TERMS OF SERVICE

M.A.M.A. Mom’s Advocate & Maternal Advisor, LLC

Effective January 1, 2021

WEBSITE TERMS OF SERVICE WITH INFORMED CONSENT

Welcome to the M.A.M.A. Mom’s Advocate & Maternal Advisor, LLC website www.mamabirthservices.com (the “Site”) (https://mamabirthservices.com) (the “Site”). M.A.M.A. Mom’s Advocate & Maternal Advisor, LLC (including our affiliates and suppliers) (collectively the “M.A.M.A.,” “we” or “us”) provides this Site for your personal use. We operate the Site with links to a third party telehealth platform provider, through which we offer an online telehealth service. As used throughout these Website Terms of Service (“Terms of Service”), the term “Services” means the provision of childbirth education classes and birth doula, postpartum doula and/or lactation counseling services by an appropriately trained birth services professional. These Services enable you and your children (collectively, “you”) to access and engage with birth services professionals to obtain the Services.

Please read these Terms of Service carefully, as well as our Website Terms of Use (“Terms of Use”), our Privacy Policy (the “Privacy Policy”), our HIPAA Notice of Privacy Practices (the “NPP”), our Website Terms of Use and any other notices on the Site, because they govern your use of the Site and the Services provided through the Site. For purposes of these Terms of Service, the term “User” includes anyone who may be a paid subscriber to the Site and Services, as well as any non-subscribing users of the Site and Services.

To use the Services, you must agree to be bound by all of the terms and conditions contained in these Terms of Service. By accessing the Site, you agree to be bound by all such terms and conditions. If you do not agree to some or all of these terms and conditions, you are not authorized to access or use the Site or the Services and should not use the Site or the Services. If you do not agree to these Terms of Service, please leave this Site.

The Services you receive from birth services professionals through the Site should not be used as a replacement for a primary care provider relationship. The Services you receive from birth services professionals through the Site may not necessarily give rise to a provider-patient relationship or an ongoing treatment relationship. You are expected to seek follow-up or emergency care when recommended by a birth services professional or when otherwise needed, and you should continue to consult with your primary care provider and/or any other health care providers as needed or recommended. Additionally, the birth services professionals who provide Services through the Site may make recommendations and/or arrangements for follow-up care, as appropriate, and you are welcome to access our Services for these follow-up visits. While our Site and the Services provided through the Site are intended to provide benefits such as convenient access to birth services professionals and the Services they provide, there do exist potential risks associated with the use of the Site and the Services, which are outlined in our Informed Consent to Treatment (the “Consent”).

THIRD-PARTY WEBSITES AND CONTENT

Our Site, via third party websites, may provide access to outside content. Additionally, the Site may integrate third-party applications, products, or services which may subsequently gain access to your data and/or protected health information (“PHI”). These third-party applications, products, and services are not affiliated with M.A.M.A. and, as such, may have different policies regarding the handling of PHI and personally-identifying information (“PII”). Your use of these third-party applications, products, and services is subject to the terms and conditions and privacy practices/policies maintained by such applications, products, and services. We make no representations or warranties with respect to third-party applications, products, or services, or how they operate, including operations involving the privacy, security, exchange, and transmission of your data. We advise you to review the terms and conditions and policies/practices for all third-party applications, products, and services with which you engage. We do not endorse or hold any responsibility for, the information, practices, and policies they hold.

As M.A.M.A. is distinct from any third party websites with whom we partner for the Services, or to which we otherwise link to through our Site, you acknowledge and agree that we are not responsible for the quality, integrity, safety, accuracy, availability, reliability, or legality of such third party websites, or resources contained therein and that we are not responsible or liable for any content, advertising, products, or other material available from such third party websites. Further, you acknowledge that M.A.M.A. shall not be responsible or liable, directly or indirectly, for any damage, harm, injury, or loss of any kind caused or alleged to be caused by or in connection with the use of or reliance upon any content, material, or services available through any third party websites.

PAYMENT

By agreeing to these Terms of Service, and also on behalf of each of your minor child(ren) enrolled in the Service, you agree that you have reviewed and understand, acknowledge and/or certify as true each of the terms below:

You acknowledge and agree that you shall be personally responsible for all incurred expenses. M.A.M.A. offers no guarantee that you shall receive any such reimbursement from your insurance provider for the Services provided by Health Care Professionals. We reserve the right to modify or implement a new pricing structure at any time prior to billing you for your initial payment or for future payments due pursuant to these Terms of Service. You understand and agree that for any Services provided on an appointment basis, you may be responsible for a missed appointment fee according to the current fee schedule if you do not cancel a scheduled appointment at least twenty-four (24) hours in advance of the scheduled appointment time.

