Terms of Service
Effective January 1, 2023
ONCALL PAIN, LLC (OnCall Pain) exists to improve access to healthcare, and we hope you’ll make great use of our service. These terms explain your rights and responsibilities when using ONCALL PAIN. If you have any questions, feel Free to contact us at firstname.lastname@example.org. You can also learn more at www.oncallpain.com. Thank you so much for choosing ONCALL PAIN.
Please note that we offer the Services “AS IS” and without warranties. If you are registering an account or using the Services on behalf of an individual or entity other than yourself, you represent that you are authorized by such individual or entity to accept this Agreement on such individual’s or entity’s behalf and shall be able to show proof of authorization.
1. ABOUT THE SITE
BY AGREEING TO THESE TERMS YOU ACCEPT THAT WE MAKE NO GUARANTEES, REPRESENTATIONS OR WARRANTIES, WHETHER EXPRESSED OR IMPLIED, WITH RESPECT TO PROFESSIONAL QUALIFICATIONS, EXPERTISE, QUALITY OF WORK, PRICE OR COST INFORMATION, INSURANCE COVERAGE OR BENEFIT INFORMATION, OR OTHER CONTENT THROUGH THE SERVICES. IN NO EVENT SHALL WE BE LIABLE TO YOU OR ANYONE ELSE FOR ANY DECISION MADE OR ACTION TAKEN BY YOU IN RELIANCE ON ANY SUCH CONTENT. FURTHERMORE, WE DO NOT IN ANY WAY ENDORSE OR RECOMMEND ANY INDIVIDUAL LISTED OR ACCESSIBLE THROUGH THE SERVICES.
2. WE DO NOT PROVIDE MEDICAL ADVICE
The Content that you obtain or receive from ONCALL PAIN, and its employees, contractors, partners, sponsors, advertisers, licensors or otherwise through the Services is for informational, scheduling and payment purposes only. All medically related information, including but not limited to information shared via ONCALL PAIN answers, the ONCALL PAIN blog, official ONCALL PAIN social channels, ONCALL PAIN emails and text messages, and ONCALL PAIN advertising, comes from independent healthcare professionals and organizations and is for information purposes only.
BY AGREEING TO THESE TERMS YOU ACCEPT THAT THE CONTENT, WHETHER SUCH CONTENT IS PROVIDED BY OR THROUGH THE USE OF THE SERVICES OR THROUGH ANY OTHER COMMUNICATIONS FROM COMPANY, IS NOT INTENDED AS A SUBSTITUTE FOR, NOR DOES IT REPLACE, PROFESSIONAL MEDICAL ADVICE, DIAGNOSIS, OR TREATMENT. DO NOT DISREGARD, AVOID OR DELAY OBTAINING MEDICAL ADVICE FROM A QUALIFIED HEALTHCARE PROVIDER BECAUSE OF SOMETHING YOU MAY HAVE READ ON THE SITE. DO NOT USE THE SERVICES FOR EMERGENCY MEDICAL NEEDS. IF YOU EXPERIENCE A MEDICAL EMERGENCY, IMMEDIATELY CALL A HEALTH CARE PROFESSIONAL AND 911. YOUR USE OF THE CONTENT IS SOLELY AT YOUR OWN RISK. NOTHING STATED OR POSTED ON THE SITE OR AVAILABLE THROUGH ANY SERVICES IS INTENDED TO BE, AND MUST NOT BE TAKEN TO BE, THE PRACTICE OF MEDICINE, DENTISTRY, NURSING, OR OTHER PROFESSIONAL HEALTH CARE ADVICE, OR THE PROVISION OF MEDICAL CARE.
We do not recommend or endorse any specific tests, Healthcare Providers, procedures, opinions, or other information that may appear through the Services. If you rely on any Content provided through the Services, you do so solely at your own risk.
3. NO DOCTOR PATIENT RELATIONSHIP.
BY AGREEING TO THESE TERMS, YOU ACCEPT THAT NO LICENSED MEDICAL PROFESSIONAL/PATIENT RELATIONSHIP IS CREATED WITH ONCALL PAIN BY USING THE CONTENT, WHETHER SUCH CONTENT IS PROVIDED BY OR THROUGH THE USE OF THE SERVICES OR THROUGH ANY OTHER COMMUNICATIONS FROM ONCALL PAIN INCLUDING, BUT NOT LIMITED TO ONCALL PAIN LOG, OFFICIAL ONCALL PAIN SOCIAL CHANNELS, ONCALL PAIN EMAILS OR TEXT MESSAGES LINKS TO OTHER SITES OR ANY ASSISTANCE WE MAY PROVIDE TO HELP YOU FIND AN APPROPRIATE HEALTHCARE PROVIDER IN ANY FIELD.
