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© 2017 Pain Relief Match
PainReliefMatch.com takes privacy very seriously. Pain Relief Match is a Business Associate, which its affiliates provides service, such as maintenance of medical records, customer-intake, billing and technical services to the physicians, known as Covered Entities, who provide telehealth services to our customers (“Physicians”). As a Business Associate, we share a commitment with the Physicians to protect the privacy and confidentiality of health information that we obtain about you subject to the terms of our Business Associate Agreements with Physicians and in compliance with the Health Insurance Portability and Accountability Act of 1996, as amended by the Health Information Technology for Economic and Clinical Health Act, and the HIPAA Privacy and Security Rules (collectively “HIPAA”).
This Privacy Statement is provided to help you better understand how we at Pain Relief Match use, disclose, and protect your health information in accordance with the terms of Business Associate Agreements between Pain Relief Match and Covered Entities such as Physicians and as required by HIPAA.
Business Associate Agreement. The Business Associate Agreement is a formal written contract between Pain Relief Match, its affiliates and a Covered Entity that requires Pain Relief Match to comply with specific requirements related to the use and disclosure of your health information.
Covered Entity. A Covered Entity is a health plan, health care provider (e.g., physician, physician group practice, hospital), or healthcare clearinghouse that must comply with HIPAA.
The following is a description of how Pain Relief Match may use and disclose your health information:
In the event of a use or disclosure of your health information that is in violation of the requirements of the Business Associate Agreements, we will mitigate, to the extent practicable, any harmful effect resulting from the violation. Such mitigation will include:
We will make your health information available to Physicians, or as directed by them, to you, in accordance with your right of access under HIPAA. Pain Relief Match will comply with your health information amendment and accounting obligations set forth in HIPAA. If you wish to access your health information, please send a written/email request to:
Regular mail: Pain Relief Match
626 RXR Plaza
Uniondale, NY 11556
Or via email to: email@example.com
Upon request, we will make available our internal practices, books, and records relating to the use and disclosure of your health information received from, or created or received by Pain Relief Match on behalf of a Physician to the Secretary of the U.S. Department of Health and Human Services for the purpose of determining compliance with HIPAA.
Telehealth is the use of electronic communications to enable physicians at different locations to share individual customer health information for the purpose of improving customer/patient care. Customer health information may be used for diagnosis, treatment, follow-up and/or education, and may include any combination of the following: (1) medical records; (2) medical images; (3) live two-way audio or video; and (4) output data from medical devices and sound and video files. Telehealth services include remote monitoring, consultations, and prescription orders and refills, among other things. The Physicians who will provide telehealth services to you are board-certified, licensed physicians, and are licensed in the state where you reside. PainReliefMatch.com and its affiliates provide administrative services, such as handling intake and maintaining electronic medical records, to these physicians. This Consent is provided to help you better understand how PainReliefMatch.com supplies you access to telehealth consultation services, the role of the physicians, and your responsibility for your decision to seek telehealth services. PainReliefMatch.com will document your verbal consent as part of your electronic medical record.
Pain Relief Match electronic systems incorporate network and software security protocols (e.g., encrypting data) to protect the confidentiality of your health information, identifying information, and imaging data, as well as measures to safeguard the data and to ensure its integrity against corruption.
Primary responsibility for your medical care and medical record should remain with your primary care doctor, if you have one. PainReliefMatch.com will provide information about your telehealth consultation(s) to your personal doctor or other healthcare providers upon your written authorization.
As explained in this Consent, there are both benefits and risks in receiving telehealth services or taking any prescribed medications.
I represent that the following has been explained to me:
The following apply to residents of certain states: Texas: I may file a complaint with the Texas Board of Medicine regarding the telehealth services that I receive from the physician(s). I can submit the complaint electronically (Online Complaint Form), by mail (Complaint Form), or by phone (1-800-201-9353), in accordance with the Texas Board of Medicine’s instructions available on the Texas Board of Medicine’s website: http://www.tmb.state.tx.us/page/place-a-complaint.
Nevada (DOs only). The PainReliefMatch.com physician(s) who provide telehealth services to me do not have a financial interest in PainReliefMatch.com or Pain Relief Match website/portal
I understand the information provided above, have discussed it with the PainReliefMatch.com nurse advocate, and all of my questions have been answered to my satisfaction. I hereby give my informed consent for the use of telehealth in my medical care.
March 2016 LEGAL\25864563\7
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We may refer to you or any individual that uses our Site as “you” or “your” or a “user.” If we use the term “Our Companies,” in addition to us, that term means and includes our agents, representatives, subsidiaries, affiliated companies, select unaffiliated companies, assigns, and brands that are owned by, licensed by, and/or partnering with Pain Relief Match.
