PATIENT ACKNOWLEDGMENT AND AGREEMENT
- I acknowledge that I have read and fully understand the risks, limitations, conditions of use, and instructions for use of Telemedicine Services (hereinafter referred to as “Services”) provided by Avicenna Digital Health Corporation (hereinafter referred to as “Avicenna”) more fully described in the following paragraphs. I understand and accept the risks outlined in this consent, associated with the use of the Services in communications with the Pharmacies, Physicians and Avicenna’s Support Team. I consent to the conditions and will follow the instructions outlined here, as well as any other conditions that Physicians and Pharmacists may impose on communications with me using the Services.
Introducing Avicenna Digital Health Corp.
- Avicenna is a Practice Management Technology Company and not a clinic. It helps healthcare professionals to deliver their services in a better way, more instantly and more accurately. Avicenna helps healthcare professionals adopt the digital transformation trends in our society resulting in higher quality of service.
- By healthcare professionals we mean Physicians (General and Specialist Practitioners), Nurse Practitioners, Pharmacists, and Laboratory Technicians.
- We provide our Services by integrating with third party software in healthcare industry through API (Application Programming Interface) exchange or other technological methods.
- Patients as “End Users” may use our Services directly through our Website, Mobile Applications, and other products, or use it through our partners’ services which use our solution.
- All healthcare professionals who use our software and solutions are solely responsible for their expert medical opinion and diagnosis. We only provide software and technical means to healthcare professionals.
- Avicenna Services are defined as Telemedicine, namely the remote delivery of healthcare services over the telecommunications infrastructure, including but not limited to online appointment scheduling from a physician or a pharmacist, providing online or over the phone visit, Electronic Prescription, Electronic Medical Record (EMR), drug delivery, etc.
- We also provide necessary complementary tools using third party solutions or in-house solutions like messaging through SMS or Instant Messaging APPs, Voice over IP (VoIP), Automated Voice Responses (AVR), Videoconferencing, Online Payments, etc.
Conditions of using the Services
Regardless of the fact that you use our Services directly or through our partners these conditions apply:
- For the first time you or your health service provider (e.g., pharmacy, online pharmacy, healthcare mobile Application) want to use our Services, your personal information (Full Name, Date of Birth, Gender, Phone Number, Address, Postal Code) must be provided. Otherwise, our physician partners will not be able to visit you. You confirm that the provided information is correct, and you are the one who will receive our Services.
- By booking an appointment, you consent Avicenna to receive and collect your personal and health information which you or your health service provider sent to us, and to instantly register it in the EMR(s) which our physicians work with.
- We will do our best to use your insurance coverage and reduce your cost or even make it free based on your coverage plan. However, in those cases that we are not sure if we could use your coverage for any reason (e.g., inter-province limitations, receiving non-eligible health number, etc.) you need to pay for the Service. In such cases, paying the service fees is necessary to use our Services.
- By choosing the time or rescheduling an appointment by you or your health service provider, you agreed that the assigned physician will call you at the scheduled time on your phone or via other telecommunication tools already determined. You consent Avicenna to contact you via your Phone or Email with respect to appointment times, referral notices, result information, appointment reminders, and other limited information.
- We cannot guarantee that you will be able call back to physicians through the number you had received the call or through the videoconference link you received. For following-up after your visit is finished you could use our support contacts.
- Your phone number is the main contact channel between you, us, and the Healthcare professionals. The responsibility of registering a valid number is on you or the service provider which registered you. You confirm that you would be available on the scheduled time and will respond to physicians’ call. Otherwise, Avicenna and the Physician would have no responsibility. It is your responsibility to keep your contact information current by informing us through our support contacts.
- The Services will not be used for medical emergencies or other time-sensitive matters.
- While the Physician will attempt to review and respond in a timely fashion to your request, the Physician cannot guarantee that the Services will be delivered to within any specific period of time.
- If for any reason the physician was unable to call you, we would inform you, try to reschedule to a first available time and provide you a way to reschedule it to a best fit time. Avicenna and the physician cannot guarantee that your appointment would be held under any circumstances although will do our best.
- If you or your health service provider cancel the Services, physicians will not contact you and there will not be any responsibility and liability for them and Avicenna.
- You confirmed that if your visit with a physician results in a prescription, we will send your prescription to the pharmacy you have already chosen or the health service provider that initiated the Services based on your request.
