CONSENT TO TELEHEALTH

Effective Date: 08-12-2021

Make sure you read all the important information below because we cover:

How our medical team consists of doctors and nurse practitioners.
How many states require you to do a video consultation or have a telephone call with one of our doctors 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.
Important information about COVID-19 antibody testing.

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 (888) 940-5004

BACKGROUND INFORMATION

AdvanaCare Inc. is an online doctor’s office. We have four medical groups. All four medical groups do business as ‘AdvanaCare Inc.’. In all states other than Kansas, New Jersey and Texas, this service is provided by AdvanaCare Inc. registered in Florida. If you are in Kansas this service is provided by AdvanaCare Inc., A Professional Association, registered in Kansas. If you are in New Jersey this service is proved by AdvanaCare Inc.Corporation. If you are in Texas this service is provided by AdvanaCare Inc., A Professional Association, registered in Texas.

Our medical team is made up of doctors and nurse practitioners. Whenever we use the term ‘doctor’ we mean both our doctors and nurse practitioners.

Some states require you to do a video consultation or to have a telephone call with our medical team. For some services we always do a video consultation or telephone call because we think that’s required for us to provide you with good medical care.

We are an online doctor’s office and not a pharmacy. If you request that your medicines be delivered to you in the mail, we’ll arrange for AdvanaCare Inc. or an independent pharmacy to mail your medicines. If you do want us to send your prescription to a local pharmacy in your area, please message or call us and we will do so at no extra charge. We do not send prescriptions to pharmacies based outside the US.

NOT FOR EMERGENCIES

I understand that I should never use AdvanaCare Inc. 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 or nurse practitioner 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 or nurse practitioner 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 or nurse practitioner accepts the duty of care.

In the case of lab tests, the duty of care is restricted exclusively to the act of ordering and interpreting specific lab tests and only occurs when the doctor or nurse practitioner has ordered the lab test. The duty of care does not extend to your wider health, even if you have told the doctor or nurse practitioner information about your health as part of our intake questionnaire.

I understand that the doctor or nurse practitioner has the right to refuse to take responsibility for my care if the doctor or nurse practitioner 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 requesting a lab test 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 of a number of days before a doctor or nurse practitioner reviews my request for treatment or a lab test 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 or nurse practitioner sends me (once I have completed the health questions and made payment, and the doctor or nurse practitioner has subsequently taken responsibility for my care) and any content that the doctor or nurse practitioner links to in such messages and advice that a doctor or nurse practitioner provides in a video or telephone consultation. 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.

BENEFITS AND RISKS OF USING OUR SERVICE

I understand that by using the service I’m seeking care that’s convenient and affordable.

I understand that important differences exist between AdvanaCare Inc.’s model of care and traditional healthcare. Specifically by using AdvanaCare Inc. I accept a greater responsibility to read and understand information throughout the App and Website about the limitations of AdvanaCare Inc.’s model of care, the risks of seeking care this way, and the risks and benefits of a proposed treatment plan.

I understand that I must read and understand the Consent to Telehealth, the Terms of Use, the Privacy Policy, the FAQs, the information provided about a service before I answer health questions, the information provided in the health questions themselves, messages I receive from AdvanaCare Inc., and, very importantly, content provided via links in the message that the doctor or nurse practitioner sends me after the doctor or nurse practitioner has reviewed all my information and recommended a treatment plan and, when appropriate, prescribed a medicine.

I understand that to read important information I may need to both click on links and various 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 AdvanaCare Inc. 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 or nurse practitioner is unable independently to verify the information and photos I provide and that the doctor or nurse practitioner 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 acne, birth control, the diagnosis and treatment of a possible UTI, the diagnosis and treatment of male pattern baldness, the diagnosis and treatment of erectile dysfunction, the diagnosis and treatment of acute bacterial sinus infection, the diagnosis and treatment of acid reflux and the diagnosis and treatment of flu, the diagnosis and treatment of high cholesterol, the diagnosis and treatment of recurrent cold sores, the diagnosis of chlamydia and gonorrhea and the treatment of chlamydia, the diagnosis and treatment of hypothyroidism, the diagnosis and treatment of depression, the diagnosis and treatment of anxiety, the diagnosis and treatment of recurrent genital herpes, A1C blood sugar testing and blood type testing, treatment of migraines, stop smoking treatments, lab testing for COVID-19 antibodies, and other treatments and advice that the doctor or nurse practitioner thinks is appropriate to give online.

