil is the active ingredient in Viagra, the brand name erectile dysfunction medicine.
I understand that by using MISTR to diagnose and treat erectile dysfunction, the doctor won’t have the opportunity to conduct a detailed physical examination that would be possible if I were to see a doctor in person. Because MISTR doctors cannot do a detailed physical examination there is a risk that they may not identify potential physical causes of my condition that they would be able to identify and investigate further if I were to see them in person.
I understand that erectile dysfunction is often the first symptom of other health conditions, including cardiovascular disease and diabetes and that it’s important to have a range of investigative laboratory tests to look for the cause of my condition.
I understand that MISTR doctors can order a set of investigative tests, help me understand the tests results and advise me on next steps. I understand that it’s my responsibility to seek follow-up care and ongoing care from a doctor in person and that it’s unlikely that MISTR doctors will be able to provide follow-up care and ongoing care for any potential health conditions highlighted by the tests.
I understand that the investigative tests that MISTR doctors will order do not include tests to identify potential hormonal causes of my erectile dysfunction. I understand that if I don’t follow the advise of MISTR doctors to order investigative laboratory tests, then I will not be able to identify potentially serious underlying health conditions, which left untreated could result in premature death or permanent disability.
I understand that South Carolina state law prohibits MISTR from offering our erectile dysfunction service in South Carolina.
STI/STD Testing and Treatment
I understand that tests will probably not find chlamydia or gonorrhea if I got them in the last 14-21 days, even if I do actually have them.
I understand that if the test finds chlamydia then MISTR can provide a separate assessment to see if it’s safe to provide me with antibiotic treatment and there is a separate visit fee for this second assessment. Depending upon my symptoms and health history I may need to see a doctor in person for chlamydia treatment even if the test found chlamydia. I understand that in those states that require MISTR to conduct a video visit with a patient seeking treatment that I will only be able to be assessed for treatment Monday to Friday during business hours.
I understand that adverse events from taking antibiotics to treat a chlamydia infection include, but aren’t limited to allergic reaction, permanent disability, and death.
I understand that if the test finds gonorrhea, Hepatitis B, Hepatitis C, HIV or Syphilis then I will need to see a physician in person who may prescribe and administer an antibiotic injection/shot.
I understand the incubation period for Hepatitis B is 45 to 160 days (average: 120 days) and Hepatitis C is 14 to 180 days (average: 45 days).
I understand that an HIV antigen/antibody test performed by a laboratory on blood from a vein can usually detect HIV infection 18 to 45 days after an exposure. Antigen/ antibody tests done with blood from a finger prick can take longer to detect HIV (18 to 90 days after an exposure).
I understand the incubation period for Syphilis has an average time between infection with Syphilis and the start of the first symptom of 21 days, but can range from 10 to 90 days. Syphilis blood test results will be negative during this time.
I understand that MISTR may have to notify my county health department if I test positive for chlamydia, gonorrhea, Hepatitis B, Hepatitis C, HIV and/or Syphilis.
At Home Testing
Most clinical tests use sensitivity and specificity as measures of performance and accuracy. “Sensitivity” describes how accurate the test is at identifying positive results correctly, and “specificity” describes how accurate the test is at identifying negative results correctly. Due to chemical and physical limitations, even the best test is not always 100% accurate, which is why we recommend confirmatory testing with a different method for any positive result, or if an unexpected negative result is obtained. Any positive result should immediately be taken to your primary care provider (or a local state health department) for further analysis and treatment options. A false negative result is also possible if testing is performed too early after exposure, or within what is called the “window period.” It takes time for the body to develop detectable levels of antibodies after exposure to an infection. For example, the window period for HIV and Hepatitis C infection can be as long as 8 to 12 weeks. That is why we recommend that testing be repeated after about 2 months of obtaining a negative result following a high risk exposure.
Many of the individual components of our third-party tests are FDA cleared and all tests have been fully validated according to state and federal guidelines (which include CLIA and College of American Pathologists (CAP) standards). Our third-party laboratory only uses the most current methods that are proven to have the highest level of accuracy for clinical diagnostic testing. A summary of the testing methods is listed below:
Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV): This test uses Strand Displacement Amplification technology for the direct, qualitative detection of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis DNA in vaginal swab specimens and male urine specimens, as well as oral and anal samples.
The lower limit of detection for chlamydia is 450 copies/mL. The lower limit of detection for gonorrhea is 20 copies/mL. The lower limit of detection for trichomoniasis is 40 copies/mL.
Human Immunodeficiency Virus (HIV): Results are obtained using a Combo Antigen/Antibody ELISA for the qualitative detection of HIV p24 antigen and antibodies to HIV type 1 (HIV-1 groups M and O) and HIV type 2 (HIV-2) in human blood.
Hepatitis C Virus (HCV): This test uses an ELISA test system for the qualitative detection of antibodies to hepatitis C virus (anti-HCV) in human blood.
Syphilis: Syphilis is a disease caused by infection with the spirochete Treponema pallidum (T. pallidum). We use an ELISA assay for the qualitative detection of IgG antibodies to T. pallidum. Since the assay specifically targets antibodies against the organism, patients with previously treated syphilis will still be positive on this test. A positive result may indicate recent, past, or successfully treated syphilis infections, therefore, the test cannot be used to differentiate between active and past cured cases.