- We do not dispense any prescription and neither have any responsibility about it nor benefit from it.
- If you have not received a response from the Physician (including their call and your prescription) within a reasonable time period, it is your responsibility to follow up your request through our support contacts and be informed when the recipient will respond.
- Telemedicine is not an appropriate substitute for in-person visit or clinical examinations, where appropriate, or for attending the Emergency Department when needed. You are responsible for following up on the Physician’s response and for scheduling appointments where warranted.
- If you require immediate assistance, or if your condition appears serious or rapidly worsens, you should not rely on the Services. Rather, you should call your Physician’s office or take other measures as appropriate, such as going to the nearest Emergency Department or urgent care clinic.
- Not all cases are eligible to be treated via telemedicine. If you or your health service provider register for these types of cases, our physicians will make the appropriate decision based on their own opinion. It is completely on them to call or cancel the appointment. If they cancel the appointment for such reason, we will inform you and ask you to visit a physician in person. These cases are as follows, which also could be updated based on govement announcements:
- Controlled medications such as Narcotics, Benzodiazepines, Stimulant;
- Abdominal pains or chest pains;
- Psychiatric conditions; and
- Emergency symptoms such as
- Shortness of breath
- Suicidal thoughts
- Major trauma
- altered state of consciousness
- We may ask you to give your feedback about our services, physicians, and other partners. You consent that Avicenna will have the right to edit or partially publish your feedbacks subject to the relevant regulations.
- You confirmed that Avicenna will keep your personal information and ordering history in your profile and also for better service in your next orders. All your data is encrypted. We will never use your information for advertising purposes. Avicenna guarantees that if for any reason Avicenna decides to share your information with a third party, you will be informed.
- Individuals authorized to access the medical records, such as Avicenna staff and those involved in the delivery and administration of your care may have access to your information. We will not forward your records to third parties, including family members, without your prior written consent, except as authorized or required by law.
- Certain Services might be used for therapeutic purposes or to communicate clinical information. Where applicable, the use of these Services will be limited to education, information, and administrative purposes.
- Despite the security which Avicenna platform provides, it is possible that communications during the Services may not be encrypted in some ways. You agree to use these Services with a full understanding of this risk.
- Avicenna is not responsible for information loss due to technical failures associated with your software or inteet service provider.
- Avicenna will store your data for as long as reasonably required for the proper provision of Services. However, you may ask to completely remove your personal data from Avicenna only by sending an email to email@example.com and after your identity verification. Nevertheless, your medical encounter will not be removed from the EMR(s) as physicians should keep the history of all their services according to the regulations.
Risks of using Telemedicine Service
We will use all reasonable means to protect the security and confidentiality of the information sent and received using the Services. However, because of the risks outlined below, Avicenna cannot fully guarantee the security and confidentiality of Services:
- Use of telemedicine to discuss sensitive information can increase the risk of such information being disclosed to third parties.
- Despite reasonable efforts to protect the privacy and security of electronic records, it is not possible to completely secure the information.
- Employers and online services may have a legal right to inspect and keep information that pass through their system.
- Electronic communications can introduce malware into a computer system, and potentially damage or disrupt the computer, networks, and security settings.
- Electronic Records can be forwarded, intercepted, circulated, stored, or even changed without the knowledge or permission of the Physician or the Patient.
- Even after the sender and recipient have deleted copies of electronic records, back-up copies may exist on a computer system.
- Electronic records may be disclosed in accordance with a legal duty to report or a court order.
- Email, text messages, and instant messages can be misdirected more easily, resulting in increased risk of being received by unintended and unknown recipients.
- Email, text messages, and instant messages can be easier to falsify than handwritten or signed hard copies. It is not feasible to verify the true identity of the sender, or to ensure that only the recipient can read the message once it has been sent.
Instructions for communication using the Services
To send a message to your physician, follow-up your case, or change your contact information, just use these support channels of Avicenna:
Text Message: (604) 484–0637
Fax: (604) 484–2122
To communicate, you must:
- Reasonably limit or avoid using any other person’s devices.
- Inform us of any changes in your email address, mobile phone number, or other account information necessary to communicate via the Services.
- Include in the message’s subject line an appropriate description of the nature of the communication (e.g. “prescription renewal”), and your full name in the body of the message.
- Review your message to ensure it is clear and that all relevant information is provided before sending it.