This Service Agreement (the "Agreement") governs your use of the services of Analyte Physicians Group, S.C., and its authorized agents (including Analyte Health, Inc.) (collectively "Analyte," "us" or "we"). By engaging our services, you agree that you have read, understand and consent to this Agreement:
You are eighteen (18) years of age or older.
You are engaging Analyte under your own name and will not misrepresent your identity or impersonate another person.
If you are male, you are not currently suffering from testicular pain and understand that such pain may be a sign of a serious medical problem for which you should seek prompt medical attention from a local provider.
If you are female, you are not currently suffering from pelvic pain and understand that such pain may be a sign of a serious medical problem for which you should seek prompt medical attention from a local provider.
In addition, you affirm, by engaging our services, that you have received our Safety Advisory Message and understand the following:
- If you have unexplained fever, vomiting or other concerning symptoms, you should seek care right away from a local doctor.
- Females: We strongly advise all women who may be pregnant to follow up with a local doctor to discuss any STD concerns.
- Since some STDs take time to become detectable, your results may not take into account any exposure within the last 3 weeks. If you’re concerned about a recent exposure, time your visit to the lab with that in mind.
- We recommend testing 1 week after finishing any antibiotics.
- We recommend testing again in 6-12 weeks if you are concerned about a recent exposure to STDs.
If you have unexplained fever, vomiting or other concerning symptoms, you should seek care right away through a local doctor.
If you are pregnant, we strongly recommend that you seek care right away from a local doctor to discuss any STD concerns.
We recommend testing 1 week after finishing any antibiotics.
We recommend repeat testing in 3 months if you have any recent exposure to STDs.
Analyte agrees to provide the following services ("Services"):
- Analyte will test you for one or more sexually transmitted diseases or infections (including HIV, where applicable) as selected on the order form, and authorized by a physician if appropriate, in accordance with applicable state laws ("Order").
- The testing will be performed at an independent clinical laboratory ("Lab") in accordance with any Order issued by an Analyte physician.
- Analyte will deliver to you (by telephone, email, or other means) educational information and your test(s) results.
- Analyte will not provide any services for medical emergencies or urgent situations. IF YOU THINK YOU HAVE AN EMERGENCY, CALL 911 IMMEDIATELY.
- You shall be responsible for providing accurate information and to update your contact address within two (2) days of any change.
- You agree to follow all recommendations, protocols and other instructions provided by Analyte and the Lab. If you decide or fail to follow any of these instructions, then you will be taking an action contrary to medical advice.
- You agree to contact Analyte no later than (i) two (2) days after receiving notice at your contact address that the results of your tests are ready, or (ii) five (5) days after being tested, whichever comes first. If you fail to do so, we may contact you via certified mail, email, or telephone.
You agree and have the legal right and ability to: (i) enter into this Agreement, (ii) use the services for your personal benefit and (iii) abide by the obligations in the Agreement.
You acknowledge and agree that you are making an informed decision to use the Services, and have been given all necessary and relevant information to make that decision. You agree by accepting the Services that you are a patient of Analyte, and are entering into a patient-provider relationship with the healthcare provider(s) that Analyte assigns to you. You give permission (consent) to Analyte to arrange for you to be tested for one or more sexually transmitted diseases or infections (including HIV, where applicable) at a Lab. You understand that the testing may involve the collection of body fluids or tissue, including blood or urine (each a "Sample"), in accordance with standard testing procedure, and that the Lab may require you to complete additional paperwork before testing. You understand that while the tests performed on your Samples are approved by regulatory agencies and designed to detect the presence or absence of a specific disease or infection, they are not perfect or absolute. As explained in greater detail on our websites, www.stdtestexpress.com and www.sexualhealth.com (the "Sites"), there is a statistical possibility that a test may yield a false positive or a false negative test result, which could result in an inadvertent misdiagnosis or delay in treatment.
You agree that any prescriptions for medical treatment or services that you receive from an Analyte physician shall be solely for your personal use. You agree to fully and carefully read all provided product information and labels and to contact a physician or pharmacist if you have any questions regarding the prescription. Analyte makes no representations or warranties about the adequacy or accuracy of any information provided by the manufacturer, pharmacist or clinician on any prescription drug products or any treatment, therapy or application provided in response to a prescription from an Analyte physician.
Privacy and Security
Electronic Health Record
Analyte maintains an Electronic Health Record ("EHR”) system and creates a record for each patient (your "Record”). Your Record is created to store your Personal Health Information (PHI), including health conditions, allergies and medications. Information provided as part of your consultation with an Analyte representative may, if appropriate, be maintained in your Record and relied on by our clinicians in providing care to you. You agree to provide accurate information, review the information in your online account, and to update such information, as needed.
Public Health Reporting
Analyte may be required by law to disclose certain health information to federal and/or state public health agencies to report, prevent, or control disease, injury or disability. For example, certain positive test results for sexually transmitted diseases require reporting to public health agencies. You may or may not be notified of these disclosures.
Password and PIN
You may access your information on the applicable Site only through the use of a password and/or PIN selected by you. You are solely responsible for maintaining the confidentiality of your password and/or PIN, and for all activities that occur under your password and/or PIN. You agree to prohibit anyone else from using your password and/or PIN and to immediately notify Analyte of any unauthorized use of your password or other security concerns of which you become aware.
