Please answer the following questions for weight loss therapy with One Body Medicine;
By booking the medical service, you accept and agree to the following:
No Guarantees: You understand that there are no guarantees or results of receiving the Medical Services.
Potential Risks: You understand that there are potential risks to any medical treatment that can be booked through this Platform. The Medical Groups and Providers will inform you of the potential risks and benefits of treatment so that you may make an informed decision about whether to proceed with care.
Consent to Telehealth: You consent to receiving a medical screening via Telehealth Services and understand that there are certain risks associated with receiving care through Telehealth Services as described below.
Complete Medical History: You understand that some treatments may be inappropriate and unsafe if you have certain health conditions or take certain medications or supplements, whether prescribed or over-the-counter. For this and other reasons, you understand that it is vital that you truthfully and accurately disclose all relevant health information to the Providers providing care to you through Medical Groups and notify them of any important changes. You understand that failure to do so may negatively affect my treatment outcome and the safety of any treatments you receive, and you understand that there shall be no liability on any Provider or Medical Group should you fail to do so.
Notice to All Female Clients Capable of Conceiving and Breastfeeding: Some treatments could present a risk during pregnancy and breastfeeding. Therefore, you agree that you will notify your Provider immediately if you are or suspect that you are pregnant, are planning to become pregnant, or if you are breastfeeding.
Consent to Telehealth Services
The purpose of this section is to inform you about Telehealth Services which may be provided by the Medical Groups.
Possible Risks of Telemedicine
◦Providers consulting with you via telehealth may not have the benefit of information that would be obtained by examining you in person and observing your physical condition. Information transmitted via telehealth technologies may not be sufficient (e.g. poor resolution of images) to allow for appropriate medical or health-care decision making by the Provider. The inability of your Provider(s) to conduct certain tests or assess vital signs in-person may in some cases prevent the Provider(s) from providing a diagnosis or treatment or from identifying the need for emergency medical care or treatment for you. To reduce the risk to you of this limitation, we strongly encourage you to provide all relevant information and discuss any and all diagnosis and treatment options with a health care provider.
◦Your Provider may not be able to provide medical treatment for your particular condition via telemedicine and you may be required to seek alternative care.
◦Delays in medical evaluation/treatment could occur due to failures of the technology.
◦A lack of access to your medical records may result in adverse drug interactions or allergic reactions or judgment errors.
◦Providers utilizing Telehealth Services may be limited by state law in prescribing certain medications to you without first conducting an in-person physical examination; and
◦Although the electronic systems we use incorporate network and software security protocols to protect the privacy and security of health information, those protocols could fail, and there could be a breach of privacy of your health information. Unfortunately, the transmission of information via the internet is not completely secure. Although we take commercially reasonable steps designed to protect your personal information, we cannot guarantee the security of your personal information transmitted to, or through, our Telehealth Services.
By using the Telehealth Services, you acknowledge and agree that you are aware of these limitations and agree to assume the risk of these limitations. Furthermore, you agree and accept that: (i) the Telehealth Services provided by Medical Groups are not intended in any case to replace a full medical evaluation or an in-person visit with a health care provider; (ii) a Provider providing Telehealth Services may not have important information that is usually obtained through a “hands-on” physical examination; and (iii) the absence of a physical examination may affect the health care provider’s ability to diagnose any potential condition, disease, or injury.
You acknowledge that it is your duty to inform any Provider you see of your medical history to ensure your Provider has your full clinical background when making treatment decisions. Providers reserve the right to deny treatment if they believe a patient may be better served by an in-person health care provider, or for any other reason according to their professional judgment. You understand that a variety of alternative methods of medical care may be available to you, and that you may decide to stop using Telehealth Services and choose one or more of these alternative modes of care at any time.
Further, you understand that it may be possible that your condition cannot be treated via the Telehealth Services, or that information transmitted through the Telehealth Services may not be sufficient or of too poor of image quality, or insufficient information or data to allow for appropriate medical decision making. Accordingly, a Provider may determine in his or her sole discretion that your condition is not suitable for treatment using telemedicine, and you may be required to seek additional in-person medical care, alternative healthcare or emergency services.
You understand that the laws that protect privacy and the confidentiality of medical information also apply to Telehealth Services. Please see the Notice of Privacy Practices which explains how Drip Hydration Medical Groups may use and disclose confidential health information for treatment, payment, and healthcare operations.
If you have any questions about this Patient Consent, hello@onebodymedicine.com
◦if you are allergic to semaglutide
◦if you have or have ever had pancreatitis (inflammation of the pancreas), diabetic retinopathy (damage to the eyes caused by diabetes), gallbladder disease, or kidney disease. Or if you have recently had diarrhea, nausea, or vomiting or if you cannot drink liquids by mouth, which may cause dehydration (loss of a large amount of body fluids).
◦if you plan to become pregnant. Your doctor may tell you to stop using semaglutide injection for 3 months before a planned pregnancy.
◦if you are pregnant or are breastfeeding. If you become pregnant while using semaglutide injection stop taking the medication and call your doctor.
◦you should know that your mental health may change in unexpected ways and you may become suicidal (thinking about harming or killing yourself or planning or trying to do so) while you are using semaglutide injection for weight loss. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: depression; talking or thinking about wanting to hurt yourself or end your life; withdrawing from friends and family; preoccupation with death and dying; or any other unusual changes in behavior or mood. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own.
◦If you are taking an oral birth control the medication may become less effective on semaglutide and alternative forms of birthcontrol are recommended.
◦Injection site redness/bruising/pain
◦Nausea, decrease appetite, diarrhea, vomiting, headache, constipation,
◦Nausea/Vomiting: Contact Clinic for anti-nausea prescription
◦Diarrhea:
◦Try Activated Charcoal or Imodium – Discontinue medication if continues
◦Constipation:
◦Try magnesium oxide (400 mg) OTC Supplementation at night with a large glass of water.
◦OR Stool Softener
◦Contact clinic if constipation continues.
◦Hypersensitivity reaction / Immune activation – Itching at injection site – Discontinue Therapy
◦Allergic reaction
◦Decreased blood sugar – feeling faint, sweating, pale, nauseated, or anxiety
◦This requires you to eat something to bring up your blood sugar levels to eat (juice/ sugar containing food)
◦Abdominal pain:
◦pancreatitis or gall bladder pain – discontinue medication, seek medical attention, and contact clinic.
◦Neck Swelling/difficult swallowing:
◦discontinue medication and contact clinic.
