Privacy Policy
OUR LEGAL RESPONSIBILITIES: We are required by law to give you this notice. It provides you with information on how we may use and disclose protected health information about you and describes your rights and our obligations regarding the use and disclosure of that information. We shall maintain the privacy of protected health information and provide you with notice of our legal duties and privacy practices with respect to your protected health information. We have the right to change these policies at any time. If we change our privacy policies, we will notify you of these changes immediately. This current policy is in effect unless stated otherwise. If the policy is changed, it will apply to all your current and past health information. You may request a copy of our notice any time. You may contact The Menopause Clinic LLC at 700 Camp St, Suite 203, New Orleans, LA 70130 at any time to request a copy of this privacy policy.
HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION The following examples describe ways that we may use your protected health information for your treatment, payments, healthcare operations etc. but please be advised that not every use or disclosure in a particular category will be listed.
Treatment: We may use and disclose your protected health information to provide you treatment. This includes disclosing your protected health information to other medical providers, trainees, therapists, medical staff, and office staff that are involved in your health care. For example, your medical provider might need to consult with another provider to coordinate your care. Also, the office staff may need to use and disclose your protected health information to other individuals outside of our office such as the pharmacy when a prescription is called in.
Payment: Your protected health information may also be used to obtain payment from an insurance company or another third part. This may include providing an insurance company your protected health information for a pre-authorization for a medication we prescribed.
Health Care Operations: We may use or disclose your protected health information in order to operate this medical practice. These activities include training students, reviewing cases with employees, utilizing your information to improve the quality of care, and contacting you be telephone, email, or text to remind you of your appointments. If we have to share your protected health information to third party “business associates” such as a billing service, if so, we will have a written contract that contains terms that will protect the privacy of your protected health information. We may also use and disclose your protected health information for marketing activities. For example, we might send you a thank you card in the mail with a coupon for specialized services or products. We may also send you information about products or services that might be of interest to you. You can contact us at any point to stop receiving this information. We will not use or disclose your protected health information for any purpose other than those identified in this policy without your specific, written Authorization. You may give us written authorization to use your protected health information or to disclose it to anyone for any purpose. You can revoke this authorization at any time but will not affect the protected health information that was shared while the authorization was in effect. Appointment reminders: We may contact you as a reminder that you have an appointment for your initial visit, follow up visit, or lab work via text, phone or email.
Others Involved in Your Health Care: We may disclose protected health information about you to your family members or friends if we obtain your verbal or written agreement to do so. For example, we may assume that if your spouse or friend is present during your evaluation, that we can disclose protected professional information to this person. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment if there is an urgent or emergent need.
Research: We will not use or disclose your health information for research purposes unless you give us authorization to do so.
Donation: If you are an organ donor, we may release protected health information to organizations that handle organ procurement or organ, eye or tissue transplantation if it is necessary to facilitate this process. Public Health Risks: We may disclose your protected health information, if necessary, in order to prevent or control disease, report adverse events from medications or products, prevent injury, disability or death. This information may be disclosed to healthcare systems, government agencies, or public health authorities. We may have to disclose your protected health information to the Food and Drug Administration to report adverse events, defects, problems, enable recalls etc. if required by FDA regulation.
Health Oversight Activities: We may disclose protected health information to health oversight agencies for audits, investigations, inspections or licensing purposes. These disclosures might be necessary for state and federal agencies to monitor healthcare systems and compliance with civil law.
Required by Law: We will disclose protected health information about you when required to do so by federal, state and/or local law. Workman’s compensation: We may disclose your protected health information to workman’s comp or similar programs.
Lawsuits: We may disclose your protected health information in response to a court action, administrative action or a subpoena.
Law Enforcement: We may release protected health information to a law enforcement official in response to a court order, subpoena, warrant, subject to all applicable legal requirements.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION Access to medical records: You have the right to access and receive copies of your protected health information that we use to make decisions about your care. You must submit a written request to obtain your protected health information to the individual listed at the end of this privacy policy. We reserve the right to charge you a fee for the time it takes to obtain and copy the protected health information and provide it to you. Amendment: If you believe the protected health information, we have about you is incorrect or incomplete, you may ask us to amend the information You will need to submit a written request on why you feel the health information should be amended. We may deny your request to amend if you did not send a written request or give a reason on why it should be amended. If we deny your request, we will provide you a written explanation. We may deny your request if we believe the protected health information is accurate and complete.
Accounting of Disclosures: You have the right to receive a list of instances in which we disclosed your personal health information unless the disclosure was used for treatment, payment, healthcare operations, was pursuant to a valid authorization and as otherwise provided in applicable federal and state laws and regulations. You must submit a written request to obtain this “accounting of disclosures” to the individual listed at the bottom of this policy. After your request has been approved, we will provide you the dates of the disclosure, the name of the individual or entity we disclosed the information to, a description of the information that was disclosed, the reason why it was disclosed, and any additional pertinent information. This information may not be longer than 5 years ago prior to the date the accounting is requested. We reserve the right to charge a reasonable fee for this process.