I understand that by using the service for a telemedical consultation, I won’t have an in person consultation and in person 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 practitioner in real time.

I understand that I must check the App or Website for messages because this is the way that the doctor or nurse practitioner 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 or nurse practitioner through the App or Website. I understand that the doctor or nurse practitioner may not review and respond to my messages until the next business day.

IMPORTANCE OF READING ALL THE INFORMATION WE PROVIDE

I understand that AdvanaCare Inc. 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 or nurse practitioner will send me when the doctor or nurse practitioner 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 or nurse practitioner 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.

I understand that AdvanaCare Inc. will provide detailed information about COVID-19 antibody testing to help me make an informed decision about whether the test is right for me.

IMPORTANCE OF ANSWERING ALL QUESTIONS FULLY AND TRUTHFULLY

I understand that by using AdvanaCare Inc. I seek to enter into a relationship where the doctor or nurse practitioner relies exclusively upon information and photos that I provide to decide whether or not treatment is safe and appropriate.

I understand that the doctor or nurse practitioner has no way of verifying the information and photos that I provide and that the doctor or nurse practitioner 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 or nurse practitioner 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 or nurse practitioner 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 or nurse practitioner 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 or nurse practitioner 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 or nurse practitioner to see the full history of care that I’ve received from AdvanaCare Inc.. This increases the chances that the doctor or nurse practitioner will not have access to important information and photos in my medical record that could influence the doctor or nurse practitioner’s clinical decision.

I understand that by using AdvanaCare Inc. I’m giving my explicit consent for the doctor or nurse practitioner to access medication history, where it’s available, from records provided by pharmacy databases via the services of Surescripts and/or DoseSpot. I understand that, if appropriate, the doctor or nurse practitioner 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 AdvanaCare Inc. visit.

RISKS OF ACCEPTING OUR TREATMENT PLAN

I understand that all the medicines that the doctor or nurse practitioner 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 or nurse practitioner 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 or nurse practitioner 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.

A1C Blood Sugar Testing

I understand that the test AdvanaCare Inc. orders looks at my blood sugar levels only. A normal test result means my blood sugars are normal. Alone it doesn’t provide a comprehensive view about my overall health.

I understand that it’s my responsibility to seek further evaluation from a doctor or nurse practitioner in person if the test shows that I have higher than normal blood sugar levels.

I understand that diabetes and prediabetes aren’t the only causes of high blood sugar levels. The test AdvanaCare Inc. orders can’t tell me the cause of high blood sugar levels.

I understand that I can’t use insurance to pay for the test that AdvanaCare Inc. will order. I understand that if I have insurance, my insurance might pay for an A1C test if I saw a doctor or nurse practitioner in person.

I understand that if I have symptoms of diabetes, a family history of diabetes, or I’m 40 and over and overweight or obese, or I have diabetes or prediabetes, then the generally accepted medical opinion is that I can benefit from an A1C blood sugar test. I understand that if I don’t fall into these groups then there isn’t sufficient data to show if the benefits of the test outweigh the potential harms. Potential harms can include ‘false-positive’ results (a result that says a condition exists when, in fact, it doesn’t) and overtreatment (treating an abnormal blood sugar level that may return to normal on its own and would have never caused health problems on its own).

Acid Reflux

I understand that adverse events from taking medicines to treat acid reflux include but aren’t limited to severe allergic reaction, permanent disability, and death.

I understand that if my symptoms keep bothering me then I should have an endoscopy that looks in my esophagus and stomach. I understand that taking medicine for acid reflux may delay a diagnosis of and treatment for a different underlying problem that is the real cause of my symptoms.

