Consent to PWNHealth Services
YOU ACKNOWLEDGE THAT YOU HAVE READ, ACCEPTED, AND AGREED TO BE BOUND BY THIS INFORMED CONSENT. IF YOU DO NOT AGREE, YOU WILL NOT BE ABLE TO USE OR RECEIVE THE PWNHEALTH SERVICES.
I agree to receive the services provided by PWN Remote Care Services, certain other affiliated professional entities and PWNHealth, LLC (the administrative services provider of the professional entities) (collectively, "PWNHealth", "we" or "us") relating to clinical oversight of Ancestry genetic tests (each, a "Test"), including, without limitation, test request evaluation and ordering, receipt and evaluation of Test results ("Results"), genetic counseling support tools (such videos, webinars, “Ask a Genetic Counselor a Question” and other messaging tools), genetic counseling and any other related services provided by PWNHealth or its service providers (the "PWNHealth Services") in connection with Ancestry.com, LLC's ("Ancestry") AncestryHealth services (the "Ancestry Services") on the Ancestry website. All clinical Services, including Services provided by physicians, will be provided through PWN Remote Care Services, P.A., PWN Remote Care Services, P.C. or their contractually affiliated professional entities.
- I understand that providing correct information in connection with the Tests and PWNHealth Services is important. The information I have provided in connection with Test and the PWNHealth Services is correct to the best of my knowledge. I will not hold PWNHealth or its health care providers responsible for any errors or omissions that I may have made in providing such information.
- I certify that I am physically present in the state of residence that I provided when I registered my kit on the Ancestry Site or other state of which I have notified PWNHealth.
- I understand I may speak to a PWNHealth healthcare provider about the Test and/or my Results. Genetic counseling is available to help understand what the results mean for me and my family members.
- I am responsible for forwarding any results to my primary care or other personal physician and for initiating followup with such physician for care, further testing, diagnosis, or medical treatment.
- I will not make medical decisions without consulting a healthcare provider or disregard medical advice from my healthcare provider or delay seeking such advice based on information as a result of the use of PWNHealth Services.
- I have read the materials provided regarding the Test and related services. I understand the purpose of the Test, including the diseases or conditions for which it is testing, the risks, benefits and limitations of the Test, the reliability of results and the level of certainty that a positive result serves as a predictor of a disease or condition.
- I have had the opportunity to ask questions regarding the Test(s) and seek genetic counseling. All my questions were answered to my satisfaction.
I understand that if I have any questions before or after my Test, I can contact PWNHealth's clinical team as set forth below
I understand that PWNHealth Services are delivered by health care providers who are not in the same physical location as I am using electronic communications, information technology or other means, including the electronic transmission of personal health information. I also understand that:
- A PWNHealth physician will determine whether or not Test(s) and PWNHealth Services are appropriate for me.
- I have the right to withdraw my consent to the use of telehealth services by contacting PWNHealth as set forth below.
- I may need to see a health care provider in-person for diagnosis, treatment and care.
- There are potential risks associated with the use of technology, including disruptions, loss of data and technical difficulties.
- There are alternative services, such as visiting a primary care provider; however, I chose to proceed with the PWNHealth Services at this time.
I may contact PWNHealth’s clinical team at Contact Us
IF YOU ARE EXPERIENCING A MEDICAL EMERGENCY, CALL YOUR DOCTOR OR 911 IMMEDIATELY. PWNHEALTH DOES NOT PROVIDE SERVICES FOR MEDICAL EMERGENCIES.
PWNHealth Services. The PWNHealth Services do not constitute treatment or diagnosis of any condition, disease or illness and PWNHealth physicians do not and will not prescribe or order any drugs or medication in connection with the PWNHealth Services. The PWNHealth Services do not replace your existing primary care or other relationship with your physician. You are solely responsible for forwarding any Results to your primary care or other personal physician and for initiating follow up with such physician for care, additional testing, diagnosis, medical treatment or to obtain an interpretation of the Results. You should not make medical decisions without consulting with a physician. Do not disregard medical advice from your healthcare provider or delay seeking such advice based on the information on the PWNHealth Site or obtained as a result of your use of the PWNHealth Services. PWNHealth does not provide clinical oversight for and is not responsible for Ancestry's ethnicity or wellness testing.
The PWNHealth Services are not intended or designed for individuals under the age of 18. By using the PWNHealth Services or the PWNHealth Site, you confirm that you are 18 or over.
The PWNHealth Services are intended for individuals located in and residing in the United States. By using the PWNHealth Services or the PWNHealth Site, you confirm that you are located in the United States when you receive the PWNHealth Services. If you access the PWNHealth Site and the PWNHealth Services from outside the United States, you are responsible for compliance with the laws of your jurisdiction. You are prohibited from using the PWNHealth Services or the PWNHealth Site to violate any local, state, national or international laws.
