General Treatment Consent
OVERVIEW OF CONSENT
At EMC Clinic, we value our patient’s health needs. We believe in the work we do, and the health outcomes we provide. As our patient, we want you to feel, see and celebrate the benefits of your treatment.
This consent form holds dual importance, both for us to understand your needs, and for you to understand what we provide. We have designed this document to empower you with essential information, enabling you to make informed decisions about your care. Our intention is to outline the patient journey and provide clarity on what you can expect from us. Please ensure you understand the following and discuss it further with our team if required.
PATIENT DECLARATION AND CONSENT
I, the patient and/or legal guardian, acknowledge that EMC Clinic refers to Australani Health Pty Ltd, Australani Pty Ltd, and all its agents and subsidiaries, and this consent form covers all staff and entities, now and in the future. Australani has provided me with all the necessary information, or I will ask for more information as needed, allowing me to make an informed decision. I will attentively follow the guidance of my EMC Clinic doctors and team regarding advice, treatments, dosage, and frequency. I am aware of potential risks, possible side effects, and complications associated with medical treatment. I acknowledge there are possible unlisted or unknown adverse effects. I understand that any provided therapy may not provide the desired relief for my medical condition or symptoms. I confirm that I have received and reviewed or will request comprehensive information about my therapies and treatments, or will request further information until I am satisfied, and I wholeheartedly consent to the therapies I use. Moreover, I am aware that I can request further information at any time, and I can choose to stop treatment or therapy at any point.
I consent to the sharing of my personal information with healthcare professionals, regulatory bodies such as the TGA, or affiliates for purposes related to treatment, applications, compliance, and overall care. I grant permission for my personal information to be collected, used, and disclosed as described above, including contact through SMS, email, application or my mobile phone number. I understand that only relevant personal information will be shared for the aforementioned actions, and I am free to withdraw, modify, or restrict my consent by notifying EMC Clinic in writing/email.
I understand that it is solely my responsibility to comply with all state and federal laws, safety guidelines, and regulations concerning prescriptions, medications and treatments. EMC Clinic assumes no liability or claims for the misuse of prescription, dispensing, compounding, or administration of prescribed products.
I acknowledge that all costs associated with accessing, purchasing, using, and other related expenses of my treatments are my personal responsibility. I understand that it is illegal to share, sell, lend, or trade prescriptions or medicines (including medicinal cannabis), or in any way provide it to another individual.
Additionally, I understand that my EMC Clinic doctor, and pharmacist may cooperate with the police and government authorities to investigate any alleged misuse of my prescription. I understand and agree that EMC Clinic may discharge me or refuse treatment at any time based on EMC Clinic's assessment.
I understand and fully comprehend that it is an offense, under section 79(2AA) of the Transport Operations (Road Use Management) Act 1995 (Qld), or equivalent State or Territory legislation, to drive, attempt to operate, or be in control of a motor vehicle, tram, train, or vessel while having delta-9-tetrahydrocannabinol (THC), opiates, benzodiazepines and other restricted medications present in my blood or saliva depending on the state or territory. I acknowledge that I must refrain from driving or operating heavy machinery while under the influence of THC, opiates, benzodiazepines and other scheduled medications, as doing so would likely be in violation of the law. Furthermore, I understand that possessing a legally issued prescription does not provide a defense for such an offense depending on the state or territory, and it is my responsibility to know and comply with the state or territory laws at that time. I take responsibility for staying up to date with state or territory laws on driving and use of the medications I take. I agree that there are possible risks and possible adverse effects from all prescribed medicines, treatments, and therapies, regardless of their registration or approval status. I agree that EMC Clinic and its agent may consult with me and/or the patient in person or via telehealth options, and bill Medicare or the payer in line with EMC Clinic Policies, and Terms and Conditions. I consent that EMC Clinic and/or its agent may financially benefit from my consultation and/or treatment, or otherwise be a beneficial owner of EMC Clinic, its agent or a company involved in my consultation and/or treatment. I fully agree to adhere to all Terms and Conditions, as well as EMC Clinic Policies. These documents can be accessed online at any time on the EMC Clinic web page: https://www.EMCClinic.com.au
PATIENT RESPONSIBILITIES
It is your responsibility as the Patient to disclose your medical history fully. As part of your commitment to your patient journey, you must declare if you have any current or previous medical conditions. For all patients, especially for medicinal cannabis treatment, you must disclose the contra-indications of:
● Known or suspected personal history of schizophrenia or psychotic illness.
● Known or suspected family history of schizophrenia or psychotic illness.
● Known or suspected personal history of any mental health disorder.
● Known or suspected severe or unstable cardio-pulmonary disease.
● Hypersensitivity to cannabinoids or any type of excipients.
● Substance addiction or the intentional use of drugs for non-medicinal purposes.
