DrCannabisConsult.com INC. Terms and Agreement of Information, Releases and Privacy Policies.
By Checking the box associated with this document, you acknowledge that you have been informed of and understand the following:
Drcannabisconsult.com (Inc.) is a consulting company.
Our Patient Care Coordinators arrange doctor appointments for patients seeking medicinal cannabis for their documented ailments in which traditional medications may have failed and or the patient may have experienced some sort of side effect and wishes to consult with an experienced doctor in this field to discuss his or her options as a candidate for medicinal cannabis use with the option to grow his or her medicine as per Health Canada’s announcement allowing patients to do so under the ACMPR.
Drcannabisconsult.com (Inc.) will consult with patient’s as to the medical documentation required for the doctor as per the doctor’s request prior to arranging the patient’s appointment.
If, and when the patient will be approved by the doctor for medicinal cannabis use drcannabisconsult.com (Inc.) will see that the patient will receive the original medical document from the prescribing doctor.
The patient is responsible to register with Health Canada by sending the original medical document along with the proper forms set forth by Health Canada for the ACMPR.
The patient hereby acknowledges drcannabisconsult.com (Inc.) and the doctor issuing the medical document WILL NOT be sending any information to Health Canada on behalf of the patient. It is the patient’s responsibility to do so.
Drcannabisconsult.com and the doctor issuing the medical document are in no way responsible for the outcome of the patient’s registration of the ACMPR with Health Canada.
The patient has been informed that the medical document is an original medical document from the prescribing doctor that the patient had their scheduled appointment with.
There will be one copy of the medical document made which will have the word COPY in the form of a stamp. This is for the patient’s file only; no other copy will be made nor is it allowed and or permitted.
If a duplicate of the medical document is made other then as specified above, an investigation may take place and legal measures may and or will apply to whom would be the responsible individual in making any such copy / copies other than specified above.
I have read the above information and agree to abide by all as written above and as per Health Canada and or the Federal Government set legal rulings pertaining to the ACMPR
I understand that the information I have been asked to provide to drcannabisconsult.com and/or associated physicians is for the diagnosis and treatment of the medical condition(s) for which I want to access medical marijuana.
I understand that if I have not accurately and completely disclosed the requested information, it may adversely impact the physician’s ability to diagnose my condition and recommend appropriate medical marijuana treatment.
I certify that the information in this questionnaire is accurate and complete.
Privacy Policy
We at drcannabisconsult.com respect and value your privacy. When you submit information to us, this privacy policy is part of our agreement. We may collect, use, retain or disclose information about you only for these legitimate purposes:
• To carry out the normal operations of our business. These may include answering your queries, processing your connection with a patient or Licensed Producer and maintaining proper tax and accounting records;
• To send you information about our services, unless you advise us not to;
• To carry out any other activity which has your consent;
• To comply with legal requirements or so that we can respond to any complaints or claims against us.
When trusted third parties (such as our accountants or a delivery companies) are performing a service for us or for you, we may provide them with our information about you only to the extent they need it to perform that service. We will not sell or lease information about you, with these exceptions:
• If we reorganize our company (ies), or sell or lease our business, the new entity, owner or operator will assume any rights we have in respect of our information about you. We would obtain reasonable assurances that your privacy would continue to be respected;
• We may create and provide data that is in a form that does not permit you to be identified.
Who has Access to Information Collected?
Who has access to personal information collected by drcannabisconsult.com? We strictly control access to your personal information to our employees who need this information in order to serve you or to employees who analyze our performance in order to measure and improve our services. Employees are kept up: to date with regards to the privacy and security practices of drcannabisconsult.com
We reserve the right to co: operate with local, provincial and national officials in any investigation requiring either personal information including any personal information provided online through drcannabisconsult.com or reports about lawful and unlawful user activities on the Web site.
If you ask us, we will remove any information about you from our files, unless some legitimate purpose makes its reasonable for us to retain it for some additional time. We will also review our files from time to time with a view to identifying and deleting stale information.
INFORMED CONSENT
1. Drcannabisconsult.com nor the physicians, the clinic staff, and/or clinic representatives are neither providing nor dispensing medical marijuana.
2. Prior to your appointment, you are required to submit a copy of your most recent government issued photo ID, and or are verified with current photo ID which is proof that you are a citizen of this country.
3. The physician or clinic staff will NOT be providing or discussing information regarding any other way of obtaining medical marijuana other than from a Health Canada approved regulation, and/or a registered licensed producer.
4. The physician is evaluating you for the use of medical cannabis and will make his/her recommendation based in part, on the medical information you have provided. It is your responsibility to ensure that there is no misrepresentation of your medical information submitted for you to obtain a recommendation to use cannabis for your medical condition.
5. You agree to only use medical cannabis for the treatment of your medical condition as agreed upon by the physician and not for recreational or non-medical purposes.
6. The physician is addressing specific aspects of your medical care and, unless otherwise stated, is in no way establishing himself/herself as your primary care physician.
