911 Covid Testing
Terms of Service & Electronic Signature Agreement
ELECTRONIC RECORD AND SIGNATURE DISCLOSURE
From time to time, 911 Covid Testing , its subsidiaries and its service providers (we, us or Company) may be required by law to provide to you certain written notices or disclosures. Described below are the terms and conditions for providing to you such notices and disclosures electronically through the 911 Covid Testing system. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to this Electronic Record and Signature Disclosure (ERSD), please confirm your agreement by selecting the check-box next to ‘I have read and accepted 911 Covid Testing Terms of Service’ before clicking ‘CONFIRM’ within the 911 Covid Testing system.
Getting paper copies
At any time, you may request from us a paper copy of any record provided or made available electronically to you by us. If you wish for us to send you paper copies of any such documents from our office to you, you will be charged a $0.20 per-page fee and prepaid postage fees. You may request delivery of such paper copies from us by following the procedure described below.
Withdrawing your consent
If you decide to receive notices and disclosures from us electronically, you may at any time change your mind and tell us that thereafter you want to receive required notices and disclosures only in paper format. How you must inform us of your decision to receive future notices and disclosure in paper format and withdraw your consent to receive notices and disclosures electronically is described below.
Consequences of changing your mind
If you elect to receive required notices and disclosures only in paper format, it will slow the speed at which we can complete certain steps in transactions with you and delivering services to you because we will need first to send the required notices or disclosures to you in paper format, and then wait until we receive back from you your acknowledgment of your receipt of such paper notices or disclosures. Further, you will no longer be able to use the 911 Covid Testing system to receive required notices and consents electronically from us or to sign electronic documents from us.
All notices and disclosures will be sent to you electronically unless you tell us otherwise in accordance with the procedures described herein, we will provide electronically to you through the 911 Covid Testing system all required notices, disclosures, authorizations, acknowledgments, and other documents that are required to be provided or made available to you during the course of our relationship with you. To reduce the chance of you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required notices and disclosures to you by the same method and to the same address that you have given us. Thus, you can receive all the disclosures and notices electronically or in paper format through the paper mail delivery system. If you do not agree with this process, please let us know as described below.
Please also see the paragraph immediately above that describes the consequences of your electing not to receive delivery of the notices and disclosures electronically from us.
How to contact 911 Covid Testing, and its subsidiaries:
You may contact us to let us know of your changes as to how we may contact you electronically, to request paper copies of certain information from us, and to withdraw your prior consent to receive notices and disclosures electronically as follows:
To contact us by email send messages to: [email protected] To let us know of a change in your email address where we should send notices and disclosures electronically to you, you must send an email message to us at [email protected] and in the body of such a request you must state: your previous email address, your new email address. We do not require any other information from you to change your email address. If you created a 911 Covid Testing account, you may update it with your new email address through your account preferences. To request paper copies from 911 Covid Testing and its subsidiaries.
To request delivery from us of paper copies of the notices and disclosures previously provided by us to you electronically, you must send us an email to [email protected] and in the body of such request you must state your email address, full name, mailing address, and telephone number. We will bill you for any fees at that time, if any.
To inform us that you no longer wish to receive future notices and disclosures in electronic format you may send us an email at [email protected] and in the body of such request you must state your email, full name, mailing address, and telephone number. We do not need any other information from you to withdraw consent. The consequences of your withdrawing consent for online documents will be that transactions may take a longer time to process.
Required hardware and software
The minimum system requirements for using the 911 Covid Testing system may change over time. The current system requirements are:
- On desktop devices: Google Chrome (latest version) or Mozilla Firefox (latest version) or Safari (Mac OS only) 6.2
- On mobile devices: Apple iOS 7.0 or Android 4.0
- Allow per session cookies
- Recommended screen resolution: 1024 x 768 or greater
- Acknowledging your access and consent to receive and sign documents electronically
To confirm to us that you can access this information electronically, which will be similar to other electronic notices and disclosures that we will provide to you, please confirm that you have read this ERSD, and (i) that you are able to print on paper or electronically save this ERSD for your future reference and access; or (ii) that you are able to email this ERSD to an email address where you will be able to print on paper or save it for your future reference and access. You consent to receiving notices and disclosures exclusively in electronic format as described herein, unless you specifically “unsubscribe” on the 911 Covid Testing system.
By selecting the check-box next to ‘I have read and accepted 911 Covid Testing Terms of Service’ , you confirm that:
You can access and read this Electronic Record and Signature Disclosure; and You can print on paper this Electronic Record and Signature Disclosure, or save or send this Electronic Record and Disclosure to a location where you can print it, for future reference and access; and Until or unless you notify 911 Covid Testing , its subsidiaries and its service providers as described above, you consent to receive exclusively through electronic means all notices, disclosures, authorizations, acknowledgments, and other documents that are required to be provided or made available to you by 911 Covid Testing , its subsidiaries and its service providers during the course of your relationship with 911 Covid Testing , its subsidiaries and its service providers.
I agree to use electronic records and signatures.
AUTHORIZATION FOR DISCLOSURE OF PROTECTED HEALTH INFORMATION
I hereby voluntarily authorize the disclosure of my protected health information, including any and all test results and vaccination records, provided by 911 Covid Testing , its subsidiaries and its service providers, to:
- Me via email, even though email is not a completely secure means of communication.
- Me via SMS, even though SMS is not a completely secure means of communication.
- My employer, company or educational institution who paid for the service.
- My healthcare professional.
I also understand and agree to the following:
- I may refuse to provide this authorization.