As part of your commitment to your treatment, you are required to:
1. Have regular reviews with your EMC Clinic doctor and follow directives as given.
2. Carefully follow our advice on dosage and frequency of your prescriptions.
3. Avoid alcohol, intoxicants, or recreational drugs that will interact with your treatment.
4. Inform your EMC Clinic doctor of any new medications or supplements you begin taking whilst receiving treatment from EMC Clinic or its agents.
5. Inform us if your medication or treatment does not work for your condition or symptoms.
6. Report if you suffer any adverse event, side-effect or reactions.
7. Comply with any laws relating to the operation of any vehicle; boat; aircraft; machinery; or other regarding the use of restricted medications, especially THC, medicinal cannabis, opiates or benzodiazepines in blood, serum, saliva, or other levels. You further agree that it is your responsibility to ensure you operate vehicles and machinery according to the applicable laws.
8. Adhere to EMC Clinic's “zero-tolerance” policy for hostile, abusive or unreasonable conduct towards any member of our team and accept that we reserve the right to refuse service or discharge you as a patient if you breach this policy.
RISKS & POSSIBLE SIDE EFFECTS OF OFF LICENSE MEDICATION PRESCRIPTION OR UNAPPROVED/EXPERIMENTAL MEDICINES INCLUDING MEDICINAL CANNABIS
You understand and acknowledge that:
1. Some medications are considered unapproved, experimental drugs, or in many cases used off-license for a different purpose than registered with the TGA, and as such, the data from which to draw specific recommendations for treatment is limited. For more information you can visit: www.tga.gov.au.
2. Medicinal cannabis is considered an unapproved, experimental drug, and in many cases, the data from which to draw specific recommendations for treatment is limited. For more information you can visit: www.tga.gov.au/medicinal-cannabis-guidance-documents.
3. Most medicinal cannabis medications and some other medications are not registered in Australia for use by the Therapeutic Goods Administration (TGA) and arrangements to access medicinal cannabis medicine are to be made through a Special Access Scheme (SAS) pathway.
4. Benefits and harms of unapproved medications including medicinal cannabis in children, pregnant women and breast-feeding mothers are not well investigated and EMC Clinic and associates are not liable for any damages or claims relating directly or indirectly from medicinal cannabis use in these groups. EMC Clinic does not recommend use of unapproved medications or medicinal cannabis in these groups of patients unless as part of an informed patient and clinical team decision.
5. Medicinal cannabis and other medication use with vaporisers or other non-oral or irregular modes of use may cause known or unknown side effects.
6. You waive and disclaim any rights against EMC Clinic for any side-effects, adverse effects, and unknown risks involved in taking treatments, therapies, unapproved medications or medicinal cannabis. You limit any possible claim against EMC Clinic or its agents to any fees paid to EMC Clinic for services. You warrant to pay EMC Clinic's costs for any claims in excess of this.
7. Possible known side-effects of medicinal cannabis compounds, principally with Tetrahydrocannabinol (THC), may include and are not limited to: nausea, light-headedness, uncontrolled laughter or euphoria, dry mouth, increased appetite, vomiting, relaxation, sedation, drowsiness, abnormal blood pressure, physical weakness, confusion, disorientation, dizziness, vertigo, coordination imbalance, memory changes, cognitive impairment, bowel changes, anxiety, hallucinations, paranoid thoughts, psychosis, mental disturbance, abnormal heart rate, lethargy, seizures, and chronic bronchitis (if inhaled). Other unlisted adverse effects are possible.
8. It is important to recognise that some medications and some forms of medicinal cannabis may impair cognitive function and the ability to drive safely, especially medicinal cannabis when containing THC or THC derivatives. EMC Clinic recommend discussing the use of products containing THC or its derivatives with your employer. Additionally, to ensure compliance with current driving legislation regarding medicinal cannabis, please check your local and state laws before starting any medicinal cannabis treatment. This general advice applies to all medications.
PATIENT ONBOARDING AND FEEDBACK
We do not share unnecessary data. We de-identify and encrypt your stored data, and we do need your consent as we onboard you. Thus, as a patient of EMC Clinic, you agree to contribute to our patient onboarding and feedback program for EMC Clinic users, and consent to your data being accessible, stored and used by EMC Clinic and our research departments. You also agree to: monitor your symptoms, progress and any other personal details relating to your treatment, and provide relevant feedback to your EMC Clinic doctor and other treating doctors, nurses and EMC Clinic staff, and to be contacted for further information as required.
CONSENT TO COMMUNICATIONS
We hate spam, however, we have to consent to contact you. You agree to receive text (SMS) messages, email or other communications from us regarding your treatment. These messages may relate to your use of our services, as well as other promotional messages. Your agreement to receive promotional texts is not a condition of any purchase or service. If you change or deactivate your phone number or other contact details, you must update your account information to help prevent us from inadvertently communicating with anyone who acquires your number or contact details. You understand that text messages, calls, or pre recorded messages may be generated by automated telephone systems.
You may opt out of receiving text messages and communications at any time by contacting us to deactivate these services. Note if you opt-out of receiving all text messages or communications from us, you may not be able to use certain services.