7. Should the physician approve you for the use of medical cannabis, it is your responsibility to ensure that a renewal appointment is made one month prior to your expiry date. During your renewal appointment the physician will re: evaluate possible continuance of cannabis.
8. You understand that it is your responsibility to stay informed regarding provincial and federal laws regarding the medicinal use, possession, sale/purchase and/or distribution of medical marijuana and or growing of medical marijuana for personal use as per your medical document issued by a registered health care provider/physician.
9. Health Canada, the physician and drcannabisconsult.com staff advise you that using cannabis is prohibited while driving or performing hazardous tasks such as operating heavy machinery. The same applies to safety: sensitive occupations such as health professionals and the supervision of children. Depending on dosage and administration, impairment can last over 24 hours following last usage.
11. The potential side effects from the use of marijuana include, but are not limited to the following; dizziness, anxiety, confusion, sedation, low blood pressure, impairment of short: term memory, euphoria, difficulty in completing complex tasks, suppression of the body’s immune system, inability to concentrate, impaired motor skills, paranoia, psychotic symptoms, general apathy, depression and/or restlessness.
12. Marijuana may exacerbate schizophrenia in persons predisposed to the disorder.
13. Marijuana use may also cause excessive talking and eating, alter your perception of time and space and impair your judgment.
14. You understand that using marijuana while under the influence of alcohol is not recommended. Additional side effects may become present when using both alcohol and marijuana.
15. Smoking marijuana may cause respiratory problems and harm, including; bronchitis, emphysema and laryngitis. In the opinion of many researchers, marijuana smoke contains known carcinogens (chemicals that cause cancer) and smoking marijuana may increase the risk of respiratory diseases and cancers in the lung, mouth and tongue. In addition, marijuana smoke contains harmful chemicals known as tars. If you begin to experience respiratory problems when using marijuana, you agree to stop using it and report your symptoms to a physician.
16. The physician and/or drcannabisconsult.com have informed you of alternatives to smoking marijuana.
17. The risk, benefits and drug interactions of marijuana are not fully understood. If you are taking medication or undergoing treatment for any medical condition, you understand that you should consult with your primary care physician(s) before you take marijuana in any form and that you should not discontinue any medication or treatment previously prescribed unless advised to do so by your primary care physician.
18. Individuals may develop a tolerance to and/or dependence on marijuana. If you develop signs of withdrawal, which can include; feelings of depression, sadness, irritability, insomnia, restlessness, agitation, loss of appetite, trouble concentrating, sleep disturbances, and unusual tiredness, contact the doctor as well your licensed producer with whom you have registered with for your medical marijuana.
19. Symptoms of marijuana overdose include but are not limited to; nausea, vomiting, hacking cough, disturbance in heart rhythm, numbness in hands, feet, arms or legs, anxiety attacks and incapacitation. If you experience these symptoms, you agree to contact your primary care physician, call 911 or go to the nearest emergency room.
20. If drcannabisconsult.com and the doctor of recommendation by drcannabisconsult.com subsequently learns that the information you have furnished is false or misleading, the recommendation by the physician for marijuana may be revoked. You agree to contact drcannabisconsult.com / the medical patient coordinator and provide additional information required in the event of any inaccuracies or misstatements in the information you have provided.
21. If you do not understand any of the above, you agree to contact the medical patient coordinator at
drcannabisconsult.com for clarification.
22. drcannabisconsult.com is a private medical patient coordinator service that charges a fee for services. For an updated fee structure, please contact our medical patient coordinator. Our service has a 48-hour cancellation policy. Failure to cancel your appointment or provide full payment within the 48-hours will result in a $200.00 processing fee. To cancel an appointment, send a response by email, phone message, or speaking with one of our Patient Care Coordinators. Cancellations on weekends or holidays will not be accepted.
23. This is a medical service connecting you with a medical doctor registered with the College of Physicians and Surgeons and licensed producers registered with Health Canada. If you are a patient wishing to grow your own medicine or wish to have a designated grower, as per Health Canada regulations, drcannabisonsult.com will NOT send any forms on your behalf to Health Canada. The patient will be responsible to fill out any and or all forms required as per Health Canada regulations, policies and or guidelines.
24. We assist in all your paperwork for registration with a registered Licensed Producer of the patient’s choice. We will send medical information to the doctor -book your doctor appointment – inform you of the licensed producers registered with Health Canada if need be. We cross check, verify all information and follow up with both patient and Licensed Producer to which the patient will be registered with.
25. A patient that has made the decision to grow their medicinal cannabis agrees to abide by all legal rulings, regulations both Federal and Provincial laws as per Health Canada guidelines and policies in which the patient takes full responsibility in all paperwork submissions to Health Canada.
26. Drcannabisconsult.com agrees to send the original medical document to the patient wishing to grow their own medicine and/or wish to have a designated grower to do so as per the legal rulings pertaining to AMCRP with Health Canada. The original medical document will be sent via secure courier service. This is required for the patient’s submission to Health Canada in which the patient agrees to file all the paperwork required by Health Canada, drcannabisconsult.com is in no way liable and/or responsible in any way for the submission of any paperwork for a patient pertaining to AMCRP with Health Canada.