We have no control over, and cannot guarantee the availability of any Healthcare Provider at any particular time. The patient medical relationship will be between the patient and his/her Healthcare Provider. We will not be liable for cancelled or otherwise unfulfilled appointments, or any injury resulting there from, or for any other injury resulting or arising from or related to the use of the Site or Services whatsoever. The patient may automatically be charged when a Healthcare Provider televisit is scheduled and confirmed. If a Healthcare Provider fails to complete a visit, the charge will be refunded to the patient.
You are advised to perform your own investigation prior to selecting a Healthcare Provider by making confirming telephone calls to the appropriate licensing or certification authorities to verify listed credentials and education, and to further verify information about a particular Healthcare Provider by confirming with the Healthcare Provider’s office, your current Healthcare Providers, the medical association(s) relevant to the Healthcare Provider’s specialty and your state medical board(s).
4. AUTHORIZATION AND ACKNOWLEDGEMENT; IMPORTANT INFORMATION ABOUT HEALTHCARE PROVIDER RELATIONSHIPS AND LISTS
In connection with using the Site and the Services to locate and schedule telemedicine appointments with Healthcare Providers, you understand that:
YOU ARE THE FINAL PERSON RESPONSIBLE FOR CHOOSING YOUR OWN HEALTHCARE PROVIDER.
ONCALL PAIN uses reasonable efforts to ensure that ONCALL PAIN Healthcare Providers only participate in ONCALL PAIN Telemedicine Services, ONCALL PAIN office visits, ONCALL PAIN work visits, ONCALL PAIN home visits and ONCALL PAIN other location visits if they hold all active licenses required by law to practice the specialties of the services offered by them, and are not excluded from participation in the Medicare and Medicaid programs. ONCALL PAIN may exclude Healthcare Providers who, in ONCALL PAIN’s discretion, have engaged in inappropriate or unprofessional conduct. We will provide you with lists and/or profile previews of Healthcare Providers who may be suitable to provide the telemedicine healthcare services you seek based on information that you provide to us (such as healthcare specialty). In an effort to aid in the discovery of Healthcare Providers and enable the maximum choice and diversity of Healthcare Providers participating in the Services, these lists and/or profile previews may also be based on other criteria (including, for example, Healthcare Provider availability, past selections by and/or ratings of Healthcare Providers by you or by other ONCALL PAIN users, and past experience of ONCALL PAIN users with Healthcare Providers); but ONCALL PAIN(a) does not recommend or endorse any Healthcare Providers, (b) does not make any representations or warranties with respect to these Healthcare Providers or the quality of the healthcare services they may provide, and (c) does not receive any fees from Healthcare Providers for referrals or for featuring them (i.e., higher or better placement on lists) through the Telemedicine Services (subject to the Sponsored Results as described below). If a health complaint cannot be resolved through telemedicine, patient agrees to follow up care through an office visit or home visit as ordered by the Healthcare Provider. The patient will have the option to accept or decline further care. However, if patient declines further care as ordered by the Healthcare Provider, Healthcare provider will not be held liable for any resulting complications.
5. THE SERVICES AND CONTENT AS INFORMATIONAL AND EDUCATIONAL RESOURCES
We make the Services available as a service to consumers from Healthcare Providers for the purposes of providing an informational and educational resource. We may, but have no obligation to, have Content posted through the Services reviewed by our editorial personnel. It is important to note, however, that the timeliness, accuracy, and completeness of any or all of the Content is not guaranteed. Neither the authors, the editorial personnel, nor any other party involved in the preparation or publication of this work can guarantee that the Content contained herein is accurate or complete, and they will not be responsible for any errors or omissions or for the results obtained from the use of such Content. You are encouraged to independently confirm the Content contained herein with other sources and to seek the advice of a qualified Healthcare Provider.
Healthcare Provider Content:
Healthcare Provider and practice Content is intended for general reference purposes only. Healthcare Provider Content is both provided by the Healthcare Provider and/or office staff, and collected from multiple other data sources that may not be confirmed by the Healthcare Provider. Such Content often changes frequently and may become out of date, incomplete or inaccurate. Neither the Site nor ONCALL PAIN provides any advice or qualification certification about any particular Healthcare Provider. You are encouraged to independently verify such Content.