- I may revoke this authorization at any time in writing emailed to 911 Covid Testing and at [email protected], except to the extent that action has been taken in reliance on this authorization.
- If this authorization has not been revoked, it will terminate one year from the date of effectiveness below.
- I have a right to request and receive a copy of this authorization.
- Any information disclosed pursuant to this authorization may be subject to redisclosure by the recipient, and any redisclosure may not be subject to HIPAA.
This authorization is effective immediately upon clicking the check-box next to ‘I have read and accepted 911 Covid Testing Terms of Service’ within the 911 Covid Testing system.
I agree to the Authorization for Disclosure of Protected Health Information.
No Medical Advice
BY USING THE SERVICE, YOU ACKNOWLEDGE THAT 911 Covid Testing , its subsidiaries and its service providers IS PROVIDING THE MATERIALS FOR INFORMATIONAL PURPOSES ONLY AND THAT THE MATERIALS ARE NOT PROVIDED TO YOU FOR THE PURPOSE OF GIVING YOU MEDICAL ADVICE OR INSTRUCTION ON THE APPROPRIATE USE OF PRODUCTS OR SERVICES PRODUCED OR SUPPLIED BY 911 Covid Testing , its subsidiaries and its service providers, ITS AFFILIATES, OR ITS PARTNERS, LICENSORS, OR SUPPLIERS. YOU SHOULD NOT RELY ON THE MATERIALS IN THE SITE IN DECIDING ON A TREATMENT PLAN OR IN EVALUATING ANY OTHER MEDICAL ADVICE REGARDING ANY DISEASE OR MEDICAL CONDITION, AND 911 Covid Testing , its subsidiaries and its service providers, ITS AFFILIATES, AND ITS PARTNERS, LICENSORS AND SUPPLIERS STRONGLY URGE THAT YOU CONSULT WITH A PHYSICIAN IN CONNECTION WITH ANY AND ALL TREATMENT OPTIONS THAT MAY BE AVAILABLE TO YOU. THE PRODUCTS DESCRIBED ON THIS SITE ARE SUBJECT TO FEDERAL LAW GOVERNING THE USE AND SALE OF SUCH PRODUCTS, AND ARE NOT APPROVED FOR SALE OR CLINICAL USE IN THE UNITED STATES. NOTHING IN THIS SITE IS INTENDED TO CONSTITUTE A CLAIM OR INDICATION FOR CLINICAL USES OF THE PRODUCTS DESCRIBED. THE CLINICAL INDICATIONS AND RECOMMENDED USES OF THE PRODUCTS DESCRIBED ON THIS SITE ARE LIMITED SOLELY AND EXCLUSIVELY TO THOSE EXPRESSLY STATED IN THE INDICATIONS FOR USE FOR SUCH PRODUCTS AS APPROVED BY FEDERAL REGULATORY AUTHORITIES.
You agree to a $50 non-refundable charge if a cancellation occurs after an appointment has been selected, and or if you “No-Show”. To receive a refund for the any unused portion, you agree to send an email within 10 days to: [email protected]. You may elect to use the $50 cancellation fee towards any other service within 30 days of the original appointment. Requests after 10 days will no longer be refunded. Refunds take 5-10 days to process and be returned to your account from when the refund charge was initiated.
Third-Party Sites, Products and Services; Links
The Site may include links or references to other external websites or services solely as a convenience to Users (“Reference Sites”). Links on Reference Sites may lead to resources located on servers maintained by third parties over whom 911 Covid Testing has no control. 911 Covid Testing does not endorse any such Reference Sites or the information, materials, products, or services contained on or accessible through Reference Sites. ACCESS AND USE OF REFERENCE SITES, INCLUDING THE INFORMATION, MATERIALS, PRODUCTS, AND SERVICES ON OR AVAILABLE THROUGH REFERENCE SITES IS SOLELY AT YOUR OWN RISK.
Authorization and assignment of benefits to 911 Covid Testing
I hereby assign to 911 Covid Testing (911CT) any insurance or other third party benefits available for healthcare services provided to me. I understand that 911CT has the right to refuse or accept assignment of such benefits. If these benefits are not assigned to 911CT, I agree to forward to 911CT all health insurance and other third party payments that I receive for services rendered to me immediately upon receipt.
I hereby allow 911CT and any of their duly authorized agents and/or employees to endorse any and all checks, drafts or money orders which are made payable to the undersigned and or policy holder.
Disclaimers; No Warranties, No Medical Advice
- No Warranties. TO THE FULLEST EXTENT PERMISSIBLE PURSUANT TO APPLICABLE LAW, 911 Covid Testing AND ITS AFFILIATES, PARTNERS, LICENSORS, AND SUPPLIERS DISCLAIM ALL WARRANTIES, STATUTORY, EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, ANY IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NON-INFRINGEMENT OF THIRD-PARTY PROPRIETARY RIGHTS. NO ADVICE OR INFORMATION, WHETHER ORAL OR WRITTEN, OBTAINED BY YOU FROM 911 Covid Testing OR THROUGH THE SITE WILL CREATE ANY WARRANTY NOT EXPRESSLY STATED HEREIN. YOU EXPRESSLY ACKNOWLEDGE THAT AS USED IN THIS
- THE TERM 911 Covid Testing INCLUDES 911 Covid Testing’s OFFICERS, DIRECTORS, EMPLOYEES, SHAREHOLDERS, AGENTS, LICENSORS, AND SUBCONTRACTORS.
Effective Date, Date Last Modified:
This Policy is effective as of June 2021