General Fees. M.A.M.A. may offer products and services on the Site that require payment of a fee(s). Please note that all fees are in U.S. dollars unless otherwise indicated.

M.A.M.A. Mom’s Advocate & Maternal Advisor, LLC (or an authorized third party) may increase or change fees at its sole discretion and at any time.

Due to package promotions, the fee/price you pay upon purchase or subscription may be different from one user to another or one time frame to another. You agree to pay the price/fee quoted at the time of your purchase. Price adjustments will not be made for discounts, promotions or other price changes that may accompany the purchases of other users.

Payments for Services rendered will be charged to the payment method you provide to our third-party telehealth platform provider (“Payment Method”) under the account you have established with the third party telehealth platform provider (your “Billing Account”). You agree to pay M.A.M.A. all charges due at the prices then in effect for any Services rendered to you or your child(ren) by birth services professionals. You authorize M.A.M.A., or a third party billing partner, to charge you through your Payment Method for these Services. We reserve the right to correct any errors or mistakes made by any parties after payments have been requested or received. You may terminate your authorization for your Payment Method at any time by contacting M.A.M.A. at info@mamabirthservices.com or by contacting the billing provider directly. Such notice will not affect any charges submitted to you for Services performed prior to the termination. We ask that you keep your billing information current and complete and update any information within 72 hours of a change. Please notify M.A.M.A. should your Payment Method be canceled or suspended for any reason.

Modifications. Prices for our products are subject to change without notice. We reserve the right at any time to modify or discontinue the Service (or any part or content thereof) without notice at any time. We shall not be liable to you or any third-party for any modification, price change, suspension or discontinuance of the Service.

Fraudulent Billing. Should you become aware of a potential breach of security for your Billing Account, such as unauthorized disclosure or use of your user name and/or password, please change your password to your account immediately through your account settings. Unless you immediately notify M.A.M.A. of any such concern, you agree that M.A.M.A. may continue billing your Billing Account for any use of the Service under your Billing Account, unless you otherwise terminate the authorization for the Billing Method as described above.

Payment Method. If we do not receive full payment from the third party payment manager who manages your payment method (“Payment Method Provider”), you agree to pay all amounts due on your Billing Account when requested within sixty (60) days. Any terms imposed separately by your Payment Method Provider are independent of these Terms of Service.

COMMUNICATIONS

You can send messages to a birth services professional by emailing them at an email address they provide to you or by calling M.A.M.A.’s main phone line and recording a voicemail; however, emails or other messages may not be returned immediately. Email messages received by M.A.M.A. may be viewed by more than one birth services professional or another agent. Voicemails and email messages will typically be answered within forty-eight (48) hours of receipt. Such voicemails and email messages do not give rise to a provider-patient relationship or an ongoing treatment relationship and do not constitute medical treatment, diagnosis, therapy, advice, or services. If you are or could be experiencing a medical emergency, please call 911 or seek emergency care immediately.

You agree that we may send to you any privacy or other notices, disclosures, or communications regarding the Services (collectively, “Communications”) through electronic means including, but not limited to: (1) email, using the email address that you provide to us during registration; (2) short messaging service (“SMS”) text messages, using the mobile number that you provide to us during registration; (3) push notifications, using the mobile number that you provide to us during registration; or (4) by posting the Communications on the Site. The delivery of any Communications from us is effective when sent by us, regardless of whether you read the Communication when you receive it or whether you actually receive the delivered communication. You can withdraw your consent to receive communications by email by canceling or discontinuing your use of the Service. You can opt-out of receiving future Communications through email, phone, or SMS text message by replying “STOP” or by calling M.A.M.A. directly. Should you choose to opt-out of receiving Communications, but you continue to use our Site and the Services, you are responsible for reading the content on our Site regarding any policy changes.

You understand that the Services require the release of your PHI and/or PII to an online personal health record serviced by a third party (in accordance with our Privacy Policy) and to Health Care Professionals and Company agents. You consent to receive emails or other Communications from us regarding the Services you receive.

PRIVACY AND SECURITY

We are required to comply with federal and state health care privacy and security laws, including the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), its implementing regulations, and any state equivalents. HIPAA requires us to implement and maintain safeguards to protect the security of your PHI. Details regarding our privacy practices, including permitted uses and/or disclosures of your PHI, can be found in our Notice of Privacy Practices.