Acne

I understand that adverse events from taking antibiotics to treat acne include but aren’t limited to allergic reaction, permanent disability, and death.

I understand that by using AdvanaCare Inc. to diagnose and treat acne, there’s a risk that the doctor or nurse practitioner misdiagnoses the cause of my skin problem resulting in a delay in diagnosing the true cause of my problem and that I’ll take prescription or over-the-counter medicines unnecessarily and expose myself to the risks of taking those medicines.

I understand that by using AdvanaCare Inc. to diagnose and treat acne, the doctor or nurse practitioner won’t be able to do a complete and thorough skin exam of my whole body and that a doctor or nurse practitioner in person may conduct a more thorough skin exam. Because AdvanaCare Inc. doctor or nurse practitioner cannot do a thorough skin exam, there is a risk that they may not identify a medical condition that needs further investigation or immediate treatment. There is also a risk that the photos of my skin that I send to AdvanaCare Inc. are not representative of my condition and that based on the photos I send the AdvanaCare Inc. doctor or nurse practitioner misdiagnose my condition.

I understand that even if AdvanaCare Inc. doctor or nurse practitioner correctly diagnose me with acne and initially prescribe treatment, it may subsequently be necessary for me to seek additional care with a doctor or nurse practitioner in person if the treatment is not effective or the doctor or nurse practitioner considers my acne to be too complicated to manage online.

Asthma

I understand that I must have a previous diagnosis of asthma from another healthcare professional before using AdvanaCare Inc. for treatment and control of my asthma symptoms.

I understand that when using AdvanaCare Inc. to treat asthma, there’s a risk that the doctor or nurse practitioner may misdiagnose the cause of my symptoms as asthma instead of another medical cause or condition. If this happens, I understand I might take prescription medicines unnecessarily, expose myself to the risks of taking those medicines, and potentially delay diagnosis of a more serious condition.

I understand that taking prescription medicine to treat asthma may result in adverse events including, but not limited to, allergic reaction, respiratory emergencies, permanent disability, and/or death.

I understand that using AdvanaCare Inc. to treat my asthma will not allow the doctor or nurse practitioner to perform certain pulmonary function tests like spirometry and peak flow tests.

I understand that if my symptoms haven’t improved after 3 days of taking treatment, or if my breathing or asthma symptoms worsen, then it’s important that I send AdvanaCare Inc. doctors or nurse practitioners a message or visit a healthcare professional in person.

Blood Type Test

I understand that the blood type test isn’t sufficient to prove who someone’s mother or father is.

I understand that routine testing for blood type isn’t medically necessary.

I understand that I can’t use insurance to pay for the test that AdvanaCare Inc. will order.

Birth Control Pills, Patch and Ring

I understand that adverse events from using hormonal birth control include but aren’t limited to stroke, heart attack, and death.

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

I understand that if I request a prescription for a combination pill, birth control patch or birth control ring – all of which contain estrogen – then it’s important that I provide a recent and accurate blood pressure measurement because it’s not appropriate to take birth control that contains estrogen if I have a history of elevated blood pressure.

I understand that if I take a combination pill, birth control patch or birth control ring without knowing my blood pressure then I have a significant risk of blood clots, stroke, permanent disability, and death.

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

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

Cholesterol

I understand that AdvanaCare Inc. can help me manage my high cholesterol and that managing my cholesterol is only one part of looking after my heart and overall wellness. I understand it’s important to complement AdvanaCare Inc. with visiting a traditional doctor’s office when I need to.

I understand that AdvanaCare Inc. only prescribes statin medicines and not other classes of medicine to treat high cholesterol.

I understand that adverse events from taking statin medicines to treat high cholesterol include but aren’t limited to severe allergic reaction, permanent disability, and death.

I understand that if AdvanaCare Inc. orders lab work then it’s my responsibility to go to Quest Diagnostics to get the lab work and if AdvanaCare Inc. recommends follow-up actions based on the lab test results then it’s my responsibility to take that action.

I understand that I will not be able to use my insurance to pay for the lab tests at Quest Diagnostics and that I will need to pay AdvanaCare Inc. for the lab work.

