terms_of_service — Columbiamed

Terms of Service

By clicking “I Agree,” you acknowledge and agree to the following in order to proceed with treatment with Semaglutide or Tirzepatide through the platform:

I have read and understand all of the above statements and have been informed of potential side effects and risks that may be associated with the use of Semaglutide and Tirzepatide prescriptions. I fully understand what I am signing and hereby request and consent to treatment using Semaglutide or Tirzepatide as prescribed to me. I understand that other treatment alternatives are available for weight loss and blood sugar management.
I agree that I am, and will be, under the care of my primary medical provider for all other conditions. I understand that Columbia Medical providers are not providing primary care.
NO GUARANTEES: I acknowledge that there are no guarantees or assurances made with respect to weight loss or any results of taking the Semaglutide or Tirzepatide prescribed for me, and I understand that it works best when combined with diet and exercise.
OFF-LABEL USE OF OZEMPIC: I understand that while Ozempic® is FDA approved for blood sugar control, it used off-label for weight loss.
NO FDA APPROVAL FOR COMPOUNDED MEDICATIONS: I understand that compounded Semaglutide and compounded Tirzepatide are not approved by the FDA for any purpose and are formulated and used on a research basis only.
NO REFUNDS: I understand that results may vary, and I understand that there are no refunds unless there is an issue with shipping as it relates to medication. I understand that my prescription is in my individual name and cannot be returned.
Complete Medical History: I understand that Semaglutide and Tirzepatide may be inappropriate and unsafe if I have certain health conditions, allergies, or take certain medications or supplements, whether prescribed or over-the-counter. For this and other reasons, I understand that it is vital that I truthfully and accurately disclose all health information requested by my Effecty provider including allergies, medications I am taking (both prescription and over the counter), medical/surgical/social/family history, and pertinent lab results, and keep my provider updated as to any changes in my health conditions and history during treatment with Semaglutide and Tirzepatide, and there shall be no liability on the part of Effecty or my Effecty provider if I fail to do so. I understand that if I become pregnant or start trying for pregnancy, I must stop this medication.

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Directions for use and Following Instructions:

I understand that I will be in charge of administering the medication prescribed to me. I will follow and comply with the recommended doses and methods of administration and understand this is very important for the safety of the treatment. I understand that failure to comply with the dosage and administration instructions could alter the weight loss results and the safety of treatment.
I understand this medication must be self-injected in the subcutaneous tissue once weekly.
I understand that I will be instructed on how to administer the injections myself, or I will need to plan to have someone assist me.
I will not adjust my medications up or down without prior instruction to do so.
I understand that the medication must be either kept frozen or refrigerated.
I will not share needles, and I will dispose of needles safely.
I agree that I will not use any medications after the Beyond Usage Date (BUD).

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Columbia Medical IDTF, LLC currently operates in the states of FL, IL, and GA. As service coverage is expanded, states will be updated here within “Terms of Service”.

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CERTIFICATION OF CONSENT TO PROCEED WITH TREATMENT: By clicking “I Agree” when asked, I confirm and agree that:

I have read this entire Informed Consent, andI understand and agree to the information herein. The nature of the therapy,and the potential risks, benefits and alternatives have been explained to me, and I have had the opportunity to ask questions and all my questions have been answered to my satisfaction. I hereby freely and voluntarily accept all risks associated with Semaglutide and/or Tirzepatide and a prescribed healthy diet for the purpose of losing weight and elect and consent to proceed with treatment.

The following are examples of a few states with additional privacy protections:

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California:

For residents of California, we comply withthe Confidentiality of Medical Information Act (CMIA), as well as California's specific privacy laws related to marketing, sale of PHI, and minors' rights. We will obtain written consent before disclosing certain information and adhere to additional privacy protections, as required by California law.

Right to Access: In addition to the rights described above, California residents have the right to request access to their PHI in a readily usable electronic format, as well as any additional information required by California law. To request access, submit a written request to our Privacy Officer.
Right to Restrict Certain Disclosures: California residents have the right to request restrictions on certain disclosures of their PHI to health plans if they paid out-of-pocket for a specific healthcare item or service in full. To request such a restriction, submit a written request to our Privacy Officer.
Confidentiality of Medical Information Act (CMIA): California residents are protected by the Confidentiality of Medical Information Act (CMIA), which provides additional privacy protections for medical information. We are required to comply with CMIA in addition to HIPAA.
Marketing and Sale of PHI: California residents have the right to request that their PHI not be used for marketing purposes or sold to third parties without their authorization. To request a restriction on the use of your PHI for marketing or the sale of your PHI, submit a written request to our Privacy Officer.
Minor's Rights: If you are a minor (under the age of 18), you have the right to request that certain information related to certain sensitive services, such as reproductive health, mental health, or substance use disorder treatment, not be disclosed to your parent or guardian without your consent. To request a restriction on the disclosure of such information, submit a written request to our Privacy Officer.

If you reside in a state other thanCalifornia, please consult your state's specific privacy laws for information about any additional rights you may have regarding your PHI. You may also contact our Privacy Officer for more information about your rights under specific state laws.

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New York:

For residents of New York, we comply with theNew York State Confidentiality of Information Law, which provides additional privacy protections for HIV-related information, mental health records, and genetic testing results. We will obtain written consent before disclosing such information, even for treatment, payment, or healthcare operations.

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Texas:

For residents of Texas, we comply with theTexas Medical Privacy Act, which offers privacy protections beyond HIPAA, including requiring consent for certain disclosures of PHI, additional safeguards for electronic PHI, and specific requirements for the destruction ofPHI. We also adhere to Texas's specific privacy protections for mental health records and substance use treatment records.

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Florida:

For residents of Florida, we comply withFlorida's privacy laws, which offer additional protections for mental health records, HIV/AIDS-related information, and substance abuse treatment records.We will obtain written consent before disclosing such information, even for treatment, payment, or healthcare operations. We also implement specific security measures to protect electronic PHI, as required by Florida law.

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Illinois:

For residents of Illinois, we comply withIllinois's specific privacy laws related to mental health records,HIV/AIDS-related information, and genetic testing results. We will obtain written consent before disclosing such information, even for treatment, payment, or healthcare operations. In addition, we will notify patients of any unauthorized access to their electronic PHI, as required by Illinois law.

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Massachusetts:

For residents of Massachusetts, we comply withMassachusetts's specific privacy laws related to mental health records,HIV/AIDS-related information, and genetic testing results. We will obtain written consent before disclosing such information, even for treatment, payment, or healthcare operations. We also implement specific security measures to protect electronic PHI, as required by Massachusetts law.

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