Payment of Fees and Cancellation Policy
- At your direction, Analyte will accept payment directly from you or other individuals authorized to make a payment on your behalf.
- Analyte will accept payment from your health insurance plan ("Plan”), if Analyte has a contract or other arrangement with your plan. If Analyte does not have a contract or other arrangement with your Plan, you will be responsible for paying Analyte directly.
- Analyte does not currently accept payment from Medicare, Medicaid or TriCare.
- Analyte accepts various forms of electronic payment for Services in accordance with Analyte policies and this agreement. We currently accept electronic payments made by credit or debit card, pre-paid cards such as gift cards, Western Union or health-savings accounts.
- If you are tested in New York, New Jersey or Rhode Island, you agree to pay for the services of Analyte and the Lab separately, as required by the laws of those states.
- We are subject to complex laws and regulations that are constantly evolving and vary from state to state. Specific billing practices and service availability may be amended periodically to comply with changes in the law or guidance from Plans and regulatory authorities.
- If you choose to use your Plan for payment, Analyte will submit a claim and accept payments in accordance with your Plan's requirements. You agree to pay any necessary co-pays or deductibles as required by your plan. If your Plan denies coverage for any Services, you agree to pay for these Services in the amount typically paid for these services by your Plan.
- You can cancel or change your Order any time prior to the earlier of (i) your visit to the Lab, or (ii) 21 days after accepting this agreement for a full refund, by contacting us at the phone number listed on the applicable Site every day except major holidays.
Term and Termination
This Agreement shall commence on the date your Order with Analyte is completed. Either you or Analyte may terminate this Agreement and your right to use Analyte at any time, with or without cause. This Agreement and any licenses granted to access the EHR shall terminate without notice in the event you (or any authorized person using your account) fail to comply with the terms and conditions of this Agreement. Analyte shall retain your Record in the EHR for a period of time as required by law.
Limitation of Liability; Indemnity
TO THE FULL EXTENT PERMITTED BY LAW: (a) IN NO EVENT WILL ANALYTE BE LIABLE FOR ANY INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL OR PUNITIVE DAMAGES ARISING OUT OF OR RELATED TO THIS AGREEMENT, EVEN IF ANALYTE HAS BEEN ADVISED OF, KNEW OF, OR SHOULD HAVE KNOWN OF THE POSSIBILITY OF SUCH DAMAGES; AND (b) IN ANY EVENT, ANALYTE’S TOTAL AGGREGATE LIABILITY IN CONNECTION WITH THIS AGREEMENT, FOR ALL CLAIMS OF ANY KIND (INCLUDING, BUT NOT LIMITED TO, ANY CLAIM RELATED TO THE SERVICES PERFORMED BY ANALYTE HEREUNDER, YOUR USE THEREOF, OR YOUR VISIT TO A LAB), WILL NOT EXCEED THE AMOUNT YOU HAVE PAID TO ANALYTE DURING THE ANNUAL PERIOD IMMEDIATELY PRECEDING THE FIRST EVENT GIVING RISE TO SUCH LIABILITY. To the extent permitted by law, you agree to release, indemnify and hold Analyte, its owners, medical advisors, officers, directors, affiliates, employees, and agents harmless from all liabilities, claims, expenses arising from injury or personal damage that occurs while you are at the Lab, your use of the Site, your choice of payment method, or your receipt of notices or information at your contact address.
You agree that this Agreement is governed by the laws of the State of Illinois, without regard to choice of law rules. Any dispute arising out of or relating to this Agreement, including the determination of the scope or applicability of this clause, shall be settled by binding arbitration administered by JAMS in accordance with its Streamlined Arbitration Rules and Procedures. The arbitration shall be heard by a single arbitrator, and shall be conducted in Cook County, Illinois. Each party shall bear his, her, or its own costs relating to such arbitration, and the parties shall equally share the arbitrator’s fees. Judgment on any award resulting from such arbitration may be entered in any court having jurisdiction. If this arbitration provision is deemed invalid, the parties agree that the court of proper and exclusive jurisdiction to resolve any action arising out of this agreement shall be a state or federal court located in Cook County, Illinois. EACH PARTY TO THIS AGREEMENT HEREBY WAIVES ANY RIGHT HE, SHE, OR IT MAY HAVE TO PARTICIPATE IN ANY CLASS ACTIONS OR CLASS ARBITRATIONS.
Analyte will generally communicate with you using the email address or telephone number you provided to Analyte. In some circumstances, we may communicate with you using the mailing address you provided to Analyte. You may contact Analyte on all matters relating to your order or services provided by us using the following resources:Analyte Health
328 South Jefferson Street
Chicago, IL 60661
For Customer Service inquiries: 866.660.2593
Compliance/Ethics Hotline: 888.723.6082
This Agreement shall constitute the entire Agreement between you and Analyte with respect to the subject matter hereof. If any provision of this Agreement is, for any reason, deemed unenforceable or in violation of law, such unenforceability or violation will not affect the remaining provisions of this Agreement, which will continue in full force and effect and be binding upon the parties hereto.
Updated March 5, 2013
Copyright © 2009 Analyte Health, Inc.