As part of providing the Services, we may need to provide you with certain communications, such as appointment reminders, service announcements, and administrative messages. These communications are considered part of the Services and related to your Account with the Site. M.A.M.A. will not include your PHI in any such communications, though M.A.M.A. may include your PHI when contacting you directly via a secure message service. M.A.M.A. cannot secure any PHI sent to us by email because such information can be accessed by other internet users. If you choose to send your PHI by email, you acknowledge and agree that email is an insecure means of communication. Information relating to the Services you receive, including clinical notes and medical records, are stored on secure, encrypted servers maintained by M.A.M.A. and our third-party partners.

USER ACCOUNTS

To access our Services, you must create a User Account and agree to provide us with the most accurate, complete, and up-to-date information. You also agree to continually update such information as needed, in order to maintain its accuracy. When you register for a User Account through our third-party telehealth platform provider, you will be required to provide some of your PII. Details of our use of your PII can be found in our Privacy Policy and our Terms of Use.

To create a User Account, you must be of legal age to form a binding contract. If you are not of legal age to form a binding contract, you may not register for a User Account or use our Services. By agreeing to these Terms of Service, you certify that the information you provide under your User Account, at all times, and any information you upload to your User Account, is true, accurate, current, and complete, to the best of your knowledge. You may not share or transfer your User Account, or create more than one User Account, with the exception of sub-User Accounts established for children for whom you are the parent or legal guardian.

You are responsible for maintaining the confidentiality of your User Account password and you are fully responsible for all activities that occur under your User Account. You are responsible for exiting your User Account completely and logging off at the end of each session. Please use caution when accessing your User Account from public or shared computers. You agree to notify M.A.M.A. immediately of any unauthorized use of your User Account or any breach in its security. We will not be held liable for any loss or damage arising from your failure to comply with the above.

USE OF THE SERVICE BY CHILDREN

The Services are available for use by children, but the User Account holder for any patients under the age of 18 who utilize the Services must be the patient’s parent or legal guardian. If you register for a User Account as the parent or legal guardian on behalf of a minor, you will be fully responsible for complying with these Terms of Service, and for any and all actions taken by the minor when accessing the Site or Services.

ACCESS RIGHTS

We hereby grant to you a limited, non-exclusive, non-transferable right to access the Site and the Services solely for your personal non-commercial use and only as permitted under these Terms of Service and any separate agreements you may have entered into with us (“Access Rights”). We reserve the right, in our sole discretion, to deny or suspend use of the Site and the Services to anyone for any reason. You agree that you will not attempt to: (a) impersonate any person or entity, or otherwise misrepresent your affiliation with a person or entity; (b) use the Site or the Services to violate any local, state, national, or international law; (c) reverse-engineer, disassemble, decompile, or translate any software or other components that the Site or the Services utilize, including third-party platforms; (d) distribute viruses or other harmful computer code through the Site or that of our third-party partners; or (e) otherwise use the Site or the Services in any manner that exceeds the scope of use granted above. In addition, you agree to refrain from abusive language and behavior which could be regarded as inappropriate, or conduct that is unlawful or illegal, when communicating with birth services professionals or other agents through the Site, and you agree to refrain from contacting Health Care Professionals for health care services outside of the Site and the Services. We are not responsible for any interactions with birth services professionals that are not conducted through the Site or the Services. We strongly recommend that you do not use the Site or the Services on public or shared computers. We also recommend that you do not store your User Account password through your web browser or other software.

TERMINATION

You may deactivate your User Account and end your registration at any time, for any reason by sending an email to info@mamabirthservices.com. M.A.M.A. may suspend or terminate your use of the Site and Services, your User Account, and/or your registration for any reason at any time. Subject to applicable law, we reserve the right to maintain, delete, or destroy all communications and materials posted or uploaded to the Site pursuant to its internal record retention and/or content destruction policies. After such termination, M.A.M.A. will have no further obligation to provide you Services, except to the extent we are obligated to provide you access to your health records or birth services professionals are required to provide you with continuing care under their applicable legal, ethical, and professional obligations to you.

RIGHT TO MODIFY

We may, at our sole discretion, change, add, or delete portions of these Terms of Service at any time. Any modifications will be communicated to our users in writing and provided to users by email at the email address they have provided, and by posting to the Site. Continued use of the Site and the Services following notice of any such changes will indicate your acknowledgement of such changes and your agreement to be bound by the revised Terms of Service, inclusive of such changes.

