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Customer Patient Care Agreement

The following agreement is for customers/shoppers.  If you are a practitioner or merchant please see our other agreements.

Prescrypt Ltd. (“Prescrypt”, as follows “we” or “us”) reserves the right to amend the Policy at any time to account for changes in the Applicable Law, our practices, and the Prescrypt Platform. We post the current version of the Policy at www.prescrypt.ca/customers-privacy-policy. Please check to see if we have amended the Policy since you last used the Prescrypt Platform to ensure you are aware, and agree to our current privacy practices.
 

Patient Care Agreement, Release, and Indemnity Agreement

 

  1. Purpose, Safety, Accurate Information: The purpose of this contract is to maintain a safe, controlled assessment and authorization plan. The information I am providing to Prescrypt Ltd, or any Authorizing Healthcare Practitioner, and the associated physician or nurse practitioners (the “Authorizing Physician”), or delegate(s) of the Authorizing Physician is for assessment of my condition and possible authorization for the use of medical cannabis. I understand that any inaccurate or false information provided by me may adversely impact the Authorizing Physician’ ability to assess my suitability for the authorization of medical cannabis. I also understand that provision of false information by me may result in the revocation of any medical cannabis authorization given to me by the physician. for medical cannabis may be revoked.

 

  1. Last Resort, Compliance: I am asking for medical cannabis because other treatments and medications I have used have not provided enough relief from my symptoms and illness. It is unlikely that any medication will completely take away all of my symptoms, but for humane reasons, I understand that I may be authorized medical cannabis for the management of my condition or the relief of my symptoms if I follow the terms of this contract. If I do not, this will result in the discontinuation of my medical cannabis authorization and possible discharge from Prescrypt Inc. and its associated licensed producers and the Authorizing Physician.

 

  1. Not Primary Care: I understand and acknowledge that while the assessing physician or nurse practitioner may execute an authorization for me to use medical cannabis, the assessing physician or nurse practitioner will not serve as my primary care practitioner. As such I agree to seek regular medical care from my primary care physician or nurse practitioner and that the assessing physician or nurse practitioner will only deal with an assessment of his support or refusal for my medical cannabis use.

 

  1. Risks, Side Effects: (a) I understand that the risks, benefits and brain-body-drug interactions of cannabis are not fully understood. If I’m taking medication or undergoing treatment for any medical condition, I understand that I should consult with my primary care physician or nurse practitioner in connection with this medical cannabis authorization. I should also NOT discontinue any medication or treatment previously prescribed unless advised to do so by my primary care physician or nurse practitioner. (b) I also understand that the possible complications of medical cannabis use may include, but are not limited to the following: CHEMICAL DEPENDENCE (ADDICTION), DIFFICULTY WITH URINATION, DROWSINESS, NAUSEA, ITCHING, SLOWED RESPIRATION, REDUCED SEXUAL FUNCTION and IMPAIRED MOTOR FUNCTION. If I consume more medical cannabis than what is authorized, a dangerous situation could result, such as coma, organ damage, or even death. I understand that if I run out of my medical cannabis too soon, or if my medical cannabis is stopped suddenly, I could experience uncomfortable or dangerous withdrawal symptoms. If I experience any serious side effects after ingesting cannabis, I will report to the nearest hospital emergency department.

 

  1. Pregnancy, Conception: If I become pregnant, there are known and unknown risks to the unborn child, which include addiction and the possibility of the baby experiencing withdrawal at birth. Medical cannabis may also affect my reduced sperm count and motility and prevent me from conceiving with my partner. I am obligated to let my doctors know if I am pregnant, or thinking of conceiving.

 

  1. Exclusivity, No Medicine Replacement: During the period of the medical cannabis authorization obtained through Prescrypt Inc. and its associated licensed producers, I will NOT contact any physicians or other health care practitioners who are not associated with Prescrypt Inc. and its associated licensed producers and attempt to access medical cannabis. If I would like to access medical cannabis through a different Authorizing Physician, I acknowledge that I must contact Prescrypt Inc. and its associated licensed producers or the Authorizing Physician listed on my medical cannabis authorization and request a discontinuation of my authorization. If it is found that I have received another authorization for medical cannabis from a source other than Prescrypt Inc. and its associated licensed producers I will be discharged from Prescrypt Inc. and its associated licensed producers and any authorizations for medical cannabis will be discontinued. I agree to consume the medical cannabis exactly as authorized by the physician or nurse practitioner. I am NOT allowed to change dosage amounts or without consulting with the Authorizing Physician. I Agree that Prescrypt Inc. and its associated licensed producers will  NOT  replace  any  lost,  stolen,  or  inaccessible medical cannabis for any reason.