PROMO CODE PROGRAMS
I understand that if I received a promo code for MISTR’s services from a third party such as my employer, health insurer, individual or other organization (‘Promo-Code-Provider’), I assume all risks associated with my use of the promo code. I understand and agree to fully release, waive, and forever discharge the Promo-Code-Provider from any and all losses, rights, liabilities, claims, demands, legal actions or right of action that I may have now or in the future, known or unknown, for any damages or personal injury that may occur during my use of a promo code for MISTR. I understand that by consenting to these terms and using the MISTR service, I forfeit any and all right to bring a suit against the Promo-Code-Provider arising from my use of the coupon. This release applies even if the injury or damage is caused in whole or in part by the negligence or fault of the Promo-Code-Provider, however, I understand that the forgoing release does not apply to gross negligence or willful misconduct by the Promo-Code-Provider.
I understand that in the event that MISTR, or any of its affiliates (including business associates and vendors) unintentionally discloses or disseminates my personal health information, my only recourse is against MISTR and its affiliates, and not against Promo-Code-Provider.
RISKS TO ELECTRONIC HEALTH INFORMATION
I understand that although MISTR implements a wide range of administrative, physical, and technical safeguards to protect my health information, MISTR cannot guarantee the privacy and confidentiality of my health information.
RESTRICTIONS OF USE
You will not, and will not attempt to:
- Modify, translate, adapt or otherwise create derivative works or improvements, of the App or Website or any content or source code;
- Reverse engineer, disassemble, decompile, decode or otherwise attempt to derive or gain access to the source code of the App or Website or any part thereof;
- Rent, lease, lend, sell, sublicense, assign, distribute, publish, publicly perform or display, transfer or otherwise make available the App or Website or any features or functionality of the App or Website, to any third party for any reason, including by making the App or Website available on a network where it is capable of being accessed by more than one device at any time;
- Remove, disable, circumvent or otherwise create or implement any workaround to any copy protection, rights management or security features in or protecting the App or Website;
- Upload or introduce any virus or malware to the App or Website;
- Interfere with the operation or availability of the App or Website, or the hardware, software and network(s) used to operate the App or Website;
- Sublicense or transfer any of your rights under this Agreement or otherwise use the Services for the benefit of a third party, to operate a service bureau or for resale of the Services;
- Create or access member’s user accounts using any automated means or under false pretenses;
- Frame or mirror the App or Website or reformat it in any way or use deep links;
- Introduce any keystroke logging or any other monitoring code into the App or Website; or,
- Otherwise use the Services or the App or Website in any manner that exceeds the scope of the access right described above.
You may not use the App or Website to do any of the following:
- Harass or advocate harassment of another person or entity;
- Perform any activities that violate any state, local, federal, or international laws or regulations;
- Impersonate any person or entity or misrepresent in any way your affiliation with a person or entity;
- Perform research studies, verify performance of samples of known analyte concentration, or any other use of our platform outside of testing of customer collected biological samples without the explicit written consent of EverlyWell;
- Transmit unsolicited mass mailings, or “spam;”
- Attempt to collect or use personal information about users or third parties without their consent;
- Collect or store any information about other users or members, other than in the normal course of using the App or Website for facilitating voluntary communication among users;
- Transmit or introduce any virus, worm, defect, Trojan horse, time bombs, date bombs, adware, spyware, or similar destructive or harmful item;
- Interfere with security-related features of the App or Website, including by (i) disabling or circumventing features that prevent or limit use or copying of any content, or (ii) reverse engineering or otherwise attempting to discover the source code of the App or Website or any part thereof except to the extent that such activity is expressly permitted by applicable law; or
- Take any action that imposes or may impose (in our sole discretion) an unreasonable or disproportionately large load on our infrastructure.
I agree to comply with this Agreement, on behalf of myself and on behalf of any other person on whose behalf I am seeking medical care. I understand and agree that if I fail to comply with the terms of the Agreement, I may be prohibited from using the Service, and I will hold MISTR harmless from any liability arising from my failure to comply.
I hereby certify that I am at least 18 years of age and possess the legal right and ability to enter into this Agreement under the name in which I have registered to use the Service. I further certify that I am physically present in a state which MISTR operates at the time that I am accessing the Service. I understand and acknowledge that my ability to access the Service is conditional upon the abovementioned criteria of my certification of age, legal authority, and physical presence in a state which MISTR operates at the time that I access the Service, and that the Providers rely upon this certification in order to interact and facilitate health care services with me.
NOTICE: BY CLICKING THE CHECK-BOX “YES, I UNDERSTAND ACCEPT POLICIES OF MISTR” YOU ARE AGREEING TO HAVE ANY ISSUE OF MEDICAL MALPRACTICE DECIDED BY NEUTRAL ARBITRATION AND YOU ARE GIVING UP MY RIGHT TO A JURY OR COURT TRIAL.
I HAVE READ THIS AGREEMENT AND AGREE TO ALL OF THE PROVISIONS CONTAINED ABOVE.