DISCLAIMER OF WARRANTIES

YOU EXPRESSLY AGREE THAT USE OF THE SITE OR THE SERVICES IS AT YOUR SOLE RISK. BOTH THE SITE AND THE SERVICES ARE PROVIDED ON AN “AS IS” AND “AS AVAILABLE” BASIS. M.A.M.A. DISCLAIMS ALL WARRANTIES OF ANY KIND, WHETHER EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, ANY WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR USE OR PURPOSE, NON-INFRINGEMENT, TITLE, OPERABILITY, CONDITION, QUIET ENJOYMENT, VALUE, ACCURACY OF DATA, AND SYSTEM INTEGRATION.

M.A.M.A. is not responsible for any inaccurate or incorrect Content posted on the Site or relayed through the Services provided. We are not responsible for any error, omission, interruption, deletion, defect, delay in operation or transmission, communications line failure, theft or destruction, or unauthorized access to, or alteration of, any Communication caused by the user, M.A.M.A., or a third party. M.A.M.A. is not responsible for any problems or technical malfunctions of network or phone lines, computer equipment or systems, servers, providers, software, email providers, or internet traffic, including injury or damage to you or any other person’s computer related to or resulting from using our Site or the Services. Under no circumstances will M.A.M.A. or any of its affiliates or third parties be responsible for any loss or damage, including personal injury or death, resulting from anyone’s use of the Site or the Services, or any Content posted on or transmitted from the Site or relayed through the Services provided. M.A.M.A. does not guarantee or promise any specific results from your use of the Site or the Services.

This site may contain certain historical information. Historical information may not be current and is provided for your reference only. We reserve the right to modify the contents of this site at any time, but we have no obligation to update any information on our site. You agree that it is your responsibility to monitor changes to our site.

General advice posted to the Site or relayed through the Services provided is for informational purposes and is thus not intended to replace or substitute for any medical service or advice. General advice also does not form the basis for a provider-patient relationship. We disclaim any and all liability regarding any treatment, action by, or effect on any person following any general information offered or provided via the Site or relayed through the Services provided. Specific concerns that require medical advice should be directed to an appropriately trained health care provider.

The Site is intended for use within the United States. Those choosing to access the Site outside of the U.S. are responsible for compliance with all local laws, including those which may apply to Content on the Site which may be prohibited locally.

GEOGRAPHICAL RESTRICTIONS

M.A.M.A. makes no representation that all products, services and/or material described on its Site, or the Services available through the Site, are appropriate, legal, or available for use in locations outside the United States or in all territories within the United States.

You hereby certify that if receiving lactation counseling services from a birth services professional via the Site, you shall provide an accurate identification for your physical location at the time you are receiving such Services. No geographical stipulation excludes delivery of Services provided by unlicensed consultants, including lactation consultants acting under this solely under the scope of practice for lactation consulting, despite other higher certifications or licensures each may hold. The birth services professionals rely upon this certification in order to provide safe Services to you, and your ability to access the Services is fully conditioned upon your truthfulness of this certification. Should the certification of your location be inaccurate or untruthful, you agree to indemnify M.A.M.A., the Health Care Professionals, and any Company subsidiaries, affiliates, officers, agents, and other partners, harmless from any resulting loss, liability, damages, costs or claims, made by you or any third party.

DISCLOSURES

Services obtained through the Site include childbirth education classes and birth doula, postpartum doula and/or lactation counseling services by an appropriately trained birth services professional. All lactation counseling services provided are done so by professionals that hold certifications in lactation education and counseling. Some performing Services through the Site hold other or higher professional licenses that were issued by a professional licensing board in the state in which he/she practices.

You can report a complaint relating to any lactation services provided by a birth services professional by contacting the professional licensing board in the state where the Services were received, or by contacting M.A.M.A. directly. In a professional relationship, sexual intimacy is never appropriate and should be reported to the professional licensing board that licenses, registers, or certifies the licensee.

Any clinical records created as a result of your use of the Site and the Services will be securely maintained by M.A.M.A. and/or its third-party partners on behalf of the birth services professional with whom you consult, for a period that is no less than the minimum number of years that such records are required to be maintained under state and federal law, typically at least six (6) years.

DISPUTE RESOLUTION

Except as otherwise set forth in these Terms of Service, you hereby agree to resolve any and all controversies, claims, and/or disputes (each, a “Dispute”) arising as a result of your use of the Site or the Services, solely pursuant to the terms of the section below.

Management Resolution. Disputes shall first be referred to each party or their authorized representatives for discussion and resolution (“Management Resolution”).