When we use the term “Site” we mean all website(s) or online solution functionality or services offered through the individual URL or Internet address locations, sites and pages within the PainReliefMatch.com domain (including all backups, mirror, replacement and substitutes). Unless otherwise noted, when we use the term “Site,” we are including all the content, text, information, images, graphics, postings, files, documents, multimedia materials, software, code, data, logos, brands, service and trademarks, the “look and feel”, as well as the selection and arrangement of items, all copyrightable or otherwise legally protectable items and elements and all of the various features, functions and services in, on or associated with our Site and we will use the term “Content” when we refer to them separately. When we use the term “Services” we mean any services provided as an online functionality or feature of the Site.
You may never use, allow or enable others to use our Site or knowingly condone use of our Site to do or attempt to:
The Site and its entire contents, features and functionality, including, but not limited to all information, text, displays, photographs, graphics, video and audio, and the design, selection and arrangement thereof (“PainReliefMatch.com Content”), are owned by, licensed by, or provided to Pain Relief Match . The Site is protected by copyright, trademark, trade secret, and other intellectual property or proprietary rights laws, and thus, we own and retain all rights in the PainReliefMatch.com Content and the Service.
All Material included on PainReliefMatch.com. , except third party content as referenced above, is the property of Pain Relief Match and is protected by United States and international copyright laws. No portion of the Material on PainReliefMatch.com may be reprinted or republished in any form without the express written permission of Pain Relief Match or, with respect to third party content, its respective owner. You may download Material from PainReliefMatch.com for your own personal, non-commercial use only, provided you do not modify the Material and keep intact all copyright and other proprietary notices. You may not further distribute or display such Material for any purpose. Without our prior written consent, you may not (a) allow, enable, or otherwise support the transmission of mass unsolicited, commercial advertising or solicitations via e-mail (spam); (b) use any high volume, automated, or electronic means (including without limitation robots, spiders, scripts or other automatic device) to monitor or copy our web pages or the content contained thereon; (c) link or deep-link to PainReliefMatch.com for any purpose; or (d) frame PainReliefMatch.com. , place pop-up windows over its pages, or otherwise affect the display of its pages.
Certain of the names, logos, and other materials displayed on PainReliefMatch.com constitute trademarks, tradenames, service marks or logos (“Marks”) of Pain Relief Match or third parties. You are not authorized to use any such Marks. Ownership of all such Marks and the goodwill associated therewith, with the exception of the third party Marks, remains with Pain Relief Match and are protected by United States and international trademark laws. Nothing contained on PainReliefMatch.com should be construed as granting, by implication or otherwise, any license or right to use any of the Marks displayed on PainReliefMatch.com. Your use of the Marks displayed on PainReliefMatch.com. , or any other content on PainReliefMatch.com. , except as provided herein, is strictly prohibited. All Marks not owned by Pain Relief Match that appear on PainReliefMatch.com are the property of their respective owners.
In accordance with the requirements set forth in the Digital Millennium Copyright Act, Title 17 United States Code Section 512(c)(2) (“DMCA”), Pain Relief Match will investigate notices of copyright infringement and take appropriate remedial action. If you believe that any Content on PainReliefMatch.com has been used or copied in a manner that infringes your work, please provide a written notification of claimed copyright infringement to the Designated Agent for the Site containing the following elements as set forth in the DMCA:
We have no obligation, nor do we verify, review for accuracy, completeness or otherwise, any User Content. We also have no obligation to monitor or continue to monitor your use of the Site or your User Content, but we reserve the right to do so and to confirm and request confirmation of any information you submit to us or on our Website, at any time for any reason or no reason at all. We do not endorse User Content, nor do we screen them.
Your User Content and/or your account are your responsibility, although we ask that you notify us if you know or suspect the security of your user identification, log-in and password may have been compromised so that we can take responsive action. But, in general, you are solely responsible for activities undertaken through your registration, profile, user account or login identification or password and you will defend and indemnify us (see the Section entitled “You Indemnify Us”) for any User Content submitted, displayed, use, or transferred under the foregoing. In accordance with the foregoing, if you suspect that your log-in identification or password may have been compromised, please notify us immediately: firstname.lastname@example.org
Giving us a non-exclusive, irrevocable, unconditional, transferable, perpetual, worldwide, royalty free license and right to use, display, reproduce, perform, adapt, translate, modify, create derivative works from, publish, distribute, disseminate and broadcast the User Content in connection with your use of the Site without additional accounting to you or notifying you in any way; and
Representing and warranting to us you have the right to submit the User Content and grant the rights and license described above.