You agree that the information you submit in connection with the PWNHealth Services is truthful and accurate. You agree that the PWNHealth Services are for your own personal use and that you will not order a Test (e.g. register a test kit) for another person.
Availability of PWNHealth Services.
The PWNHealth Services may not be available in certain states. You will be notified on the Ancestry site if PWNHealth Services are not available in the state in which you are located. PWNHealth Services may be modified from time to time at the sole discretion of PWNHealth.
TClinical Oversight of Tests
Clinical Oversight of Tests
PWNHealth is an independent group of affiliated health care providers, including physicians and genetic counselors that provides clinical oversight of the Ancestry Tests. All PWNHealth Services provided by physicians and genetic counselors shall be provided through PWN Remote Care Services or its affiliated professional entities
Test Request Evaluation
PWNHealth will evaluate Test requests based on information you have provided. PWNHealth may contact you if additional information is required. If appropriate, the Test will be ordered by a PWNHealth physician. You will be notified whether or not your Test has been approved. Any order will cease to be in effect after twelve (12) months.
Test Results and Support
Once your Results have been received by PWNHealth, they will be evaluated and released by the PWNHealth clinical team. You will have access to PWNHealth genetic counseling support tools, as applicable to your Results, including on demand videos, webinars by genetic counselors with a messaging feature, "Ask a Genetic Counselor a Question" messaging feature and genetic counseling sessions. A member of the PWNHealth clinical team may reach out to you to schedule a genetic counseling session.
You may receive your Results in the mail in certain circumstances, such as if a PWNHealth genetic counselor attempted to reach out to you to discuss your Results but was not able to reach you and you have not viewed your Results.
You may contact the PWNHealth clinical team at any time either before or after the Test through the Contact Us link below.
Links to Other Websites.
The PWNHealth Site may contain links to third party websites. PWNHealth is not responsible for the content of such third party websites. If you elect to use such third party websites, your use is at your own risk and is subject to the terms and conditions of use for such sites.
You may not use the PWNHealth Site or PWNHealth Services except as expressly permitted in these Terms. You will not:
- Use the PWNHealth Services or PWNHealth Site for any unlawful purpose;
- Use the PWNHealth Site in any manner that could disable, damage or overburden the PWNHealth Site or interfere with other users' use of the PWNHealth Site;
- Introduce any viruses, Trojan horses, worms, malware, time bombs or other material that is malicious, harmful or may damage the PWNHealth Site;
- Disrupt, interfere with, or attempt to gain unauthorized access to any part of the PWNHealth Site, including any data on the PWNHealth Site or connected server or database;
- Circumvent, bypass or breach any security device, protection or technological measure implemented by PWNHealth or our service providers to protect the PWNHealth Site;
- Attempt, in any manner, to obtain the password, account, credentials or other security information from any other user or impersonate any other user, person or entity; or
- Remove, delete, alter or obscure any trademarks, specifications, warranties or any copyright, trademark, patent or other intellectual property or proprietary rights notices from the PWNHealth Site or any content made available to you through the PWNHealth Site.
Limitation of Liability.
IN NO EVENT WILL PWNHEATH OR ITS AFFILIATES AND THEIR RESPECTIVE OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, PARTNERS, LICENSORS, PHYSICIANS, HEALTHCARE PROVIDERS OR SERVICE PROVIDERS BE LIABLE TO YOU FOR ANY FOR ANY INDIRECT, INCIDENTAL, CONSEQUENTIAL, OR SPECIAL DAMAGES, WHETHER BASED IN CONTRACT, TORT, STRICT LIABILITY, OR OTHERWISE ARISING OUT OF OR IN ANY WAY CONNECTED WITH ACCESS TO OR USE OF PWNHEALTH SITE OR THE PWNHEALTH SERVICES, EVEN IF PWNHEALTH HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.
IN NO EVENT SHALL THE TOTAL LIABILITY OF PWNHEALTH AND ITS AFFILIATES AND THEIR RESPECTIVE OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, PARTNERS, LICENSORS, PHYSICIANS, HEALTHCARE PROVIDERS AND SERVICE PROVIDERS ARISING IN CONNECTION WITH OR UNDER THESE TERMS EXCEED U.S. ONE HUNDRED DOLLARS ($100 USD). YOU AGREE THAT ANY CLAIM OR CAUSE OF ACTION ARISING UNDER THESE TERMS OR THE PERFORMANCE OR NON-PERFORMANCE OF THE PWNHEALTH SITE OR PWNHEALTH SERVICES MUST BE BROUGHT WITHIN ONE (1) YEAR AFTER SUCH CLAIM OR CAUSE OF ACTION ARISES, OR BE FOREVER BARRED.