I understand that if AdvanaCare Inc. recommends treatment or increase dosage of statin medicine and I decline then I accept that I may be at increased risk of preventable heart attack or stroke.

Cold Sores

I understand that adverse events from taking prescription medicines for cold sores include but aren’t limited to allergic reaction, stroke, heart attack, permanent disability, and death.

I understand that the FDA has not specifically approved medicines to be taken on a daily basis or as-needed basis as AdvanaCare Inc. doctors or nurse practitioners prescribe them, and that taking cold sore medicines in this way is ‘off-label use’.

I understand that cold sore medicine does not aim to remove the underlying virus that causes cold sores.

COVID-19 antibody testing

The antibody tests we order at Quest Diagnostics or ship to you from Scanwell Health are not approved by the FDA. These tests look for the SARS-CoV-2 IgG antibody to determine whether you had prior exposure to the SARS-CoV-2 virus which causes COVID-19. These tests cannot determine if you currently have an active COVID-19 infection. If you have evidence of prior exposure, it’s unclear at this time if you have immunity from the virus and for how long. IgG antibodies are typically detectable 10 to 18 days after being exposed to an illness. If you test within the first 18 days of illness, the result can be a false negative (i.e. you do not have illness when in fact you do). In this situation, retesting or alternative testing may be suggested. These tests can sometimes detect antibodies from other coronaviruses, which can cause a false positive result if you have been previously diagnosed with or exposed to other types of coronaviruses. These tests have been made available and have been authorized by the FDA under an Emergency Use Authorization; these tests have not been FDA cleared or approved. These tests are only authorized for the duration of the declaration that circumstances exist justifying the authorization of emergency use of in vitro diagnostic tests for detection and/or diagnosis of COVID-19 under Section 564(b)(1) of the Act, 21 U.S.C. § 360bbb-3(b)(1), unless the authorization is terminated or revoked sooner. The IgG antibody serology test has not been reviewed by the FDA. By deciding to order this test from AdvanaCare Inc. you’re choosing not to seek reimbursement for your test. Federal legislation enacted in March 2020 requires comprehensive private health insurance plans to cover this test and provides funds for reimbursement to providers for COVID-19 testing for uninsured patients.

This is what the FDA says about antibody testing for COVID-19: “As important, those who use an antibody test need to understand its limitations and use test results as just one piece of data to inform decision making. All tests can provide at least some false results. Even a high-performing antibody test when used on individuals in a population that does not have many cases of COVID-19 infection – a population with low prevalence – may produce as many or more false results as true results because the likelihood of finding someone who has been infected is very small. This doesn’t mean the test is bad, but rather recognizes the inherent limitations of these kinds of tests. Therefore, it may be necessary for some individuals to have two serology tests performed to generate reliable results. That is why antibody tests should only be used as part of a well-conceived testing plan and why the results should always be interpreted by appropriate experts.”

Dark Spots

I understand that by using AdvanaCare Inc. to treat dark spots (hyperpigmentation), the doctor or nurse practitioner won’t have the opportunity to conduct a detailed in-person physical examination. In person a doctor or nurse practitioner may conduct a more complete examination, including but not limited to a thorough skin examination.

Because the AdvanaCare Inc. doctor or nurse practitioner can’t do a more detailed physical examination there is a risk that they may not identify any other alternative and potentially life-threatening causes of my dark spots (such as skin cancer) that they would be able to identify and investigate further if I were to see them in person. This can cause a delay in diagnosing and treating the true cause of my dark spots and I’ll take prescription medicines unnecessarily and expose myself to the risks of taking those medicines. The doctor or nurse practitioner will rely on your medical history, symptoms, and examination of photos to help rule out alternative causes of darks spots.

I understand that I should go for a yearly physical exam with my doctor or nurse practitioner in person, and tell them about any suspicious skin spots I have. If I notice spots or marks on my skin that are changing in number, size, or shape over time, I understand I should also see a dermatologist for a more comprehensive skin exam.