Arbitration. Should Management Resolution fail to resolve the Dispute, then you agree that the Dispute shall be resolved by final, binding arbitration (“Arbitration”) administered by the American Arbitration Association (“AAA”) under the AAA’s Commercial Arbitration Rules. Under any event of Arbitration, including but not limited to any action to compel, enforce award of Arbitration or seek injunctive relief pursuant to these Terms of Service, the prevailing party shall be entitled to an award of their reasonable attorney’s fees and costs for such proceeding, including any related trial or levels of appeal.

LIMITATIONS ON LIABILITY

TO THE EXTENT PERMITTED UNDER APPLICABLE LAW, IN NO EVENT WILL M.A.M.A. OR ANY OF ITS OFFICERS, EMPLOYEES, PARENTS, SUBSIDIARIES, AFFILIATES, AGENTS, OR LICENSORS BE LIABLE FOR ANY CONSEQUENTIAL, INCIDENTAL, INDIRECT, SPECIAL, ACTUAL, PUNITIVE, AND/OR EXEMPLARY DAMAGES (INCLUDING BUT NOT LIMITED TO LOSS OF PROFITS, REVENUES, GOODWILL, USE OR DATA, SERVICE INTERRUPTION, COMPUTER DAMAGE OR SYSTEM FAILURE, COST OF SUBSTITUTE PRODUCTS OR SERVICES, BODILY INJURY, OR DEATH OR OTHER INTANGIBLE LOSSES) ARISING OUT OF OR RELATED IN ANY WAY TO YOUR USE OF THE SITE OR THE SERVICES, REGARDLESS OF WHETHER SUCH DAMAGES ARE UNDER THEORY OF BREACH OF CONTRACT, TORT, NEGLIGENCE, CONTRACT, WARRANTY, STATUTE, STRICT LIABILITY, OR OTHERWISE, EVEN IF WE OR THEY HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. NOTWITHSTANDING ANYTHING CONTRARY CONTAINED HEREIN, M.A.M.A.’S LIABILITY TO YOU ARISING FROM THESE TERMS, THE USE OF OR INABILITY TO USE THE SITE OR THE SERVICES, WILL AT ALL TIMES BE LIMITED TO THE GREATER OF $100.00 USD OR THE AMOUNT PAID BY YOU TO M.A.M.A. FOR ACCESS TO AND USE OF THE SITE AND/OR THE SERVICES.

YOU RELEASE M.A.M.A. AND HOLD IT AND ITS THIRD PARTY TECHNOLOGY PLATFORM PROVIDER, SUPPLIERS, AND PROVIDERS, AND ANY THIRD PARTY WHO PROMOTES THE SERVICE OR PROVIDES YOU WITH A LINK TO THE WEBSITE HARMLESS FROM ANY AND ALL CLAIMS, DEMANDS, AND DAMAGES OF EVERY KIND AND NATURE AS CITED ABOVE, ARISING OUT OF OR IN ANY WAY CONNECTED WITH YOUR USE OF THE SITE AND THE SERVICES. WE, AND THOSE REFERENCED DIRECTLY ABOVE, EXPRESSLY DISCLAIM ANY AND ALL LIABILITY RESULTING FROM THE DELIVERY OF LACTATION CONSULTING SERVICES VIA OUR SITE OR THIRD PARTY TECHNOLOGY PLATFORM PROVIDER, INCLUDING, BUT NOT LIMITED TO, LIABILITY FOR MEDICAL MALPRACTICE. YOU WAIVE THE PROVISION OF ANY STATE OR LOCAL LAW LIMITING OR PROHIBITING A GENERAL RELEASE. To the extent M.A.M.A. may not, as a matter of applicable law, disclaim any implied warranty or limit its liabilities, the scope and duration of such warranty and the extent of our liability will be the minimum permitted under such applicable law.

The failure of our Company to enforce any right or provision of these Terms of Service does not constitute a waiver of future enforcement of any right or provision. If, for any reason, a court of competent jurisdiction or an arbitrator finds any portion of a provision of these Terms of Service unenforceable or invalid, that provision will otherwise be enforced to the maximum extent permissible. All other provisions of these Terms of Service will remain in full force and effect.

THESE TERMS OF SERVICE REQUIRE BINDING ARBITRATION ON AN INDIVIDUAL BASIS TO RESOLVE DISPUTES, RATHER THAN JURY TRIALS, AND INCLUDE A CLASS ACTION WAIVER. THESE TERMS OF SERVICE LIMIT THE REMEDIES THAT MAY BE AVAILABLE TO YOU IN THE EVENT OF A DISPUTE.