The procedures, products, services and devices discussed and/or marketed through the Services are not applicable to all individuals, patients or all clinical situations. Any products, services or devices represented through the Services by advertisers, sponsors, and other participants of the Services, either paid or unpaid, are presented for your awareness and do not necessarily imply, and we make no claims as to, safety or appropriateness for any particular individual or prediction of effectiveness, outcome or success.
As part of the registration process, you will provide your full name, email address and phone number. These are your identifiers for accessing the Services. You should keep your identifiers private and not share with anyone else. You must immediately notify us if your information has been stolen or compromised by sending an email to email@example.com.
7. YOUR PERSONAL INFORMATION
8. YOUR RESPONSIBILITIES
9. CHANGES TO THE SERVICES; NEW SERVICES; ADDITIONAL TERMS
9.1 Changes to the Services
We may from time to time add new services to the Services, substitute a new service for one of the existing Services, or discontinue or suspend one of the existing Services. Information about the new services will be included through the Services, and the use of new services will be governed by this Agreement. You agree that ONCALL PAIN will not be liable to you or any third party for any suspension or discontinuation of any of the Services or portion thereof.
9.2 Additional Terms
Certain of the Services may have additional terms (including without limitation policies, guidelines, and rules) that will further govern your use of that particular Service, and supplement this Agreement. If you choose to register for, access or use any such Services, you may be presented with such additional terms. By using those Services, you agree to comply with any such additional terms, which are incorporated by reference into this Agreement.
10. LINKS TO OTHER SITES
The Services may include links to other websites, including links provided as automated search results. Some of these websites may contain materials that are objectionable, unlawful, or inaccurate. These links are provided for your convenience only and we do not endorse these sites or the products and services they provide. You acknowledge and agree that we are not responsible or liable for the content or accuracy of these other websites.
11. CLIENT’S USE OF CONTENT
All of the Content is owned by us or our licensors and is protected by copyright, trademark, patent, and trade secret laws, other proprietary rights, and international treaties. You acknowledge that the Services and any underlying technology or software used in connection with the Services contain ONCALL PAIN’s proprietary information. We give you permission to use the aforementioned content for personal, non-commercial purposes only and do not transfer any intellectual property rights to you by virtue of permitting your use of the Services. You may print, download, and store information from the Site for your own convenience, but you may not copy, distribute, re-publish (except as permitted in this paragraph), sell, or exploit any of the content, or exploit the Site or Services in whole or in part, for any commercial gain or purpose whatsoever. Except as expressly and unambiguously provided herein, neither ONCALL PAIN nor its suppliers grant you any express or implied rights, and all rights in the Site and the Services not expressly granted by ONCALL PAIN to you are retained by ONCALL PAIN.
12. NO WARRANTY DISCLAIMER
We have no special relationship with or fiduciary duty to you. You acknowledge that we have no control over, and no duty to take any action regarding: which users gain access to the Site and/or the Services; what content you access via the Site and/or the Services; what effects the content on the Site and/or the Services may have on you; how you may interpret or use the content on the Site and/or the Services; or what actions you may take as a result of having been exposed to the content on the Site and/or the Services. You release us from all liability for you having acquired or not acquired content through the Site and/or the Services. The Site and/or the Services may contain, or direct you to websites containing, information that some people may find offensive or inappropriate. We make no representations concerning any content contained in or accessed through the Site and/or the Services, and we will not be responsible or liable for the accuracy, copyright compliance, legality or decency of material contained in or accessed through the Site and/or the Services. We make no representations or warranties regarding suggestions or recommendations of services or products offered or purchased through the Site and/or the Services.
WE PROVIDE THE SITE AND THE SERVICES “AS IS”, “WITH ALL FAULTS” AND “AS AVAILABLE.” WE MAKE NO EXPRESS OR IMPLIED WARRANTIES OR GUARANTEES ABOUT THE SERVICES. TO THE MAXIMUM EXTENT PERMITTED BY LAW, WE HEREBY DISCLAIM ALL SUCH WARRANTIES, INCLUDING ALL STATUTORY WARRANTIES, WITH RESPECT TO THE SERVICES AND THE SITE, INCLUDING WITHOUT LIMITATION ANY WARRANTIES THAT THE SERVICES ARE MERCHANTABLE, OF SATISFACTORY QUALITY, ACCURATE, FIT FOR A PARTICULAR PURPOSE OR NEED, OR NON-INFRINGING.
