By completing this form, you are giving consent to Mint Health + Drugs representatives to contact your current pharmacy provider to obtain a prescription transfer request. I understand that during my admission into any program where medications are administered by the facility’s staff or by a designated personnel from Mint Health + Drugs, I may be required to have my medications daily dispensed and/or administered by Mint Health + Drugs: CMP as per the program’s policies and procedures for reasons pertaining to safety. Where this is not applicable, standard dispensing intervals issued by your prescriber would apply.
I understand that Mint Health + Drugs may be required to access/share my health records and your Intake Application/Care Plan in accordance with the Health Information Act to provide the most comprehensive care possible. In addition, you are giving consent to Mint Health + Drugs representatives to contact your current practitioner and those providers involved in your care which includes but is not limited to: your physician, nurse practitioner, psychiatrist, etc. regarding your prescriptions which may require continuation and/or extension or other (e.g. AHS Home Care, etc.). In receiving care from Mint Health + Drugs: CMP during the admission of the program, I understand that when it is deemed appropriate to do so, I may be required to access pharmacy and professional services through a virtual platform (e.g. phone, video conferencing, email, etc.) when in-person care is impractical or impossible or in circumstances where virtual care will optimize and complement the in-person care I receive regularly. In consenting to virtual services, I understand there are risks and limitations of consultations and assessments performed over such platforms (e.g. risk of technical difficulties, limitations in performing physical assessments, time required to learn the technology, risk of issues pertaining to privacy/confidentiality, etc.), and that I’m responsible for ensuring that I’m located within a private/confidential environment suited to my own comfort level when receiving virtual care. I understand that I may revoke this consent at any time should I not wish to continue my care through Mint Health + Drugs: CMP, and may at any time follow-up with the pharmacy by phone and/or make arrangements for in-person consultations. In situations involving medical emergencies, I understand I’m to contact 911 or present to the local emergency room. In the event of a needle stick injury or other injuries, I consent to undergo baseline laboratory tests in accordance with public/provincial health guidelines to assess health status and ensure appropriate medical management for all parties involved.