INDEMNIFICATION

YOU AGREE TO DEFEND, INDEMNIFY, AND HOLD M.A.M.A., ITS THIRD PARTY TECHNOLOGY PLATFORM PROVIDER, AND ANY SUBSIDIARIES, AFFILIATES, OFFICERS, AGENTS, AND OTHER THIRD PARTY PARTNERS AND EMPLOYEES, HARMLESS FROM ANY AND ALL CLAIMS, DAMAGES, LOSSES, LIABILITIES, DEMANDS, COSTS, AND EXPENSES OF EVERY KIND AND NATURE (INCLUDING ACTUAL, SPECIAL, INCIDENTAL, AND CONSEQUENTIAL), KNOWN OR UNKNOWN, SUSPECTED OR UNSUSPECTED, DISCLOSED OR UNDISCLOSED, ARISING OUT OF OR IN ANY WAY CONNECTED TO, YOUR USE OF THE SITE AND THE SERVICES. YOU WAIVE THE PROVISION OF ANY STATE OR LOCAL LAWS THAT LIMIT OR PROHIBIT SUCH A GENERAL RELEASE.

Governing Law. This agreement is governed by the laws of the District of Columbia. For any action to compel Arbitration, enforce an Arbitration award or seek injunctive relief pursuant to these Terms of Service, the parties consent to the venue of the District of Columbia, United States, and each party expressly waives any objection to jurisdiction and venue in such courts.

Injunctive Relief. Each party retains the right to seek injunctive or other equitable relief in a court of competent jurisdiction to prevent the actual or threatened infringement, misappropriation or violation of a party’s copyrights, trademarks, trade secrets, patents, or other intellectual property rights.

AGREEMENT TO SERVICE

You understand that by using our Site you are agreeing to these Terms of Service, as well as all other terms, and that such action constitutes a legal signature.

I ACKNOWLEDGE THAT ALL MY QUESTIONS HAVE BEEN ANSWERED TO MY SATISFACTION.

I ACKNOWLEDGE THAT I HAVE READ THESE TERMS OF SERVICE AND THAT I AGREE TO ALL OF THE PROVISIONS CONTAINED HEREIN.

No waiver by M.A.M.A. of any term or condition set forth in these Terms of Service shall be deemed a further or continuing waiver of such term or condition or a waiver of any other term or condition, and any failure of M.A.M.A. to assert a right or provision under these Terms of Service shall not constitute a waiver of such right or provision. If any provision of these Terms of Service is held by a court or other tribunal of competent jurisdiction to be invalid, illegal or unenforceable for any reason, such provision shall be eliminated or limited to the minimum extent such that the remaining provisions of the Terms of Service will continue in full force and effect.

If you have any questions about these Terms of Service, or the Site or Services, or would like to report any violations of our Terms of Service, please contact M.A.M.A. at info@mamabirthservices.com.

INFORMED CONSENT TO TREATMENT

M.A.M.A. offers telehealth-based lactation consulting services provided by births services professionals to Site users. The terms “telemedicine,” “telehealth,” and “distance care” refer to a form of health care services that relies on telecommunications technology, such as an interactive audio-video interface, that allows a patient or provider in one location to see, speak with, share information with, and consult with a provider in another distant location. The information so exchanged may be used for diagnosis, therapy, treatment, follow-up care, consultation, education, care management, and/or self-management of a patient’s health care, and may include any of the following:

Patient medical records;
Patient medical images;
Live two-way audio and video communications; and/or
Output data from medical devices and sound and video files.

Electronic systems used to provide telemedicine services will incorporate network and software security protocols to protect the confidentiality and integrity of patient PHI, including patient imaging data, and will include measures to safeguard the data to protect its confidentiality, integrity against unauthorized use/disclosure and/or intentional or unintentional corruption, and availability. For more information, see M.A.M.A.’s Privacy Policy and Notice of Privacy Practices.

The below information summarizes the main risks and benefits of telemedicine services and affords you the opportunity to agree to or to decline to consent to receiving such services.

BENEFITS AND RISKS OF TELEMEDICINE SERVICES

Telemedicine provides access to care in circumstances where it may be difficult to provide otherwise. The benefits of telemedicine services may include improved and easier access to health care by enabling patients to remain in their own locations and more efficient health care evaluation and management, often at a lower cost compared to other alternatives.