WE DO NOT GUARANTEE THAT THE RESULTS THAT MAY BE OBTAINED FROM THE USE OF THE SERVICES WILL BE EFFECTIVE, RELIABLE OR ACCURATE OR WILL MEET YOUR REQUIREMENTS. WE DO NOT GUARANTEE THAT YOU WILL BE ABLE TO ACCESS OR USE THE SERVICES (EITHER DIRECTLY OR THROUGH THIRD PARTY NETWORKS) AT TIMES OR LOCATIONS OF YOUR CHOOSING. WE ARE NOT RESPONSIBLE FOR THE ACCURACY, RELIABILITY, TIMELINESS OR COMPLETENESS OF INFORMATION PROVIDED BY USERS OF THE SERVICES OR ANY OTHER DATA OR INFORMATION PROVIDED OR RECEIVED THROUGH THE SERVICES. EXCEPT AS EXPRESSLY SET FORTH HEREIN, ONCALL PAIN MAKES NO WARRANTIES ABOUT THE INFORMATION SYSTEMS, SOFTWARE AND FUNCTIONS MADE ACCESSIBLE THROUGH THE SERVICES OR ANY OTHER SECURITY ASSOCIATED WITH THE TRANSMISSION OF SENSITIVE INFORMATION. ONCALL PAIN DOES NOT WARRANT THAT THE SITE OR THE SERVICES WILL OPERATE ERROR FREE, BUG FREE OR FREE FROM DEFECTS, THAT LOSS OF DATA WILL NOT OCCUR, OR THAT THE SERVICES, SOFTWARE OR SITE ARE FREE OF COMPUTER VIRUSES, CONTAMINANTS OR OTHER HARMFUL ITEMS.
13. GENERAL LIMITATION OF LIABILITY
YOUR SOLE AND EXCLUSIVE REMEDY FOR ANY DISPUTE WITH US IS THE CANCELLATION OF YOUR REGISTRATION. IN NO EVENT SHALL OUR TOTAL CUMULATIVE LIABILITY TO YOU FOR ANY AND ALL CLAIMS RELATING TO OR ARISING OUT OF YOUR USE OF THE SERVICES OR THE SITE, REGARDLESS OF THE FORM OF ACTION, EXCEED THE GREATER OF: (a) THE TOTAL AMOUNT OF FEES, IF ANY, THAT YOU PAID TO REGISTER FOR THE SITE OR THE SERVICES, OR (b) $100; EXCEPT THAT, FOR ANY AND ALL CLAIMS RELATING TO OR ARISING OUT OF YOUR USE OF THE TRANSACTION PROCESSING SERVICES (AS DEFINED IN THE ADDITIONAL TERMS), IN NO EVENT SHALL OUR CUMULATIVE LIABILITY THEREOF REGARDLESS OF THE FORM OF ACTION EXCEED THE TOTAL AMOUNT OF TRANSACTION PROCESSING FEES (AS DESCRIBED IN THE ADDITIONAL TERMS), IF ANY, REMITTED TO AND RETAINED BY ONCALL PAIN FOR PROVIDING TRANSACTION PROCESSING SERVICES FOR APPOINTMENTS MADE BY YOU IN THE SIX (6) MONTHS PRIOR TO THE EVENT GIVING RISE TO THE APPLICABLE CLAIM. IN NO EVENT SHALL WE BE LIABLE TO YOU (OR TO ANY THIRD PARTY CLAIMING UNDER OR THROUGH YOU) FOR ANY INDIRECT, SPECIAL, INCIDENTAL, CONSEQUENTIAL OR EXEMPLARY DAMAGES ARISING FROM YOUR USE OF, OR INABILITY TO USE, THE SITE AND/OR THE SERVICES. THESE EXCLUSIONS APPLY TO ANY CLAIMS FOR LOST PROFITS, LOST DATA, LOSS OF GOODWILL, WORK STOPPAGE, COMPUTER FAILURE OR MALFUNCTION, ANY OTHER COMMERCIAL DAMAGES OR LOSSES, OR MEDICAL MALPRACTICE OR NEGLIGENCE OF HEALTHCARE PROVIDERS UTILIZED THROUGH USE OF THE SERVICE, EVEN IF WE KNEW OR SHOULD HAVE KNOWN OF THE POSSIBILITY OF SUCH DAMAGES. BECAUSE SOME STATES OR JURISDICTIONS DO NOT ALLOW THE EXCLUSION OR THE LIMITATION OF LIABILITY FOR CONSEQUENTIAL OR INCIDENTAL DAMAGES, IN SUCH STATES OR JURISDICTIONS, OUR LIABILITY SHALL BE LIMITED IN ACCORDANCE HEREIN TO THE MAXIMUM EXTENT PERMITTED BY LAW. IF YOU ARE A ARIZONA RESIDENT, YOU WAIVE YOUR RIGHTS WITH RESPECT TO ARIZONA CIVIL CODE SECTION 1542, WHICH SAYS “A GENERAL RELEASE DOES NOT EXTEND TO CLAIMS WHICH THE CREDITOR DOES NOT KNOW OR SUSPECT TO EXIST IN HIS FAVOR AT THE TIME OF EXECUTING THE RELEASE, WHICH, IF KNOWN BY HIM MUST HAVE MATERIALLY AFFECTED HIS SETTLEMENT WITH THE DEBTOR”.
