Disclaimer for Health Data Collection (Mounjaro Treatment)
Before you begin treatment with Mounjaro (tirzepatide), we are requesting your consent to collect and use your health information. This information is crucial for monitoring your progress, ensuring your safety, and optimizing your treatment plan. Please read this disclaimer carefully before signing the consent form.
Purpose of Data Collection:
* Treatment Monitoring: To assess the effectiveness of Mounjaro in your specific case, track your progress, and make any necessary adjustments to your treatment plan.
* Safety Monitoring: To identify and monitor any potential side effects or adverse reactions you may experience while taking Mounjaro. This is essential for your safety and well-being.
* Communication: We may use your contact information to communicate with you about your treatment, appointments, and any important safety information related to Mounjaro.
Types of Data Collected:
The data we collect may include:
* Demographic Information: Age, gender, etc.
* Medical History: Pre-existing conditions, medications you are taking, allergies, etc.
* Physical Measurements: Weight, blood pressure, etc.
* Laboratory Results: Blood tests, etc.
* Treatment Response Lifestyle Information: Information about your diet, exercise habits, etc., which may be relevant to your treatment. You will have the option to provide this information.
Data Security and Confidentiality:
We are committed to protecting the privacy and security of your health information. We use industry-standard security measures to safeguard your data from unauthorized access, use, or disclosure. All data collected will be stored securely and accessed only by authorized personnel involved in your care.
Data Sharing:
We will only share your health information with:
* Your Healthcare Providers: Including doctors, nurses, and other healthcare professionals involved in your treatment.
* Regulatory Authorities: If required by law (e.g., reporting adverse events).
Your Rights:
You have the right to:
* Access your health information: You can request to see the data we have collected about you.
* Request corrections: You can request corrections to any inaccurate information.
* Withdraw your consent: You can withdraw your consent to participate in data collection at any time. However, please note that withdrawing your consent may affect your ongoing treatment.
By signing the consent form, you acknowledge that you have read and understand this disclaimer and agree to the collection and use of your health information as described.