Last updated: April 2024

This describes TravelRite Medications treatment and payment policies and includes:

1. Your consent to receive medical treatment from contracted professional health care providers (and your other rights and responsibilities);

2. Your agreement to receive services using telehealth technology; and Your agreement to pay in full any charges that are your responsibility.

3. Your agreement to use the prescribed medications only in the event of an emergency and under the guidance of a qualified healthcare professional.

TravelRite Medications Virtual Healthcare

By using the TravelRite Medications virtual visit option, I agree to receive telehealth services. Telehealth involves the delivery of health care services, including assessment, treatment, diagnosis, and education, using interactive digital communications. During my visit, my TravelRite Medications provider and I will be able to communicate with each other from remote locations.

I understand and agree that:

1. I will not be in the same location or room as my medical provider.

2. My TravelRite Medications contracted provider is licensed in the state in which I am receiving services.

3. I will report my location accurately during registration.

Potential risks of telehealth include: (i) limited or no availability of diagnostic laboratory, x-ray, EKG, and other testing, and some prescriptions, to assist my medical provider in diagnosis and treatment; (ii) my provider’s inability to conduct a hands-on physical examination of me and my condition; and (iii) delays in evaluation and treatment due to technical difficulties or interruptions, distortion of diagnostic images or specimens resulting from electronic transmission issues, unauthorized access to my information, or loss of information due to technical failures.

I will not hold TravelRite Medications or its nurse practitioner responsible for lost information due to technological failures.

I consent to the use of potential non-secure forms of communication that may contain sensitive health data.

I further understand that my provider’s advice, recommendations, and/or decisions may be based on factors not within her control, including incomplete or inaccurate data provided by me.

I understand that my provider relies on information provided by me before and during our telehealth encounter and that I must provide information about my medical history, condition(s), and current or previous medical care that is complete and accurate to the best of my ability.

I may discuss these risks and benefits with the provider and will be allowed to ask questions about the virtual visits.

I have the right to withdraw this consent to telehealth services or end the telehealth session at any time without affecting my right to present or future treatment by TravelRite Medications or its healthcare provider.

I understand that the level of care provided by my TravelRite Medications contracted provider is to be the same level of care that is available to me through an in-person medical visit. However, if my provider believes I would be better served by face-to-face services or another form of care, I will be referred to the nearest medical center, hospital emergency department, or another appropriate healthcare provider.

In case of an emergency, I will dial 911 or go directly to the nearest hospital emergency room.

I consent to, understand, and agree that: I have the right to discuss the risks and benefits of all procedures and courses of treatment proposed by my healthcare provider, together with any available alternatives.

The TravelRite Medications provider will provide care consistent with the prevailing standards of medical practice but make no assurances or guarantees as to the results of treatment.

My TravelRite Medications provider will not prescribe any controlled substances including opioids to me during a telehealth visit.

Emergency Use of Antibiotics

I agree if antibiotics or other medications are prescribed as a result of a virtual visit, that I will use said antibiotics or medications only in an emergency situation, after first seeking to secure the assistance of a qualified healthcare professional and determining that qualified healthcare assistance is not readily available.

Further, I will promptly inform the provider of any significant change in my health.

I understand and agree that these antibiotics and other medications should be stored properly and kept securely out of the reach or access of children.

Any questions relating to the use of antibiotics or medications should be directed to the nurse practitioner.

I have the right to review and receive copies of my medical records, including all information obtained during a telehealth interaction, subject to TravelRite Medications’s standard policies regarding request and receipt of medical records and applicable law.

The laws of the state where I am located will apply to my receipt of virtual services.

Payment Policy

I acknowledge, understand, and agree that:

1. I will pay at the time of service.

2. By providing my credit card information and receiving virtual health services, I (i) authorize TravelRite Medications to charge my credit card for any and all unpaid amounts that TravelRite Medications determines are my responsibility, and (ii) agree to pay all amounts charged pursuant to this consent and authorization in accordance with the issuing bank cardholder agreement.

3. I agree that TravelRite Medications may charge my credit card for such amounts at the end of my virtual health visit or at a later date.

4. I will be billed for all unpaid balances deemed by TravelRite Medications to be my responsibility and agree to pay such amounts in full.

5. Delinquent accounts may be turned over to a collection agency at which time I am responsible for a $40 collections charge and all associated legal fees in addition to the amount owed.

6. TravelRite Medications reserves the right to deny non-emergency services if my account is delinquent.

Disclosure of Conflict of Interest

I acknowledge that TravelRite Medications and its relevant physician-owners have disclosed to me the existence of a potential or actual conflict of interest, on the part of the physician-owner, arising out of the physician-owner’s economic and ownership interest in TravelRite Medications. I understand that this conflict of interest may compromise the independent professional judgment and recommendations of the provider-owner as the same relates to me, my treatment, and the issuing of any prescriptions on my behalf.