16.1 Electronic Contracting; Copyright Dispute
16.3 Limitation of Claims
No action arising under or in connection with this Agreement, regardless of the form, may be brought by you more than one (1) year after the cause of action arose; actions brought thereafter are forever barred.
16.4 Choice of Law; Arbitration Clause and Class Action Waiver – Important – Please Review as This Affects Your Legal Rights
This Agreement shall be deemed to have been entered into and shall be construed and enforced in accordance with the laws of the State of Arizona as applied to contracts made and to be performed entirely within Arizona, without giving effect to the state’s conflicts of law statute.
YOU AGREE THAT ALL DISPUTES BETWEEN YOU AND US (WHETHER OR NOT SUCH DISPUTE INVOLVES A THIRD PARTY) WITH REGARD TO YOUR RELATIONSHIP WITH US, INCLUDING WITHOUT LIMITATION DISPUTES RELATED TO THIS AGREEMENT, YOUR USE OF THE SERVICES, AND/OR RIGHTS OF PRIVACY AND/OR PUBLICITY, WILL BE RESOLVED BY BINDING, INDIVIDUAL ARBITRATION UNDER THE AMERICAN ARBITRATION ASSOCIATION’S RULES FOR ARBITRATION OF CONSUMER RELATED DISPUTES AND YOU AND WE HEREBY EXPRESSLY WAIVE TRIAL BY JURY.
Neither you nor we will participate in a class action or classwide arbitration for any claims covered by this Agreement to arbitrate.
YOU ARE WAIVING THE ABILITY TO PARTICIPATE AS A CLASS REPRESENTATIVE OR CLASS MEMBER ON ANY CLASS CLAIM YOU MAY HAVE AGAINST US INCLUDING ANY RIGHT TO CLASS ARBITRATION OR ANY CONSOLIDATION OF INDIVIDUAL ARBITRATIONS. You also agree not to participate in claims brought in a private attorney general or representative capacity, or consolidated claims involving another person’s account, if we are a party to the proceeding. This dispute resolution provision will be governed by the Federal Arbitration Act and not by any state law concerning arbitration. Judgment on the award rendered by the arbitrator may be entered in any court having competent jurisdiction. Any provision of applicable law notwithstanding, the arbitrator will not have authority to award damages, remedies or awards that conflict with these Terms of Service.
16.5 Entire Agreement
The headings of the sections of this Agreement are for convenience only, do not form a part hereof, and in no way limit, define, describe, modify, interpret or construe the meaning, scope or intent of this Agreement or any terms or conditions therein.
We may assign this contract at any time, including without limitation to any parent, subsidiary, or any affiliated company, or as part of the sale to, merger with, or other transfer of our ONCALL PAIN to another entity. You may not assign, transfer or sublicense this Agreement to anyone else and any attempt to do so in violation of this section shall be null and void.
Informed Consent for Treatment
BY USING OR OTHERWISE ACCESSING THE SERVICES, AND/OR BY REGISTERING WITH ONCALL PAIN, YOU AGREE TO ONCALL PAIN'S INFORMED CONSENT FOR TREATMENT AND HEREBY AUTHORIZE THE PROFESSIONAL STAFF AT ONCALL PAIN TO ADMINISTER TREATMENT FOR THE PURPOSE OF MEDICAL CARE AS NEEDED.
The Provider Providers are Board Certified Nurse Practitioners (NP). NP's have additional advanced training in the diagnosis of and medication management for painful conditions. During your sessions, providers shall go through your health concerns and identify issues you may or may not have. Providers shall review issues and identify whether or not they are capable of addressing your issues.