I also understand that the medicines that the doctor or nurse practitioner will prescribe will be compounded by the pharmacy and are not manufactured formulations that the FDA has approved for hyperpigmentation.

Depression and Anxiety

I understand that if I am threat to myself or to other people, I should not use AdvanaCare Inc. and should instead call 911 or call the National Suicide Prevention Hotline 1-800-273-8255.

I understand that the prescription medicine class prescribed, selective serotonin inhibitors (SSRIs), norepinephrine serotonin reuptake inhibitors (SNRI) and atypical antidepressant (bupropion) are FDA approved for depression and/or anxiety and are prescribed in that manner. I understand that taking these types of medicines may cause sexual dysfunction (problems with orgasm, ejaculation, and/or erectile dysfunction), and also potentially life-threatening side effects, the risk of suicidal thoughts and behavior and can cause a severe allergic reaction that can lead to disability and even death.

I understand that abruptly stopping any of the treatments may cause symptoms including but not limited to anxiety, irritability, agitation, dizziness, nausea and sensory disturbances such as the feeling of having an electric shock.

I understand that as part of treatment that AdvanaCare Inc. doctors and nurse practitioners will require me to provide an emergency contact person as well as ensuring any weapons at home are both unloaded and locked. I understand as part of treatment that AdvanaCare Inc. doctors and nurse practitioners will require me to abstain from any alcohol or substance use including but not limited to marijuana, cocaine, and stimulants (uppers). I understand if I am unable to abide by these terms of treatments that I may not be an appropriate candidate for this service.

I understand that there are alternatives to the prescription-only medicines available from AdvanaCare Inc. doctors and nurse practitioners, like cognitive behavioral therapy (CBT) for treatment of depression or anxiety.

Erectile Dysfunction

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 AdvanaCare Inc. doctors and nurse practitioners will prescribe 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 AdvanaCare Inc. to diagnose and treat erectile dysfunction, the doctor or nurse practitioner won’t have the opportunity to conduct a detailed physical examination that would be possible if I were to see a doctor or nurse practitioner in person. Because AdvanaCare Inc. doctors and nurse practitioners 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 AdvanaCare Inc. doctors and nurse practitioners 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 or nurse practitioner in person and that it’s unlikely that AdvanaCare Inc. doctors and nurse practitioners 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 AdvanaCare Inc. doctors and nurse practitioners 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 AdvanaCare Inc. doctors and nurse practitioners 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 Minnesota, North Dakota and South Carolina state laws prohibit AdvanaCare Inc. from offering our erectile dysfunction service in those states.

Flu

I understand that adverse events from taking antivirals to treat the flu include but aren’t limited to allergic reaction, permanent disability, and death.

I understand that by using AdvanaCare Inc. to diagnose and treat a flu infection, there’s a risk that the doctor or nurse practitioner misdiagnoses the cause of my symptoms as the flu and not some other cause. If this happens then I’ll take an antiviral medicine unnecessarily, expose myself to the risks of taking that medicine, and potentially delay the investigation of a more serious condition.

I understand that if my flu symptoms haven’t improved after 3 days of taking the antiviral medicine, then it’s important that I visit a doctor or nurse practitioner in person.

Genital Herpes

I understand that adverse events from taking prescription medicines for genital herpes include but aren’t limited to allergic reaction, stroke, heart attack, permanent disability, and death.

I understand that the FDA has not specifically approved medicines to be taken on a daily basis or as-needed basis as AdvanaCare Inc. doctor and nurse practitioners prescribe them, that this practice is commonly done in the community, and that taking genital herpes medicines in this way is ‘off-label use’.

I understand that genital herpes medicine does not aim to remove the underlying virus that causes genital herpes.

Hair Loss

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

I understand that by using AdvanaCare Inc. to diagnose and treat male pattern baldness, the doctor or nurse practitioner won’t be able to carry out a ‘hair-pull’ test that could assist in the diagnosis of male pattern baldness.

Health and Wellness Coaching

I understand that my Health & Wellness Coach is not providing therapy or any services a doctor, psychiatrist, therapist, or psychologist can provide.