If anyone else has or may have rights to the User Content you are submitting, it is your responsibility to find out and obtain whatever agreements, licenses and rights you need from them to do so, because if and when you submit Content to us, you will be solely responsible and liable and you will defend and indemnify us (See the Section entitled “You Indemnify Us”).
By subscribing to PainReliefMatch.com. you expressly request to receive information via telephone call, email and text/SMS message (including through the use of an automatic telephone dialing system or artificial/prerecorded voice, SMS or MMS (text) messages, even if your telephone number(s) is/are currently listed on any state, federal or corporate Do Not Call list). Consent is not a requirement to purchasing the goods or services that PainReliefMatch.com. is offering. Standard text message rates and cellular data charges apply. You may opt-out by replying “stop” to any message that you receive.
From time to time we may offer sweepstakes, contests, or other similar promotions (“Promotions”). Promotions vary and may require you to submit information about yourself to us. Each Promotion has its own Terms and Conditions, which govern your participation in the Promotion. You must read and agree to these separate Terms and Conditions before entering into any such Promotion.
If the Site contains links to other sites and resources provided by third parties, such links are provided for convenience purposes only. This includes links contained in advertisements, banner advertisements, and sponsored links. We have no control over, and no liability for any third party websites or materials. We work with a number of partners and affiliates whose Internet sites may be linked with the Site. Because neither we nor our Site has control over the content and performance of these partner and affiliate sites, we make no guarantees about the accuracy, currency, content, or quality of the information provided by such sites, and we assume no responsibility for unintended, objectionable, inaccurate, misleading, or unlawful content that may reside on those sites.
PainReliefMatch.com contains many Offers from third party partners and affiliates which may allow you to order, receive, or redeem various products and services by business that are not owned or operated by us. The delivery, guarantee, maintenance, and all other matters concerning your transactions with these businesses are solely between you and such businesses. We do not endorse, warrant, or guarantee any such third party Offers and we are not liable for the accuracy, completeness, or usefulness of such information or the availability of any Offers.
We permit third parties to advertise and promote our Websites and we may place and permit third parties to place advertising, cookies, web beacons and other content, including links to other websites on our Websites. We and our third party marketing partners may use these technological means placed on our Websites to collect and share Information. The following is a list of our marketing partners . A select group of these partners may contact you by telephone, email and/or SMS text messaging. Your email will only be shared with our preferred mailing partner for the purpose of sending third party promotional email communication.
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OUR LIABILITY TO YOU IS LIMITED. TO THE FULLEST EXTENT PERMITTED BY LAW, WE DISCLAIM ALL LIABILITY FOR LOSS, DAMAGE, COST AND/OR EXPENSE OF ANY KIND (INCLUDING, BUT NOT LIMITED TO, SPECIAL, INCIDENTAL, OR CONSEQUENTIAL DAMAGES, LOST PROFITS, OR LOST DATA, REGARDLESS OF THE FORM OF ACTION OR BASIS OF THE CLAIM AND WHETHER OR NOT A PARTY HAS BEEN ADVISED OF THE POSSIBILITY OF DAMAGES) IN CONNECTION WITH OR ARISING FROM USE OF OUR SITE OR ANY OTHER MATERIALS OR SERVICES WE PROVIDE TO YOU.
SOME JURISDICTIONS DO NOT ALLOW EXCLUSIONS OF CERTAIN WARRANTIES OR LIMITATIONS ON CERTAIN DAMAGES, SO SOME OF THESE EXCLUSIONS AND LIMITATIONS MAY NOT APPLY TO YOU. HOWEVER, IF ANY LIMITATION OR EXCLUSION OF DAMAGES OR LIABILITY IS PROHIBITED OR RESTRICTED BY LAW, WE SHALL BE ENTITLED TO THE MAXIMUM LIMITATIONS AND EXCLUSIONS PERMITTED; HOWEVER, IN NO EVENT SHALL OUR TOTAL LIABILITY TO YOU EXCEED ONE HUNDRED DOLLARS ($100).
You agree to first contact us for any dispute or controversy so as to attempt to resolve the dispute or controversy informally. Any controversy or claim arising out of or related to the use of the Site or Service that cannot be resolved through such informal process or through negotiation within 120 days shall be settled by binding arbitration administered by the American Arbitration Association in accordance with its Commercial Arbitration Rules, and judgment on the award rendered may be entered in any court having jurisdiction thereof. The arbitration will be conducted in the English language in the city of Tampa, Florida by a single neutral arbitrator.