Session Length There is no specific determination on how many sessions are needed by a client/patient as this may depend on the progress of said client/patient and this can be discussed with your provider.
Relationship The required relationship that a client/patient should have with his/her provider is strictly professional. Any other relationship, such as business or personal relationships that a client/patient may have with a provider may prevent or undermine the effectiveness of the treatment.
Confidentiality Visits between the provider and the client/patient are strictly confidential. Any notes taken by the providers, audio recordings, video recordings during your visits shall be kept confidential and secure by the providers at all times and shall not be disclosed without prior written consent by the client/patient, with exception to certain limitations by law such as:
Abuse to a child, disabled, elderly, other people;
Acts which may involve the transmission of HIV/AIDS;
Any other instance where the provider has a duty or he or she has a firm belief that there is a necessity to disclose. In case you have any questions regarding confidentiality, please discuss this with your provider.
Risks The side effects of opioids and other pain medications have been well studied and can be managed effectively. It is important to have an interdisciplinary approach to symptom management.
Common side effects of opioids and other pain medications include:
Speak to your provider about other common side effects and pain medication risks.
Advantages Some of the potential advantages include better control of pain, which may improve how you feel and function physically; an increased ability to function in personal and professional relationships, as well as an improved sense of overall well-being; and or a decrease in the intensity of pain.
Court Proceedings In case of a court proceeding involving the client/patient, it is agreed that the providers cannot testify, such as but not limited to, custody proceedings, divorce proceedings, injuries, or any other lawsuits that shall result in the disclosure of the records of the provider about his/her client/patient.
Questions For questions or concerns, please email us at firstname.lastname@example.org or call our office at (602) 345-0647.
This consent can be revoked orally or in writing prior to or during the treatment period.
No guarantee or assurance has been made to me as to the results that may be obtained.
All healthcare providers are legally required to report incidences of communicable diseases to the Department of Public Health. If, during the course of treatment, it is determined by your healthcare provider that you have acquired a communicable disease, this information will be reported to the Department of Public Health. This report will be made to individuals who are required by law to be notified.
I have been informed of the nature and purpose of treatment, common side effects thereof, alternative treatment modalities, approximate length of care, and that consent can be revoked orally or in writing prior to or during the treatment period.
I have read and fully understand the above Authorization for Treatment. No guarantee or assurance has been made to me as to the results that may be obtained.
Informed Consent for Telemedicine
Telemedicine involves the use of electronic communications to enable healthcare providers at different locations to share individual patient medical information for the purpose of improving patient care. Providers may include but may not be limited to, primary care practitioners, specialists, and/or sub-specialists. The information may be used for diagnosis, therapy, follow-up and/or education, and may include any of the following:
Patient medical records
Live two-way audio and video
Output data from medical devices and sound and video files
Electronic systems used will incorporate network and software security protocols to protect the confidentiality of patient identification and imaging data and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption.
Improved access to medical care
More efficient medical evaluation and management
Obtaining expertise of a distant specialist
In rare cases, information transmitted may not be sufficient to allow for appropriate medical decision making by the physician and consultant(s).
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.
BY USING OR OTHERWISE ACCESSING THE SERVICES, AND/OR BY REGISTERING WITH US, YOU AGREE TO ONCALL PAINS INFORMED CONSENT FOR TELEMEDICINE AND UNDERSTAND THE FOLLOWING:
I understand that 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 which identifies me will be disclosed to researchers or other entities without my consent.
I understand that I have the right to withhold or withdraw my consent to the use of telemedicine in the course of my care at any time, without affecting my right to future care or treatment.
I understand that I have the right to inspect all information obtained and recorded in the course of a telemedicine interaction, and may receive copies of this information for a reasonable fee.
I understand that 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 healthcare provider has explained the alternatives to my satisfaction.
I understand that telemedicine may involve electronic communication of my personal medical information to other healthcare providers who may be located in other areas, including out of state.
I understand that it is my duty to inform my provider of electronic interactions regarding my care that I may have with other healthcare providers.
I understand that I may expect the anticipated benefits from the use of telemedicine in my care, but that no results can be guaranteed or assured.
Medication Compliance Policy
Per recommended guidelines, OnCall Pain has updated our program policies to remain compliant and provide safe and effective pain management to all of our patients.