I understand that the general wellness strategies that my Health & Wellness Coaches provide are not intended to diagnose, treat, or provide therapy for any disease or condition I may have.

I understand that my Coach doesn’t provide specific medical guidance and can not recommend changes in any medications I may take from AdvanaCare Inc. or other healthcare providers.

I understand that I am responsible for any decisions I make in coaching, and that my coach is not liable for changes I make as a result of our work.

High Blood Pressure

I understand that I must have a previous diagnosis of high blood pressure from another healthcare professional before using AdvanaCare Inc. for treatment of my high blood pressure.

I understand that I must provide true and accurate blood pressure and heart rate readings to AdvanaCare Inc. because inaccurate readings could be risky to my health and treatment I receive.

I understand that this service is not for emergency blood pressure control and that if my blood pressure is higher than 180 / 120 mm Hg or If I am experiencing symptoms of end organ damage including headache, chest pain, problem with vision, back pain or other symptoms related to high blood pressure, that I should seek in-person medical care.

I understand that to use and continue with this service that periodic blood work is necessary to monitor blood electrolytes. If I’m unable to follow-up with blood work, I should seek in-person medical care.

I understand that taking prescription medicine to treat my high blood pressure may result in adverse events including, but not limited to, allergic reaction, facial swelling, respiratory emergencies, permanent disability, and/or death.

Hormone Replacement Therapy (HRT)

I understand that the HRT medicines that the doctor or nurse practitioner will prescribe will be compounded by the pharmacy and are not manufactured formulations that the FDA has approved for HRT.

I understand that HRT to treat menopausal hot flashes or vaginal symptoms comes with the risk of serious adverse events, including but not limited to blood clots in the legs/lungs, breast cancer, cancer of the uterus, heart attack, stroke, and liver problems.

I understand that by using AdvanaCare Inc. to treat hot flashes or vaginal dryness/symptoms related to menopause, the doctor or nurse practitioner won’t have the opportunity to conduct a detailed in-person physical examination. In person a doctor or nurse practitioner may conduct a more complete examination, including but not limited to a thorough head/neck, cardiovascular, pelvic, and vaginal exam. Because the AdvanaCare Inc. doctor or nurse practitioner can’t do a more detailed physical examination there is a risk that the doctor or nurse practitioner may not identify an alternative and potentially life-threatening cause of my symptoms (such as cancer, infection, stroke, thyroid problems, etc) that they would be able to identify and investigate further if I were to see them in person. This can cause a delay in diagnosing and treating the true cause of my hot flashes or vaginal symptoms, and I’ll take prescription medicines unnecessarily and expose myself to the risks of taking those medicines. The doctor or nurse practitioner will rely on your medical history, symptoms, and discussion over live video/phone to help rule out alternative causes of my hot flashes or vaginal symptoms.

I understand that I should not use AdvanaCare Inc. for my hot flashes or vaginal dryness/symptoms if I am not menopausal, or have a history of breast cancer, uterine cancer, endometrial cancer, or undiagnosed abnormal uterine or vaginal bleeding.

Hypothyroidism

I understand that I should only request levothyroxine from AdvanaCare Inc. doctors and nurse practitioners if a medical professional has previously diagnosed me with low thyroid.

I understand that only levothyroxine is prescribed from AdvanaCare Inc. doctors and nurse practitioners for hypothyroidism and will not be prescribed ‘off-label’ for other conditions or in combination with other thyroid treatments including but not limited to desiccated thyroid or triiodothyronine (T3).

I understand that adverse events from taking levothyroxine include but aren’t limited to allergic reaction, stroke, heart attack, permanent disability, and death.

I understand that by using AdvanaCare Inc. to diagnose and treat hypothyroidism, the doctors or nurse practitioners won’t have the opportunity to conduct a detailed physical examination that would be possible if I were to see a doctor or nurse practitioner in person. Because AdvanaCare Inc. doctors and nurse practitioners 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.