You agree that disputes will only be arbitrated on an individual basis and shall not be consolidated, on a class wide, representative basis, or with any other arbitration(s) or other proceedings that involve any claim or controversy of any other party. If for any reason this arbitration clause is unenforceable or inapplicable, both you and we agree, to the extent permissible by law, to waive any right to pursue any claims on a class action basis. If any portion of this class action waiver is limited, void, or unenforceable, then our agreement to arbitrate under this section will not apply and any controversy or claim must be brought exclusively in the state and federal courts in Tampa, Florida.
Nothing contained on the Site should be understood as granting you a license to use any of the trademarks, service marks, or logos owned by us or by any third party.
We control and operate the Site from our offices in the State of Florida. We make no representation that any of the materials or the services to which you have been given access are available or appropriate for use outside the United States and access to the Site from territories where its contents are illegal or restricted is prohibited. If you choose to access the Site from outside the United States, you do so on your own initiative and are responsible for compliance with applicable laws, rules and regulations.
Pain Relief Match welcomes your feedback and suggestions about Pain Relief Match ’s programs or services or with respect to how to improve the Site. By transmitting any suggestions, information, material, or other content (collectively, “feedback”) to Pain Relief Match and/or PainReliefMatch.com. , you represent and warrant that such feedback does not infringe or violate the intellectual property or proprietary rights of any third party (including, without limitation, patents, copyrights, or trademark rights) and that you have all rights necessary to convey to Pain Relief Match and/or PainReliefMatch.com and enable Pain Relief Match and/or PainReliefMatch.com to use such feedback. In addition, any feedback received through the Site will be deemed to include a royalty-free, perpetual, irrevocable, transferable, non-exclusive right and license for Pain Relief Match and/or PainReliefMatch.com to adopt, publish, reproduce, disseminate, transmit, distribute, copy, use, create derivative works, and display (in whole or in part) worldwide, or act on such feedback without additional approval or consideration, in any form, media, or technology now known or later developed for the full term of any rights that may exist in such content, and you hereby waive any claim to the contrary.
Pain Relief Match does not participate in Medicare, Medicaid, or other government assisted programs and operates subject to state regulations; certain services may not be available in all states. Speaking with a Pain Relief Match provider is not a guarantee of receiving a diagnosis or prescription. Pain Relief Match participating providers will not write prescriptions for controlled substances and reserve the right to deny care when medically appropriate or due to lack of patient information. Should the doctor find it medically appropriate to issue you a prescription, you have the choice to have the prescription fulfilled by a pharmacy of your choosing, or, we would be happy to provide a mail order option.
Telehealth is the use of electronic communications to enable physicians at different locations to share individual customer health information for the purpose of improving customer/patient care. Customer health information may be used for diagnosis, treatment, follow-up and/or education, and may include any combination of the following: (1) medical records; (2) medical images; (3) live two-way audio or video; and (4) output data from medical devices and sound and video files. Telehealth services include remote monitoring, consultations, and prescription orders and refills, among other things.
The Physicians who will provide telehealth services to you are board-certified, licensed physicians, and are licensed in the state where you reside. Pain Relief Match provides administrative services, such as handling intake and maintaining electronic medical records, to these physicians. This Consent is provided to help you better understand how Pain Relief Match supplies you access to telehealth consultation services, the role of the physicians, and your responsibility for your decision to seek telehealth services. Pain Relief Match will document your verbal consent as part of your electronic medical record.
Pain Relief Match ’s electronic systems incorporate network and software security protocols (e.g., encrypting data) to protect the confidentiality of your health information, identifying information and any images, as well as measures to safeguard the data and to ensure its integrity against corruption.
Primary responsibility for your medical care and medical record should remain with your primary care doctor, if you have one. Pain Relief Match will provide information about your telehealth consultation(s) to your personal doctor or other healthcare providers upon your written authorization.
As explained in this Consent, there are both benefits and risks in receiving telehealth services or taking any prescribed medications.
I represent that the following has been explained to me:
Texas: I may file a complaint with the Texas Board of Medicine regarding the telehealth services that I receive from the physician(s). I can submit the complaint electronically (Online Complaint Form), by mail (Complaint Form), or by phone (1-800-201-9353), in accordance with the Texas Board of Medicine’s instructions available on the Texas Board of Medicine’s website: http://www.tmb.state.tx.us/page/place-a-complaint.
Nevada (DOs only). The Pain Relief Match physician(s) who provide telehealth services to me do not have a financial interest in Pain Relief Match or Pain Relief Match ’s website/portal I understand the information provided above, have discussed it with the Pain Relief Match nurse advocate, and all of my questions have been answered to my satisfaction. I hereby give my informed consent for the use of telehealth in my medical care.
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