Yet, as with any type of health care service, there are potential risks associated with the use of telemedicine services and, hence, the Services provided via this Site. Among the most important are the following:

Information available to the birth services professional may not be sufficient to make a correct diagnosis or other medical decisions. There could be limitations, for example, in the information transmitted to the Health Care Professional; access to the patient’s complete medical records, which could lead to incorrect diagnoses or adverse drug interactions or allergic reactions; and the physical examination that birth services professional can perform (in particular, information that can be obtained only by touching the patient or being physically present with the patient will not be available).

In some cases, the birth services professional may conclude that the information transmitted is not sufficient (e.g., poor resolution of images), or on some other basis the nature of you or your child’s problem is such that it does not allow for the Services to be provided appropriately by the professional without an in-person evaluation.

Telemedicine relies on electronic communications and devices. Any technical failure or power outage could therefore delay or disrupt such communications and hinder, delay, or erase our ability to assist you. These limitations could result in an incorrect diagnosis, which in turn could lead to treatment that is not helpful, or that could even be harmful; or to adverse drug interactions, allergic reactions or other problems. Birth services professionals performing Services through the Site are aware of these limitations and take them into account in making clinical decisions within the scope of their practice. Where necessary, these birth services professionals will refer patients to in-person care. The risk of error nevertheless exists.

No electronic communication is entirely safe from intruders. Security protocols could fail, causing a breach of privacy of personal medical or mental health information. See our Privacy Policy.

In some cases, applicable laws may prevent lactation consultants from providing the Services you desire through the Site. When that is the case, the birth services professional will refer you to an appropriate provider who can provide the services you desire.

Since telemedicine remains a relatively new approach to care, risks not yet identified, possibly significant, could also exist.

You are under no obligation, of course, to obtain care via telemedicine. You may do so through conventional, in-person services instead of or in addition to these Services. Please feel free to provide feedback to M.A.M.A. should you become concerned that care via telemedicine may be insufficient for your needs.

EMERGENCIES

M.A.M.A. DOES NOT PROVIDE EMERGENCY CARE. If you think you or your child is facing an emergency, please do not rely on M.A.M.A. for help. Immediately call 911 or go to your nearest emergency room.

CONFIDENTIALITY

See our Privacy Policy.

CHILDREN UNDER 18

If you wish to allow birth services professionals you encounter through the Site to diagnose or treat a child under the age of 18 (“Minor”), except where under applicable law at the site of treatment parental consent is not required, you must, at the time and for the duration of your communication with a birth services professional through the Site be physically present with the Minor. You must identify yourself as the Minor’s parent or guardian. You must decide whether, on the Minor’s behalf, to grant informed consent to the birth services professional’s provision of the Services.

In certain circumstances as determined by District of Columbia Law, a child under the age of 18 is himself or herself deemed capable of granting informed consent, independent of a parent or guardian. M.A.M.A. is solely responsible for determining whether those circumstances apply to the case of any given minor. Where they do, your consent is not required, nor is your presence, during the communication between the child and the Provider. In fact, the child may lawfully forbid the Provider to disclose to you any information concerning care to which these exceptions apply and may prohibit your physical presence during the consultation.

ADULT PATIENT CONSENT TO THE USE OF TELEMEDICINE

I am over the age of 18.

I am not under the influence of any medications or other substances that could impair my understanding of the information in this document. I have had sufficient time to read and understand the information provided above regarding telemedicine. I have had the opportunity to discuss this consent with the treating birth services professional providing lactation counseling services. I have been given all of the opportunity I require to ask any and all of my questions, and such questions have been answered to my satisfaction in words I understand.

If I obtain Services through telemedicine, I may obtain the anticipated benefits from the use of telemedicine in my care, but I may not, because as with all medical or health care services provided, no results can be guaranteed. In fact, as with all medical or health care services provided, I may be subject to lactation consulting services provided through telemedicine that may cause some harm, including potentially serious harm.

I understand that a variety of alternative methods of medical care may be available to me, and that I may choose one or more of these at any time. The birth services professional has explained these alternatives to my satisfaction.

I acknowledge that, in the exercise of their clinical judgment, a birth services professional may determine: (1) that the nature of my problem is such that it is not professionally appropriate to assist me with that problem through telemedicine; or (2) that it may not be lawful for the birth services professional to diagnose or treat me through telemedicine; or (3) both. Should the birth services professional make any such determination that they will be unable to assist me through telemedicine, he/she will confer with me about other possible approaches to handling my medical problems, such as referring me to my primary care physician.

I understand that it is my duty to inform my primary care provider of any electronic interactions regarding my health care that I may have with other health care providers.