DAILY DOSE GUIDELINES:
Patients exceeding a 200 total daily dose can be encouraged to try to reduce their dose. The goal is to try and get them on the lowest possible dose with no high risk polypharmacy. This is a recommendation, not required and up to the complete discretion of the provider.
For those few patients that are on very high doses of medication > 500, the titration may take a very long time. Very small decreases are still working towards the goal of lowering total daily dose. Even if by only a few mg.
Promethazine codeine cough syrup (if a necessary part of treatment plan, needs to be prescribed by pulmonology or PCP)
Sleep aids (will allow trazodone and hydroxyzine)
ANY benzodiazepine (if absolutely necessary as part of treatment plan, needs to be managed and prescribed by a mental health provider)
Soma (not to be used with any pain medication)
Any medication that should be prescribed by a primary care provider (BP meds, cholesterol meds, etc)
Hormone replacement: this needs to be prescribed by an endocrinologist or PCP.
Mental health meds for more severe depression, bipolar, ADD/ADHD, panic attacks, anxiety etc. These need to be prescribed by a mental health provider. Antidepressants that are used for pain management pain are acceptable.
In order for any of the above medications to be deemed an appropriate part of a patient's treatment plan, provider needs to have documentation or records from the prescribing provider that deems it necessary.
Post op medication will only be provided on a limited basis which is usually 5-7 days.
If patient fills a script from another provider and we were not aware of it, it is considered a violation in the pain agreement.
If a medication needs a prior authorization, provider may change the treatment plan to formulary preferred medications and quantities.
Based on insurance recommendations, patients may need to try and fail what is on formulary.
If tasks are not completed, we can request the patient be seen in 2 weeks (at the reduced Check-In Visit rate) to ensure completion of the tasks.
ALL PATIENTS MUST SEE A PROVIDER AT LEAST ONE TIME EVERY 30 DAYS.
If you have medication that lasts more than 30 days you are still required to be seen.
Patients may not receive more than 30 days of medication at a time
NO EARLY REFILLS ON MEDICATION
YOU WILL BE ASKED FOR A RANDOM PILL COUNT AT LEAST ONE TIME PER YEAR
YOU WILL FOLLOW THE DIRECTIONS OF YOUR SCRIPT. You cannot adjust the medication in any way on your own. If you run short on your medication for any reason, the medication will NOT be replaced. If medication is lost, stolen, dropped or any other reason you no longer have it, it will NOT be replaced. The following may happen if you are short on your medication:
Discharged from our care
1 week appointment with the provider
Frequent pill counts
Or any other intervention the provider deems appropriate and fair
Opioid Safety Principles (Pain Contract)
The purpose of this Agreement is to prevent misunderstandings about certain medications you will be taking for pain management. This Agreement is to help you and your provider to comply with the law regarding controlled pharmaceuticals.
BY USING OR OTHERWISE ACCESSING OUR SERVICES, AND/OR BY REGISTERING WITH US, YOU AGREE TO ONCALL PAINS OPIOID SAFETY PRINCIPLES AND UNDERSTAND THE FOLLOWING:
I will sign a Consent for Release of Medical Records form and I understand that my provider cannot write a script until my official records have been received and reviewed.
I will attend all scheduled appointments with my provider(s) and other members of the treatment team.
I will take my medication as instructed and I will not change the way I take it without first talking to my provider or other member of the treatment team.
I will tell my provider all other medicines that I take, and let them know right away if I have a prescription for a new medicine.
I will keep my medicine safe, secure and out of the reach of children. If the medicine is lost or stolen, I understand medication will not be replaced until my next appointment, and may not be replaced at all.
I understand that prescriptions may only be filled during scheduled visits with my treatment team.
I will call 911 immediately if I am experiencing an overdose or medical emergency.
I will not sell my medicine or share it with others. I understand that selling or sharing medication is a felony, that doing so may result in imprisonment and/or fines and, if I do, my treatment will be stopped.
I will participate in all alternative treatments that my provider recommends.
I will properly dispose of any unused medication. If it is a medication prescribed by OnCall Pain, you must bring unused medication to your local “take back” or mail back program or medication drop box at a police station, DEA-authorized collection site or pharmacy, if the pharmacy has a secure drop-box program. You must provide documentation for the quantity and type of medication that was disposed.
I will not take sleep aids or anti-anxiety medications together with a pain medication and without discussing with my provider. I understand that doing so can be very dangerous. If a sleep aid or anti-anxiety medication is prescribed by anyone other than my pain provider, I will discuss with the provider prescribing my pain medication.