Insomnia

I understand that alternative non-prescription treatments for insomnia, such as cognitive behavioral therapy (CBT), are available instead of the prescription-only medicines that AdvanaCare Inc. doctors or nurse practitioners can prescribe. I also understand that AdvanaCare Inc. doctors and nurse practitioners don’t prescribe the more powerful controlled medicines that are available to treat insomnia.

I understand that the medicines AdvanaCare Inc. doctors or nurse practitioners prescribe haven’t been evaluated by the FDA specifically for treatment of insomnia, and that taking these medicines is ‘off-label use’.

I understand that insomnia can be a symptom of other underlying medical conditions and that AdvanaCare Inc. doctors and nurse practitioners may advise me to seek an in-person medical examination.

Migraine

I understand that by using AdvanaCare Inc. to treat migraine headaches, the doctor or nurse practitioner won’t have the opportunity to conduct a detailed in-person physical examination. In person a doctor or nurse practitioner may conduct a more complete examination, including but not limited to a thorough neurologic, head/neck, and eye exam. Because the AdvanaCare Inc. doctor or nurse practitioner can’t do a more detailed physical examination there is a risk that they may not identify an alternative and potentially life-threatening cause of my headache (such as infection, stroke, brain bleed, tumor, elevated pressure in the brain, neuralgia, etc) that they would be able to identify and investigate further if I were to see them in person. This can cause a delay in diagnosing and treating the true cause of my headache and I’ll take prescription migraine medicines unnecessarily and expose myself to the risks of taking those medicines. The doctor or nurse practitioner will rely on your medical history, symptoms, and examination over live video to help rule out alternative headache cases.

Premature Ejaculation (“PE”)

I understand that PE medicines are not recreational drugs, and that they come with the risk of serious adverse events, including but not limited to gastrointestinal bleeding, seizures, coma, impairment of cognitive or motor functions, irritability, death and disability.

I understand that if I have a condition where sex is not advised then I should not take PE medicines.

I understand that AdvanaCare Inc. doctors and nurse practitioners may prescribe sertraline, sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra) to treat PE.

I understand that the FDA has not licensed any medicines to treat PE and that AdvanaCare Inc. doctor and nurse practitioners will prescribe PE medicines ‘off-label’.

I understand that sertraline is licensed by the FDA to treat anxiety and depression, not PE.

I understand that I should not take sertraline for PE if I am taking another medicine to treat anxiety or depression (such as a selective serotonin reuptake inhibitor or tri-cyclic antidepressant), or if I have a history of suicidal thoughts, self-harming, bipolar disorder, or uncontrolled depression. Doing so may cause potentially life-threatening side effects.

I understand that if I take sertraline, I have the option to take it as needed before sex, or on a daily basis. Studies have shown that it is more effective when taken on a daily basis, but I understand that this increases the likelihood of adverse events, and difficulties when I decide to stop taking it.

I understand that abruptly stopping sertraline can cause symptoms including but not limited to anxiety, irritability, agitation, dizziness, nausea and sensory disturbances such as the feeling of having an electric shock.

I understand that although the FDA has licensed sildenafil 25mg/50mg/100mg, tadalafil, and vardenafil to treat erectile dysfunction, the FDA has not licensed them to treat PE.

I understand that the FDA has not licensed sildenafil 20mg tablets to treat ED.

I understand that by using AdvanaCare Inc. to diagnose and treat PE, the doctor or nurse practitioner won’t have the opportunity to conduct a detailed in person physical examination that would be possible if I were to see a doctor or nurse practitioner in person. Because AdvanaCare Inc. doctors and nurse practitioners cannot do a detailed in person 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 Minnesota and South Carolina state laws prohibit AdvanaCare Inc. from offering our PE service.

Sinus Infection

I understand that adverse events from taking antibiotics to treat an acute bacterial sinus infection include but aren’t limited to allergic reaction, permanent disability, and death.

I understand that by using AdvanaCare Inc. to diagnose and treat a possible acute bacterial sinus infection, there’s a risk that the doctor or nurse practitioner misdiagnoses the cause of my infection as bacteria and not a virus or an allergy.