 

  1. Legal Duties, Renewal: I understand that it is my responsibility to stay informed regarding provincial, federal and local laws and regulations regarding the possession and use of medical cannabis. It is also my responsibility to ensure that a renewal appointment is made one month prior to the expiry of the current authorization. During my renewal, the Authorizing Physician will re-evaluate me for possible continuance of medical cannabis.

 

  1. Benefits Test: I understand that the benefits of my medical cannabis will be evaluated during renewal using the following criteria of symptom relief: (a) increase in general function; (b) increase in life activities; (c) reduction in pain or discomfort intensity levels; (d) absence of unacceptable side effects; and (e) ability to work and maintain a job.

 

  1. NO Illegal Drugs, Resale, or Hoarding: I agree to the following: (a) that I am NOT currently abusing illicit or prescription drugs and that I am not undergoing treatment for substance dependence or abuse; (b) that I have never been involved in the illegal sale, possession, or transport of drugs; and (c) That I will store all medical cannabis in a safe and secure manner away from children and I will not hoard, sell or give away my medical cannabis.

 

  1. Release: I hereby release the assessing physician or nurse practitioner, his/her clinic, my family physician, and any other involved physicians, delegate(s), administrative staff from any and all actions, claims, causes of actions, complaints and demands for damages, loss, or injury whatsoever arising, including by family, friends and representatives directly or indirectly as a consequence to my use of medical cannabis and/or my application to Prescrypt Inc. and its associated licensed producers and Health Canada to possess medical cannabis.

 

  1. Understanding of Contract Terms: I understand and agree to the terms of this contract. I certify that the information I will provide in the questionnaire or to any intake office is accurate and complete. If any part of this contract as outlined above is broken, I understand that it will result in my immediate discharge from Prescrypt Inc. and its associated licensed producers and discontinuation of all medical cannabis authorizations.

 

  1. Safety/Health Canada: I understand that Prescrypt Inc. and its associated licensed producers and the assessing physician(s)/nurse practitioner(s) have hereby advised me that using cannabis is prohibited while driving or performing hazardous tasks such as operating other vehicles and/or heavy machinery and that people in safety oriented occupations or supervising children should also be vigilant to avoid medicating inappropriately based on their responsibilities. Depending on dosage and administration, impairment can last over 24 hours following last usage.

 

