SERVICE AGREEMENT AND INFORMED CONSENT

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.1) (collectively "Analyte," "us" or "we"). By engaging our services, you agree that you have read, understand and consent to this Agreement:

Eligibility Requirements
  • 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 pregnant, we strongly recommend that you visit a doctor or other healthcare provider. It is very important that you get the right kind of prenatal care. Please talk to the doctor or healthcare provider about your concerns about STDs.
  • In addition, you acknowledge you understand the Safety Advisory Message that is explained during the medical intake.
  • You understand that this is not a replacement for conditions that may be considered a medical emergency and require immediate care at a local provider. IF YOU THINK YOU HAVE AN EMERGENCY, CALL 911 IMMEDIATELY.
Service Acceptance/Informed Consent to Medical Services and Provision of Medical Services through Electronic Means

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 understand that our Services are or may be provided through telemedicine and/or telehealth, through a combination of audio, visual and store and forward technology and are not appropriate for all medical issues and should not be used in emergency situations.
  • You understand that there are potential risks associated with the use of telemedicine. These risks include, but may not be limited to, delays in medical evaluation and treatment due to limitations, deficiencies and/or failures of the technology. Additionally, in rare instances, security protocols could fail, causing a breach of privacy of personal medical information.
  • 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 understand that the Services provided by Analyte do not replace an existing primary care physician relationship and, in certain instances, will require follow-up care with a local healthcare provider.
  • You understand that the testing may involve the collection of bodily fluids or tissue (each a "Sample"), in accordance with standard testing procedures, and that the phlebotomist 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, 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.
Our Services

Analyte agrees to provide the following services ("Services"):

  • Analyte will test you for one or more conditions as instructed on the test requisition ("Order"), and authorized by a physician, in accordance with applicable state laws.
  • The specimen collection will be conducted at a site of your choice within our service area, either by a mobile phlebotomist through our partner, Iggbo, LLC ("Partner") or at an independent clinical laboratory ("Lab"). The test will be processed at the 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/or your test(s) results.
  • Services conducted by Analyte do not replace your existing physician relationships.
  • Analyte will not provide any services for medical emergencies or urgent situations. IF YOU THINK YOU HAVE AN EMERGENCY, CALL 911 IMMEDIATELY.
  • Analyte does not guarantee that a prescription will be written. Prescriptions are left to the physician’s discretion and will only be written if medically appropriate and permitted by state law.
  • Services will only be provided for the following conditions:
    • STI Screening (which include Chlamydia, Gonorrhea, Hepatitis B & C, Herpes 1 & 2, Syphilis, Trichomonas, and HIV).
Your Responsibilities
  • You are responsible for providing accurate information and for updating any demographic information in the medical record.
  • You agree to follow all recommendations, protocols and other instructions provided by Analyte, our Partner (the mobile phlebotomist), and the Lab. You understand that, if you decide or fail to follow any of these instructions, then you will be taking an action contrary to medical advice.
  • Eligible consults must be scheduled within 21 days of test results delivery. Consults requested after 21 days are subject to an additional charge.
  • If you fail to view your results within 14 days, we reserve the right to contact you via other means, including by certified mail or telephone.
Privacy and Security

Analyte respects your privacy and takes privacy very seriously. By accepting this Agreement, you consent to permit Analyte to use and disclose your personally identifiable information, including health information, provided to us or developed while receiving Services as outlined in our Notice of Privacy Practices, which is a part of the Agreement. We also encourage you to read and become familiar with our Privacy Policy.

Electronic Health Record

Analyte maintains an Electronic Health Record (“EHR”) system and creates a record for each patient (your “Record”) and stores them in accordance with relevant medical record keeping state requirements. Your Record is created to store your Personal Health Information (PHI), including health conditions, allergies, relevant medical history, 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 and to update such information, as needed.

For additional information regarding use of your Record and your rights relating to health information we collect or maintain about you, please see our Notice of Privacy Practices.

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 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 Ordering/Cancellation Policy
  • At your direction, Analyte will accept payment directly from you or other individuals authorized to make a payment on your behalf.
  • Analyte may accept payment from your health insurance plan ("Plan"), if Analyte has a contract or other arrangement with your plan.
  • Analyte does not currently accept payment from Medicare, Medicaid or TriCare. In the event you submit insurance information supported by Medicare, Medicaid or TriCare, that payment will not be accepted and you will be responsible for paying the amount in full.
  • 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 credit cards or health-savings accounts.
  • 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 a Plan with which we are in in-network 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 understand and agree that you will be responsible for payment of any amounts not covered by your Plan.
  • If you choose to use a health insurance plan with which we are out-of-network, Analyte will forward your plan information, as provided by you, to the laboratory for processing in accordance with the laboratory’s regular insurance processing policies and procedures. You understand that - in this situation - the amount charged by the laboratory to your insurance and the amount covered by your insurance company will be determined by the laboratory and your insurance plan and Analyte makes no assurances with respect to the amount that may be charged and for what, if any amount, you may be responsible.
  • You can cancel or change your Order any time prior to the earlier of (i) your visit to the Lab or in-home collection appointment, 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.
  • Any test not completed within 30 days of placing an order may require a new order and doctor’s lab authorization to test.
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.

Disputes

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.

Notice

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
Suite 770
Chicago, IL 60661

For Customer Service inquiries: 866.660.2593

Compliance/Ethics Hotline: 888.723.6082

General Provisions

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.