CONSENT FOR TREATMENT

Effective Date: Jan 15, 2025

  1. Introduction

Thank you for choosing Reef Medical (“we,” “our,” or “us”) for your healthcare needs. This document serves as your agreement to receive medical services from us and outlines the terms under which those services will be provided. Please review this form carefully before signing.

  1. Consent for Services

2.1 General Consent

By signing this form, you voluntarily consent to receive cannabis consultation services from Reef Medical. These services may include, but are not limited to:

  • Medical Evaluations: Assessments by licensed healthcare professionals to determine your eligibility for medical marijuana use.
  • Consultations: Guidance and recommendations related to cannabis-based treatments.
  • Educational Support: Information on the safe and effective use of medical marijuana.

2.2 Scope of Services

Our cannabis consultation services are provided in accordance with Florida laws governing medical marijuana use. We focus on patient education and medical evaluations but do not dispense or sell medical cannabis.

  1. Informed Decision-Making

3.1 Right to Information

You have the right to:

  • Receive clear and understandable explanations about your diagnosis, treatment options, risks, benefits, and estimated costs.
  • Ask questions and discuss concerns with your healthcare provider before deciding on a course of action.

3.2 Right to Refuse or Withdraw Consent

You have the right to refuse or withdraw consent for any specific treatment or service at any time. You will be informed of any potential health risks or consequences associated with refusing or withdrawing treatment.

3.3 Advance Directives

If applicable, you may provide advance directives (e.g., living wills, healthcare surrogates) to guide your care in the event that you are unable to make decisions.

  1. Risks and Benefits

4.1 No Guarantee of Results

While we strive to provide the highest standard of care, no guarantees can be made regarding treatment outcomes.

4.2 Known Risks

Certain treatments or recommendations, including the use of medical cannabis, may have associated risks or side effects. These will be explained to you prior to proceeding with any evaluation or consultation.

4.3 Responsibility to Disclose Information

To ensure the safety and effectiveness of your treatment, it is your responsibility to inform us of:

  • Any allergies or adverse reactions.
  • Pre-existing medical conditions.
  • Current medications, supplements, or therapies.
  • Changes in your health status.
  1. Privacy and Confidentiality

5.1 Protection of Your Health Information

We are committed to protecting your personal health information (PHI) in compliance with the Health Insurance Portability and Accountability Act (HIPAA) and applicable Florida laws.

5.2 Use and Disclosure of PHI

Your PHI may be used for purposes such as:

  • Providing treatment.
  • Coordinating care with other healthcare providers.
  • Billing and compliance with legal or regulatory requirements.

5.3 Authorization for Additional Disclosures

We will obtain your written consent before sharing your PHI for any purpose not permitted by law.

  1. Financial Responsibility

6.1 Payment for Services

You are responsible for the cost of services provided by Reef Medical, including fees for evaluations, consultations, or other services. Payment is due at the time of service unless other arrangements are made in advance.

6.2 Insurance Coverage

The Company does not bill insurance companies for services. It is your responsibility to confirm coverage or seek reimbursement directly from your insurer if applicable.

  1. Grievance Process

If you have any concerns or complaints regarding the care you receive, you may file a grievance using the procedures outlined in the Patient Bill of Rights and Responsibilities, which has been provided to you.

  1. Acknowledgment and Acceptance

By signing below, you confirm that:

  1. You have read and understand this Consent for Treatment form.
  2. You voluntarily agree to receive services from Reef Medical.
  3. You understand your rights and responsibilities as a patient, including your ability to refuse or withdraw consent at any time.
  4. You acknowledge that the Patient Bill of Rights and Responsibilities has been provided to you and that you understand its contents.
  1. Contact Information

If you have any questions about this Consent for Treatment or wish to revoke your consent, please contact us at:

Reef Medical
1515 Herbert St, Suite 208
Port Orange, FL 32129
Phone: (386) 957-9300
Email: reefmedicalinfo@gmail.com