  1. Patient Release, Acknowledgement, Indemnity: I understand that this Release and Acknowledgement contains IMPORTANT information about medical cannabis that the assessing physician requires that I acknowledge and understand before he/she may issue an authorization for use of medical cannabis. I further understand that the assessing physician or nurse practitioner will not be assuming care for me. He/She will, however, assess and evaluate the appropriateness of my request to use medical cannabis to assist in managing the conditions and associated symptoms that I believe; from my own personal experience, medical cannabis to be helpful in managing. I accordingly confirm that the assessing physician will be my medical practitioner for the sole purpose of medical cannabis authorization. I agree not to make any claim or commence any legal proceedings against the assessing physician, his/her practice, associated delegate(s), my family physician or any other involved physicians (such as specialists) in relation to: a) my use of medical cannabis; and b) my application or authorization for possessing, obtaining and using medical cannabis. I am well aware that physicians generally agree that medical cannabis may: distort my perception (sights, sounds, time, touch); impair my memory and learning; impair my coordination; impair my thinking and problem-solving; increase my heart rate and reduce blood flow; produce anxiety, fear, distrust, or panic. I am well aware there is a great lack of consensus among physicians about the appropriate medical use of cannabis; the appropriate dosage for medical cannabis; the risks of smoking medical cannabis as compared to vaporizing or ingesting medical cannabis;  the risks of smoking whole plant medical cannabis as compared to extracting the medicinally active cannabinoids and medicating with same; the long-term health and psychological risks associated with the use of medical cannabis;. the degree to which regular consumption of medical cannabis: (a) may contribute to pulmonary infections and respiratory cancer; (b) may damage the cells in the bronchial passages which protect the body against inhaled microorganisms and decrease the ability of the immune cells in the lungs to fight off fungi, bacteria, and tumor cells. For patients with already weakened immune systems, this means an increase in the possibility of dangerous pulmonary infections, including pneumonia; (c) may weaken various natural immune mechanisms, including macrophages and T-cells (d) may trigger attacks of mental illness, such as bipolar (manic-depressive) psychosis and schizophrenia. I am further well aware that the above listed medical concerns are further compounded by the lack of consistency and uniformity in available medical cannabis products. With conventional drug products I generally consume a medication of a precisely known molecular quantity. I recognize that raw plant medical cannabis does not work this way. I appreciate that I will get varying compositions of different cannabinoids and varying proportions of different cannabinoids from strain of plant to strain of plant and even, to a lesser degree, from plant to plant of the same strain. I further appreciate that there is a significant uncertainty regarding the consistency of the medical cannabis drug products I may medicate with which further complicates and compounds the practical issue of medicating with an inconsistent drug product like medical cannabis. I am further aware that ingesting a high dose of medical cannabis can cause nausea and disorientation. Despite all these medical concerns, debates and practical issues I honestly believe that for the management of my condition(s) and symptom(s) the benefits of medicating with medical cannabis outweigh the risks. This is my decision and I also do not support any claims made by my family, friends or other interested parties against Prescrypt Ltd, or amd Authorizing Healthcare Practitioner, assessing physicians or physicians' delegates. I hereby release the assessing physician/nurse practitioner, his/her clinic, my family physician, and any other involved physicians from any and all actions, claims, causes of actions, complaints (even by family and friends) and demands for damages, loss, or injury whatsoever arising directly or indirectly as a consequence to my use of medical cannabis and my application to Health Canada to possess medical cannabis. This release from liability is to be binding on heirs, executors and assigns. I also consent to the disclosure of my personal data by the assessing physician and his/her clinic to Health Canada. I understand and acknowledge that while the assessing physician may execute a declaration that I stand to potentially benefit from medical cannabis, the assessing physician will not serve as my primary care physician. As such I agree to seek regular medical care from my primary care physician/nurse practitioner and that the assessing physician/nurse practitioner will only deal with assessing his support for my medical cannabis use. I also consent to the assessing physician notifying any specialists who have seen of my decision to use medical cannabis and I accept any consequences of such notification. I agree to notify my primary care physician/nurse practitioner myself about any license I receive to use cannabis medicinally as cannabis can interact with other medications. If licensed, I agree not to resell any of my medication. I have been advised and understand that a Health Canada license may not prevent police charges nor prevent police and/or local government officials from entering and inspecting my home or place of growth. I agree to check with local bylaws in my area. I also agree that any legal actions will take place in Ontario and be governed by the laws of Ontario, Canada.

 

  1. Privacy Policy Prescrypt Inc. and its associated licensed producers, as well as any assessing physicians and physician(s)’ delegate(s) respect and value my privacy. Prescrypt Inc. and its associated licensed producers will collect, store or share information for the following purposes: (a) To carry out the normal operations of its business, perform a service for me, to coordinate my care, intake and medical cannabis authorization and to act upon my instructions. These uses may include but are not limited to discussing Prescrypt Inc. and its associated licensed producers 's services, or answering my queries, processing or administering my connection with or communicating with the Authorizing Physician and/or their Delegate(s) and maintaining proper records. This will serve as my consent and direction to Prescrypt Inc. and its associated licensed producers to share information, medical use reports and accounting, including without limitation the my Medical Document for Cannabis, as requested to comply with legal, regulatory or insurance requirements; and (b) to comply with the terms of purchase and sale of all or substantially all of Prescrypt Inc. and its associated licensed producers’s business wherein the new entity, owner or operator will assume the responsibilities and rights Prescrypt Inc. and its associated licensed producers has in respect of this information, and (c) to create and/or provide data in a discrete manner and to serve me or to analyze and improve Prescrypt Inc. and its associated licensed producers’s services. In all cases, Prescrypt Inc. and its associated licensed producers’s employees  are  kept  up  to  date  with  regard  to  the  privacy and  security  practices of Prescrypt Inc. and its associated licensed producers and the Authorizing Physician.

 

By initializing and / or signing this document, I affirm that all of the information in this medical cannabis contract is true and I agree and consent to all of the AGREEMENTS, ACKNOWLEDGEMENTS, and terms hereof.

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