I understand that lactation consultants will not prescribe medications to treat my problem.

I understand that I may have to pay M.A.M.A. in advance through a charge to my credit card or other payment method requested before any Services may be rendered by a birth services professional.

I understand that telemedicine may involve electronic communication of my personal medical information to other medical professionals who may be located in other areas, including out of state. I understand that the laws that protect privacy and the confidentiality of medical information also apply to telemedicine, and that no information obtained in the use of telemedicine, which identifies me, will be disclosed to researchers or other entities without my consent. I also acknowledge, however, that the security and privacy of electronic communications cannot be guaranteed.

I have read and understand the Privacy Policy.

I understand that I have the right to inspect all information obtained and recorded in the course of a telemedicine interaction, and may receive copies of this information for a reasonable fee.

I understand that I have the right to withhold or withdraw my consent to the use of telemedicine in the course of my care at any time, without affecting my right to future care or treatment.

By acknowledging “I AGREE,” I hereby authorize M.A.M.A. and any birth services professional performing Services through the Site to use telemedicine in the course of my diagnosis and treatment.

I agree that my electronic agreement to this document is equivalent to the signature of a patient. I understand a copy of this consent form is available by printing this document or by request.

PEDIATRIC PATIENT CONSENT TO THE USE OF TELEMEDICINE

I am the parent/guardian of the child(ren) under the age of 18 (“Minors”) who are identified under my registration with M.A.M.A..

If I obtain Services through telemedicine, my child(ren) may obtain the anticipated benefits from the use of telemedicine in my care, but he/she/they may not, because as with all medical or health care services provided, no results can be guaranteed. In fact, as with all medical or health care services provided, I may be subject to lactation consulting services provided through telemedicine that may cause some harm, including potentially serious harm.

I understand that a variety of alternative methods of medical care may be available to my child(ren), and that I may choose one or more of these at any time. The birth services professional has explained these alternatives to my satisfaction.

I acknowledge that, in the exercise of their clinical judgment, a birth services professional may determine: (1) that the nature of my child(ren)’s problem is such that it is not professionally appropriate to assist his/her/them with that problem through telemedicine; or (2) that it may not be lawful for the birth services professional to diagnose or treat him/her/them through telemedicine; or (3) both. Should the birth services professional make any such determination that they will be unable to assist me through telemedicine, he/she will confer with me about other possible approaches to handling these medical problems, such as referring me to my child(ren)’s primary care physician.

I understand that it is my duty to inform my child(ren)’s primary care physician of electronic interactions regarding care that my child(ren) may have with other health care providers.

I understand that lactation consultants will not prescribe medications to treat my problem.

I understand that I may have to pay M.A.M.A. in advance through a charge to my credit card or other payment method requested before any Services may be rendered by a birth services professional.

I understand that telemedicine may involve electronic communication of my child(ren)’s personal medical information to other medical professionals who may be located in other areas, including out of state. I understand that the laws that protect the privacy and the confidentiality of medical information also apply to telemedicine, and that no information obtained in the use of telemedicine, which identifies my child(ren), will be disclosed to researchers or other entities without my consent. I also acknowledge, however, that the security and privacy of electronic communications cannot be guaranteed.

I have read and understand the Privacy Policy.

I understand that I have the right to inspect all information obtained and recorded in the course of a telemedicine interaction with my child(ren), and may receive copies of this information for a reasonable fee.

I understand that I have the right to withhold or withdraw my consent to the use of telemedicine in the course of my child(ren)’s care at any time, without affecting my child(ren)’s right to future care or treatment.

By acknowledging “I AGREE,” I hereby authorize M.A.M.A. and any birth services professional performing Services through the Site to use telemedicine in the course of my child(ren)’s diagnosis and treatment.

By agreeing herein, I certify that I am the legal parent or guardian of the child(ren) identified above and that I am acting within my authority in agreeing to this consent form.

INSURANCE BENEFITS AUTHORIZATION AND ASSIGNMENT

I authorize M.A.M.A. to release to my insurance company any information required in the course of my examination or treatment. I also authorize any physician, hospital, or clinic to provide details of my history to M.A.M.A..

I hereby assign payment direct to M.A.M.A. for medical benefits payable for these services. I understand that I am responsible for payment of all services rendered regardless of insurance coverage.

I agree that my electronic agreement to this document is equivalent to the signature of a patient. I understand a copy of this consent form is available by printing this document or by request.

Terms of Service

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Mom’s Advocate & Maternal Advisor, LLC.

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