Medical Consent & Authorization

Please review the following consent forms carefully

Authorization to Use & Disclose Medical Information

Last updated: April 29, 2025

By clicking "I Agree," checking a box, or otherwise affirming this consent, you acknowledge that you've read and agree to:

Allow MetabolixMD ("we," "us," "our") and affiliates to use or disclose your Protected Health Information (PHI) to:

  • Provide disease‑management information and support.
  • Notify you about offers from pharmaceutical companies or other relevant services.
  • Share PHI with manufacturers to support patient‑assistance programs (e.g., copay aid, coverage verification, adherence services, educational support).
  • Provide educational/promotional materials related to pharmaceuticals.
  • Administer federal 340B program requirements when applicable.

Disclose PHI to:

  • Pharmaceutical manufacturers, their affiliates, agents, and representatives.
  • Service providers handling program administration, data aggregation, analysis, or de-identification.
  • Your health insurer(s).

Understand that PHI may include your full medical record, mental health, substance‑use, genetic data, etc.

Acknowledge that we may receive compensation from third parties (e.g., manufacturers) for communications made under this authorization.

Understand your right to revoke this authorization anytime by emailing contact@metabolixmdindia.com, except for disclosures already made under this consent.

Be aware that once disclosed, PHI may be re-disclosed by recipients and may lose legal protection under applicable Indian data protection laws.

Know you are not required to sign—refusal won't affect your ability to receive treatment or services.

Have the right to request a copy of this Authorization.

Consent that this Authorization expires one year from signing or as allowed by applicable Indian laws.

MetabolixMD Informed Consent for Telehealth

By clicking "I Agree" or otherwise proceeding, you consent to telehealth services from licensed healthcare or mental-health professionals through MetabolixMD.

What is Telehealth?

Remote delivery of care and education via video, audio, secure messaging, electronic document exchange, or device data transmission.

Benefits

  • Convenient access from home
  • Flexible scheduling
  • Avoids need for in-office visits

Risks

  • Technology may malfunction or impair diagnosis
  • Remote care lacks physical examination capabilities
  • Connectivity issues could delay treatment or lead to misdiagnosis
  • Electronic privacy cannot be 100% guaranteed
  • Some prescriptions may be limited by regulations
  • Lab kits (if used) may produce false or inconclusive results

Emergencies & Urgent Care

Don't use this service for emergencies.

For life-threatening situations (e.g., suicidal thoughts), call 108 (Emergency Services), 102 (Ambulance), or contact your local emergency services immediately.

For mental health crises, you can contact:

  • Vandrevala Foundation Helpline: 1860-2662-345 or 1800-2333-330
  • iCall: 022-25521111 (available Monday to Saturday, 8 AM to 10 PM)
  • Kiran Mental Health Rehabilitation Helpline: 1800-599-0019

If urgent in-person care is needed, go to an emergency department or urgent care clinic.

Telehealth providers may not respond immediately; do not rely on this service in an emergency.

For tech issues/questions, email contact@metabolixmdindia.com.

Privacy & Security

We use software and network safeguards to protect your PHI in accordance with the Digital Personal Data Protection Act, 2023 and other applicable Indian data protection laws.

Email and messaging may not be fully secure—no guarantee of privacy.

Disclosures without consent may occur as legally required (e.g., threats to safety, reporting abuse).

Third-party lab tests are provided "as-is"—we do not guarantee their accuracy.

Your Acknowledgments

  • Telehealth consultations may be delivered by physicians, nurse practitioners, physician assistants, or licensed therapists registered with the Medical Council of India or respective State Medical Councils.
  • Technology may still be in development/beta and subject to glitches.
  • You're responsible for providing complete and accurate medical information.
  • Sessions will not be recorded unless explicitly stated otherwise.
  • You can withdraw consent at any time via email; this won't affect care already delivered.
  • Telehealth may not suit every condition—alternative care may be needed.
  • You are financially responsible for all telehealth-related costs—even if seeking insurance reimbursement.
  • You may fill prescriptions via our pharmacy partners or any pharmacy you choose.
  • If you have concerns about a provider, you may contact the Medical Council of India or the appropriate State Medical Council in your state.