**DO NOT DRIVE AND OR OPERATE ANY MACHINERY WHEN CONSUMING YOUR MEDICAL CANNABIS KEEP ALL MEDICAL CANNABIS IN A SAFE PLACE AND OUT OF THE REACH OF CHILDREN AS WELL OUT OF REACH FROM PETS AND ANIMALS**
Doctor Consent and Terms for the Release of Information
By Checking the box associated with this document, you acknowledge that you have been informed of and understand the following:
*Because we take our responsibilities to authorize and supervise the medical use of marijuana very seriously, we ask you to read, understand and agree to the following Doctor consents.
1. I request a DrCannabisConsult.com INC. affiliated MD, to sign a medical document for me under the Health Canada ACMPR legislation, so that I may legally use marijuana to treat my medical condition.
2. I agree to receive a medical document for marijuana only from one physician, who is affiliated with DrCannabisConsult.com INC.
3. I agree to consume no more marijuana than the doses authorized for me by the affiliated doctor at DrCannabisConsult.com INC. I will not request a refill before the agreed upon refill date.
4. I agree to not distribute my marijuana to any other person, for personal use or for sale. I am aware that redistribution of any marijuana for sale is an illegal activity.
5. I am aware that using marijuana is associated with psychosis in persons who are still undergoing neurodevelopment (brain growth). Therefore, I will ensure that no person under the age of 25 years has access to my marijuana.
6. I agree to the safe storage of my marijuana
7. I am aware that taking marijuana with other substances, especially sedating substances, may cause harm and possibly even death. I will not use illegal drugs (eg. Cocaine, heroin) or controlled substances (eg. Narcotics, stimulants, anxiety pills) that were not prescribed for me.
8. I will not use controlled substances that were prescribed by another doctor unless your DrCannabisConsult.com INC MD, is aware of this.
9. I agree to testing (eg. Urine drug screening) when and as requested by my physician.
10. I agree to have an office visit and medical assessment at least every Six months.
11. I understand that Health Canada has provided access to marijuana by signed medical document from a physician for the treatment of certain medical conditions, but despite this, Health Canada has not approved marijuana as a registered medication in Canada
12. I understand that my physician may not be knowledgeable about all of the risks associated with the use of a non-Health Canada approved substance like marijuana.
13. I agree to communicate with my DrCannabisConsult.com INC. MD, any experiences of altered mental status or possible medical side effects of the use of marijuana.
14. I accept full responsibility for any, and all risks associated with the use of marijuana, including theft, altered mental status, and side effects.
15. I am aware that marijuana use is not advisable during pregnancy and breastfeeding. I agree to inform my DrCannabisConsult.com INC. MD, if I am pregnant.
16. I am aware that smoking any substances can cause harm and medical complications to my breathing and respiratory status. I will avoid smoking marijuana. I will avoid mixing marijuana with tobacco. I agree to use my marijuana only by vaporizer or as an edible product.
17. I am aware that my physician may discontinue authorizing marijuana for my condition if he or she assesses that the medical or mental health rick or side effects are too high.
18. I agree to see specialists or therapists about my condition at my physician’s request.
19. I agree to avoid driving a vehicle or operating heavy machinery for at least 4 hours after the use of marijuana, and for longer if I feel any persistent negative effects on my ability to drive.
20. As per the Health Canada ACMPR legislation, I agree to purchase my marijuana only from a licensed producer. I am aware that possession of marijuana from other sources is illegal.
21. I am aware that any possible criminal activity related to my marijuana use may be investigated by legal authorities and criminal charges may be laid. During an investigation, legal authorities have the right to access my medical information with a warrant.
22. Following the terms of this contract is one of the conditions I must meet to access marijuana for treatment. I understand that if I violate any of this agreement’s terms, my physician may stop authorizing my use of cannabis.
23. My, DrCannabisConsult.com INC. MD has the right to discuss my health care issues with other health care professionals or family members if it if felt, on balance, that my safety outweighs my right to confidentiality.
24.The DrCannabisConsult.com INC. physician has ordered to communicate using the following means of electronic communication (The services)
Videoconferencing – (Skype – Facetime)
PATIENT ACKNOWLEDGMENT AND AGREEMENT
I acknowledge that I have read and fully understand the risks, limitations, conditions of use, and instructions for use of the selected electronic communication services more fully described in the Appendix to this consent form. I understand and accept the risk outlined in the Appendix to this consent form, associated with the use of the services in communications with the physician and physician’s staff. I consent to the conditions and will follow the instructions outlined in the Appendix as well any other conditions that the physician may impose on the communications with patients using the services.
I acknowledge and understand and that despite recommendations that encryption software be used as a security mechanism for electronic communications, it is possible that communications with physician or the physician’s staff using the services may not be encrypted. Despite this, I agree to communicate with the physician or the physician’s staff using these services with the full understanding of the risk.
I acknowledge that either I or the physician mat, at any time withdraw the option of communication electronically through services upon providing written notice. Any questions I had, have been answered by Drcannabisconsult.com INC..