THE PWNHEALTH SITE IS PROVIDED SOLELY ON AN “AS IS” AND “AS AVAILABLE” BASIS, WITHOUT WARRANTY OF ANY KIND, EXPRESS OR IMPLIED. PWNHEALTH AND ITS AFFILIATES AND THEIR OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, PARTNERS, LICENSORS, PHYSICIANS, HEALTHCARE PROVIDERS OR SERVICE PROVIDERS HEREBY DISCLAIM ALL EXPRESSED AND IMPLIED WARRANTIES AND CONDITIONS WITH REGARD TO THE PWNHEALTH SITE AND THE CONTENT, INCLUDING ALL IMPLIED WARRANTIES AND CONDITIONS OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, TITLE, NON-INFRINGEMENT, AND ANY OTHER WARRANTY, WHETHER ORAL OR WRITTEN.
YOUR USE OF THE PWNHEALTH SERVICES AND THE PWNHEALTH SITE IS AT YOUR OWN RISK. PWNHEALTH AND ITS AFFILIATES AND THEIR OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, PARTNERS, LICENSORS, PHYSICIANS, HEALTHCARE PROVIDERS AND SERVICE PROVIDERS SHALL NOT BE HELD RESPONSIBLE FOR ANY ACTION TAKEN BY YOU OR OTHERS THAT IS BASED ON THE CONTENT PRESENTED THROUGH THE PWNHEALTH SITE AND MAKE NO REPRESENTATIONS OR WARRANTIES THAT (I) THE USE OF THE PWNHEALTH SITE WILL BE UNINTERRUPTED OR ERROR-FREE, (II) THAT THE CONTENT IS ACCURATE, COMPLETE, RELIABLE OR CURRENT, (III) THAT THE PWNHEALTH SITE AND THE CONTENT ARE FREE OF VIRUSES OR OTHER DISABLING DEVICES OR (IV) THAT THERE WILL BE NO DELAY, FAILURE OR CORRUPTION OF DATA TRANSMITTED THROUGH THE PWNHEALTH SITE. IN NO EVENT SHALL PWNHEALTH BE LIABLE FOR ANY DAMAGES OR HARM CAUSED FROM OR BY YOUR USE OF THE PWNHEALTH SERVICES, PWNHEALTH SITE OR ANY RELATED CONTENT IF SUCH USE VIOLATES THESE TERMS.
Proprietary Rights The PWNHealth Site and the content made available to you on or through the PWNHealth Site, including, without limitation, all content, text, graphics, icons and images, and all intellectual property rights therein and any suggestions, ideas or other feedback provide by you are the sole and exclusive property of PWNHealth or our service or content providers and are protected by U.S. and foreign intellectual property laws. The PWNHealth Site and related content contain proprietary and confidential information that is protected under U.S. and international intellectual property laws, including copyright, trademarks, service marks, patents or other proprietary rights and laws. The compilation of all of the content on the PWNHealth Site is also the exclusive property of PWNHealth and is protected by U.S. and foreign intellectual property laws. Except as expressly authorized by PWNHealth, you may not use, sell, modify, reproduce, redistribute, create derivative works, or otherwise exploit information provided to you through the PWNHealth Site, in whole or in part. PWNHealth grants you a limited, non-exclusive right to access and use the PWNHealth Site for personal, non-commercial purposes. Any use of the PWNHealth Site other than specifically authorized herein is strictly prohibited. Certain names, logos, brand or other materials displayed in and through the PWNHealth Site may constitute trademarks, trade names, service marks or logos (“Trademarks”) of PWNHealth, its affiliates or partners. You may not use such Trademarks without the prior written permission of PWNHealth or its affiliates or partners, as applicable.
For Texas Residents
NOTICE CONCERNING COMPLAINTS Complaints about physicians, as well as other licensees and registrants of the Texas Medical Board, including physician assistants, acupuncturists, and surgical assistants may be reported for investigation at the following address: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018, Assistance in filing a complaint is available by calling the following telephone number: 1-800-201-9353, For more information, please visit our website at www.tmb.state.tx.us.
AVISO SOBRE LAS QUEJAS, Las quejas sobre médicos, asi como sobre otros profesionales acreditados e inscritos del Consejo Médico de Tejas, incluyendo asistentes de médicos, practicantes de acupuntura y asistentes de cirugia, se pueden presentar en la siguiente dirección para ser investigadas: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018, Si necesita ayuda para presentar una queja, llame al: 1-800-201-9353, Para obtener más información, visite nuestro sitio web en www.tmb.state.tx.us.