Emet Drip Co

A DBA of Emet Nursing and Wound Care, A Professional Corporation

Clinical Policies

PATIENT CONSENT FOR IV INFUSION, INJECTION, AND NEBULIZED/INHALED THERAPIES WITH EMET DRIP CO.

If you have any questions, please feel free to ask us. Please review each point acknowledging you understand that:

• Health insurance typically does not cover services provided at Emet Drip Co. If you want to seek insurance reimbursement, we would be happy to provide you itemized invoices that you can submit to your insurance company.
• I understand that Emet Drip Co offers different types of formulations. Some are provided for general wellness, hydration, or nutritional support. Others are symptom-targeted formulations intended to provide relief for an acute condition. My treating clinician will determine which type of formulation, if any, is appropriate for me today, and I may receive either or both types.
• If I receive a general wellness/hydration formulation, I understand that it is intended for general wellness, hydration, or nutritional support. It is not intended to diagnose, treat, cure, or prevent any specific medical condition or disease, and any wellness claims made about it have not been evaluated by the US Food and Drug Administration (FDA). I understand that this type of formulation is not FDA-approved for any indication and is not considered a medical necessity.
• If I receive a symptom-targeted/acute-condition formulation, I understand that it contains FDA-approved medications (such as an antiemetic, an NSAID, an antihistamine, a bronchodilator, or similar) used for their approved purpose to provide symptomatic relief of an acute condition based on my treating clinician’s assessment. I understand that this treatment addresses my symptoms during today’s visit, does not establish an ongoing diagnosis, and does not treat, cure, or manage any underlying chronic condition. It is not a substitute for follow-up with my primary care provider or any specialist.
• I agree that if I am having any side effects or become sick, that I will follow up with my primary care provider or go to an urgent care or emergency department.
• I acknowledge that Emet Drip Co and any Emet Drip Co staff are not my primary care provider. I agree that I will continue with routine care through my primary care provider and notify them of treatments prescribed and performed at Emet Drip Co.
• I understand that there are no refunds for services or products rendered.
• I understand that having an appointment with Emet Drip Co does not necessarily entitle me to having an IV infusion, injection, or nebulized/inhaled therapy procedure performed. Every individual is different, and it is at the medical provider’s discretion to issue treatment.
• I acknowledge that I have been advised of the risks and benefits of treatment. I also acknowledge that I have been advised of possible complications and side effects. I understand the risks, benefits, complications, and side effects of treatment.
• I am voluntarily requesting treatment with Emet Drip Co in regard to IV infusion therapy, injection therapy, and/or nebulized/inhaled therapy as determined by a mutual decision between myself and the medical provider, even if it is not considered a medical necessity.
• I do not hold any medical practitioner of Emet Drip Co responsible for performing age-related preventive care. I agree that I will follow up with my primary care provider to obtain these screenings and I hold Emet Drip Co harmless if an adverse event occurs during my treatment.

I have read, understood, and agree with all of the above statements.