NuHuman LLC Medical Consent
Revision Date: Feb 13, 2025 

WE ARE NOT A REPLACEMENT FOR EMERGENCY MEDICAL SERVICES. IF YOU HAVE A MEDICAL EMERGENCY, SEEK EMERGENCY MEDICAL CARE IMMEDIATELY IN PERSON OR DIAL 911 OR YOUR LOCAL EMERGENCY NUMBER.

We may change these terms at any time, as required by law. This may include changing, adding, or removing terms in response to legal, business, competitive, or other necessary considerations.

Telehealth Consent

Telehealth enables clients to access health services using audio-video interfaces such as videoconferencing.

Electronic systems used incorporate network and software security protocols to protect the confidentiality of client identification and imaging data. These measures safeguard the data and ensure its integrity against intentional or unintentional corruption.

Expected Benefits:

  • Improved access to weight loss management healthcare by enabling clients to receive services remotely.

  • More efficient medical evaluation and management.

  • Access to expertise from distant specialists.

  • Continuity of care with established providers across different locations.

Possible Risks:

  • In rare cases, information transmitted may not be sufficient (e.g., poor resolution of images) to allow for appropriate medical decision-making.

  • Delays in medical evaluation and treatment could occur due to equipment deficiencies or failures.

  • Although rare, security protocols could fail, causing a breach of personal medical information.

  • Limited access to complete medical records may lead to adverse drug interactions or allergic reactions.

By consenting to this form, I understand the following:

  • The same privacy and confidentiality protections that apply to in-person medical care also apply to telehealth services.

  • I have the right to withhold or withdraw consent at any time without affecting my right to future care.

  • I have the right to access and obtain copies of information documented during my telehealth interactions for a reasonable fee.

  • I may choose alternative methods of weight loss management healthcare at any time.

  • It is in my best interest to inform my provider of any other healthcare professionals involved in my care.

  • No results from telehealth consultations are guaranteed or assured.

Client Consent to Telehealth Use: I have read and understood the above information about telehealth. I have discussed it with my provider, and all my questions have been answered. I give my informed consent for the use of telehealth in my weight loss management healthcare. My continued use of the services constitutes my acceptance of these terms.

 

HIPAA Consent

The Health Insurance Portability and Accountability Act (HIPAA) provides safeguards to protect your privacy. Implementation of HIPAA requirements began on April 14, 2003. This form is a simplified version, and a more complete text is available upon request.

Our Policies:

  • Patient information will be kept confidential, except as necessary to provide services or manage administrative matters related to care.

  • Information may be shared with other healthcare providers, laboratories, and health insurance payers as necessary and appropriate for your care.

  • Patient files will not contain any coding that identifies a condition or private information beyond public records.

  • We may remind patients of their appointments via phone, email, U.S. mail, or other convenient means.

  • Vendors who access PHI must agree to abide by HIPAA confidentiality rules.

  • Government agencies or insurance payers may inspect office documents in accordance with their duties.

  • Confidential information will not be used for marketing or advertising purposes.

  • Patients have the right to access their records as permitted by state and federal laws.

We may change these policies as needed. Patients may request restrictions on PHI use, but we are not obligated to alter policies based on requests.

My continued use of NuHuman LLC’s services constitutes my understanding and acceptance of these HIPAA terms and any subsequent policy changes.

 

Financial Consent

I understand and accept the following financial terms:

  • A credit card may be kept on file, and any outstanding balances for services must be paid in full.

  • I authorize NuHuman LLC to process payments for consultations, services, and goods received.

  • I authorize NuHuman LLC to debit my account for unpaid balances.

  • All programs are auto-renewing, and I consent to automatic charges unless I request cancellation before the payment is processed.

  • There are no refunds or exchanges. By signing, I confirm I am an authorized user of the credit card provided and will not dispute payments.

 

Shipping Authorization

All prescription medications are dispensed per state and federal laws with pharmacist approval. Medications are considered dispensed when shipped, not upon delivery. Clients agree to hold NuHuman LLC harmless for shipping delays or errors.

My continued use of NuHuman LLC’s services constitutes my acceptance of these terms, and I authorize the shipment of medications to the address provided during intake or another address I provide later.