I will use caution when driving or operating any machinery while taking opioid medication.
I will not use illegal drugs such as heroin, cocaine, marijuana, or amphetamines. I understand that if I do, my treatment may be stopped.
I agree to conduct drug testing and pill counts within 24 hours of being notified. I understand that I must make sure the office has current contact information in order to reach me, and that any missed tests will be considered positive for drugs.
I will keep up to date with any bills from the office and tell the doctor or member of the treatment team immediately if I can't pay for treatment anymore.
I understand that any aberrant behavior is grounds for discharge including but not limited to violent outbursts, threats, yelling, harassment and/or verbal abuse.
I understand that I may lose my right to treatment if I break any part of this agreement.
Financial & Office Policies
BY USING OR OTHERWISE ACCESSING OUR SERVICES, AND/OR BY REGISTERING WITH US, YOU AGREE TO ONCALL PAINS FINANCIAL & OFFICE POLICIES AND UNDERSTAND THE FOLLOWING:
INSURANCE (All Patients): OnCall Pain does not bill or work directly with ANY insurers. All services (including Medicare/Medicaid) are non-covered services and patients are soley responsible for payment. We offer a competitive cash pay fee schedule. You will be charged the appropriate amount from our standard fee schedule (https://www.oncallpain.com/our-services) and are responsible for payment to hold your appointment. We will, as a convenience to you, provide a "Superbill" to allow the patient to submit for reimbursement if desired.
PRESCRIPTIONS, LABS AND ORDERS: Depending on your insurance carrier, patients insurance may be used for prescriptions, labs and orders. OnCall Pain does not participate with ANY insurance carriers and OnCall Pain services are non-covered services. As a non-participating and non-covered service, I understand that, in certain cases, patients insurance may not cover prescriptions, labs and orders sent by a non-participating or non-covered service. Patients are responsible for the cost of any prescriptions, labs and/or orders sent on their behalf.
INITIAL VISIT CANCELLATION POLICY: Due to the time & expense of the new patient intake process & reserving time with your provider, Initial Visit fees are non-refundable.
REFUNDS: All refunds will be issued back to the original method of purchase. Please allow 2-14 days for refund to process. Merchant processing fees are non-refundable. A 3% fee will be withheld from all refunds to cover non-refundable credit card expenses. Followup Visits must be cancelled by 5pm the business day before to your scheduled appointment. If cancelled in time, a refund may be issued for the cost of the visit minus non-refundable merchant fees.
RESCHEDULING: Patients are expected to be seen on schedule and in accordance with state guidelines. Rescheduled appointments will be charged a $25 Rescheduling Fee.
LATE PAYMENTS: Payment request is sent via invoice each Friday before your scheduled appointment. Payment is due upon receipt and is considered late if not paid by 5pm the business day before your appointment. If payment is not received in time, your visit will be automatically rescheduled and a $25 Rescheduling Fee will apply.
NO SHOWS: If you miss your appointment without notice, you may be charged a No Show Fee equal to your visit charge amount. Please contact our office as soon as possible with any schedule changes.
EQUIPMENT: To participate in online visits you must have the proper equipment, proper internet connection and you must follow the required checkin procedures. If you are unable to check in for your appointment due to your equipment, your internet connection or for improper check in procedures, your visit may be cancelled and you may be charged a No Show fee.
PAPERWORK SERVICES: Any paperwork filled out by our providers such as Short-term disability, or FMLA are subject to a $50 Administration Fee.
MEDICAL RECORDS COPIES: Electronic copies of medical records for personal use or for parties other than your health insurance company or other physicians involved with your care are subject to a $30 flat fee. Printed records are subject to a $15 flat fee for the first 10 pages plus $0.50 per page over 10 pages plus shipping.
DELINQUENT ACCOUNT POLICY: Delinquent accounts will be reported to our collection agency. To cover the cost of collections, delinquent accounts balances will be subject to a 45% increase of the overdue amount. Please notify our staff if you know your payment will be late in arriving or if payment arrangements are needed.
DISPUTED PAYMENTS: Disputing payment after services are rendered is considered theft of service. Disputed payments may be reported to local authorities. Late Payment and Delinquent Account Fees may be added to payment disputes.
COURTESY WAIVE: We understand that unusual circumstances may arise. As a courtesy, we offer all patients a one-time Courtesy Waive on change fees up to $25.
This financial policy supersedes all prior written financial policies, contracts, or verbal agreements.