I understand that there’s a risk that I’ll be misdiagnosed with an acute bacterial sinus infection when in fact my symptoms are caused by a virus. If this happens then I’ll take an antibiotic unnecessarily and expose myself to the risks of taking that antibiotic.

I understand that if my symptoms haven’t improved after 3 days of taking the antibiotic treatment, then it’s important that I send AdvanaCare Inc. doctors and nurse practitioners a message or visit a doctor or nurse practitioner in person.

STD testing and treatment

I understand that the test offered by AdvanaCare Inc. looks for chlamydia and gonorrhea only, and only in the penis and vagina, and not in the throat or anus.

I understand that the test will probably not find chlamydia or gonorrhea if I got them in the last two weeks, even if I do actually have them.

I understand that if the AdvanaCare Inc. test finds chlamydia then AdvanaCare Inc. 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 or nurse practitioner in person for chlamydia treatment even if the AdvanaCare Inc. test found chlamydia. I understand that in those states that require AdvanaCare Inc. 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 then I will need to go to a doctor’s office in person to have an antibiotic injection/shot.

I understand that AdvanaCare Inc. may have to notify my county health department if I test positive for chlamydia or gonorrhea.

Stop Smoking

I understand that there are alternatives to the prescription-only stop smoking medicines available from AdvanaCare Inc. doctors and nurse practitioners, and that over-the-counter alternatives (such as nicotine patches, gum and lozenges) are less likely to cause serious side effects than the prescription-only alternatives.

Prescription-only stop smoking medicines can increase the risk of suicidal thoughts and behavior and can cause a severe allergic reaction that can lead to disability and even death.

UTI

I understand that adverse events from taking antibiotics to treat a UTI include but aren’t limited to allergic reaction, permanent disability, and death.

I understand that by using AdvanaCare Inc. to diagnose and treat a possible UTI, the doctor or nurse practitioner won’t be able to conduct a live interview and physical exam that might identify a medical condition that needs further investigation or immediate treatment. Also, the doctor or nurse practitioner won’t be able to carry out 3 tests that would help determine if I have a UTI or whether a different condition is the cause of my symptoms. Specifically, these 3 tests are a urine dipstick test, a urinalysis and a urine culture. Without carrying out these tests and solely relying on my answers to the questionnaire in the app, the doctor or nurse practitioner will correctly diagnose approximately 80% of patients who have a UTI and 80% of patients who don’t have a UTI. 20% of patients who actually have a UTI and 20% of patients who don’t actually have a UTI will be incorrectly diagnosed without these additional tests.

I understand that in cases where the doctor or nurse practitioner makes an incorrect diagnosis of a UTI, the doctor or nurse practitioner may prescribe an antibiotic treatment that isn’t appropriate for my specific needs. This means I may take an antibiotic that I don’t need to take.

I understand that if my symptoms haven’t disappeared after 3 days of taking the antibiotic treatment, then it’s important that I visit a doctor or nurse practitioner in person for a physical examination.

PROMO CODE PROGRAMS

I understand that if I received a promo code for AdvanaCare Inc.’s services from a third party such as my employer, health insurer, 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 AdvanaCare Inc.. I understand that by consenting to these terms and using the AdvanaCare Inc. 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 AdvanaCare Inc., or any of its affiliates (including business associates and vendors) unintentionally discloses or disseminates my personal health information, my only recourse is against AdvanaCare Inc. and its affiliates, and not against Promo-Code-Provider.

PACKAGING IS NOT CHILD PROOF

The pharmacies we work with may mail your medicine in single use packs. Single use packs are not child proof. Child proof packaging is available upon request by messaging us through your AdvanaCare Inc. account.

RISKS TO ELECTRONIC HEALTH INFORMATION

I understand that although AdvanaCare Inc. implements a wide range of administrative, physical, and technical safeguards to protect my health information AdvanaCare Inc. cannot guarantee the privacy and confidentiality of my health information.

For more details about how AdvanaCare Inc. protects and uses your health information see our Privacy Policy.

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