Restriction Requests: You have the right to request a restriction or limitation on the protected health information we use or disclose about you for treatment, payment, or healthcare operations. If you pay for a service or item in full, out-of-pocket, you have the right to request that we not disclose information about that service or item to your health insurance plan. We are required to honor this request unless disclosure is otherwise required by law. We shall accommodate your request except where the disclosure is required by law. We require this be a written request submitted to the individual at the end of this policy. Confidential Communication: You have the right to request that we communicate with you about healthcare matters in a certain way and at a certain location. We must accommodate your request if it is reasonable and allows us to continue to collect payments and bill you. Paper copy of this notice: You may request a hard copy of this practice policy if you reviewed and signed it via electronic means. To obtain this copy, contact the individual at the end of this privacy policy. Complaints: If you believe your privacy rights have been violated, you may file a complaint with our office. You may also file a complaint with the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request. Automated patient communications are logged to the practice operations system and constitute a designated component of the medical record.
Informed Consent for Hormone Therapy
1. Introduction. I, the undersigned, hereby give my consent to undergo hormone therapy as part of my medical treatment. This therapy may involve the administration of hormones to help address my health concerns, including but not limited to hormonal imbalances, or other related conditions.
2. Purpose of Treatment The purpose of hormone therapy is to achieve the following:
Alleviate symptoms related to hormonal imbalances, perimenopause, menopause, post-menopause.
Support physical and emotional changes as desired.
Improve overall quality of life.
3. Description of Hormone Therapy I understand that hormone therapy may involve the use of:
Estrogens
Anti-androgens
Testosterone
Other medications as deemed appropriate by my healthcare provider. I also understand that some of the medications being utilized within The Confidence Clinic LLC /The Menopause Clinic may be considered to be used “off label” and might not be FDA approved for my desired purpose.
4. Risks and Benefits I acknowledge that the potential benefits of hormone therapy include improved mood, enhanced physical appearance, and better overall health. However, I am also aware of the potential risks and side effects, which may include but are not limited to:
Blood clots
Mood swings
Weight gain or loss
Changes in libido
Other hormone-related side effects
I understand that hormone therapy is a widely studied and generally safe treatment option for managing symptoms related to menopause and hormone deficiencies. However, while research shows hormone therapy is safe for many individuals, the full range of its long-term effects is not entirely known. I acknowledge that hormone therapy may potentially worsen certain pre-existing conditions, including but not limited to endometriosis and uterine fibroids. I also understand that while breast cancer and other types of cancer can occur in individuals receiving hormone therapy, the presence of cancer does not necessarily mean it was caused by the hormone therapy itself. The decision to proceed with hormone therapy in my care is based on a shared decision-making process, weighing the potential risks and benefits while prioritizing my quality of life. I have had the opportunity to ask questions and discuss alternative options, and I understand that ongoing monitoring and adjustments to my treatment may be necessary. By signing below, I acknowledge that I have read and understood this information, and I consent to proceed with hormone therapy as part of my treatment plan.
5. Alternatives I understand that there are alternative treatments available, which may include psychotherapy, lifestyle changes, or other medical interventions. I have had the opportunity to discuss these alternatives with my healthcare provider.
6. Right to Withdraw Consent I am aware that I have the right to withdraw my consent for hormone therapy at any time without affecting my future care. 8. Acknowledgment By signing below, I acknowledge that I have read this consent form, understand its contents, and have had the opportunity to ask questions regarding hormone therapy. I consent to proceed with the treatment.
Telehealth Consent
1. Introduction I, the undersigned, consent to participate in telehealth services provided by The Menopause Clinic/The Confidence Clinic LLC. Telehealth includes the use of electronic communications to facilitate remote medical consultations, assessments, and follow-up care.
2. Purpose of Telehealth The purpose of telehealth is to provide healthcare services in a convenient and efficient manner, allowing for consultation, diagnosis, and treatment without the need for an in-person visit.
3. Nature of Telehealth Services I understand that telehealth services may include:
Video conferencing
Phone consultations
Secure messaging
Remote monitoring of health data
4. Risks and Benefits I acknowledge that telehealth has benefits, including increased access to care and reduced travel time. However, I am also aware of the potential risks, such as:
Limitations in assessing certain health conditions due to the virtual format
Technical issues (e.g., internet connectivity problems). Telehealth services will only be provided while the Patient is physically located in a state where the treating provider is licensed. The Patient agrees to notify the Practice if they will be located outside of Louisiana [or other licensed states] at the time of a scheduled telehealth visit, as this may require rescheduling or an in-person alternative.
5. Right to Withdraw Consent I understand that I have the right to withdraw my consent to telehealth services at any time without affecting my right to receive future care.
6. Acknowledgment By signing below, I acknowledge that I have read this consent form, understand its contents, and have had the opportunity to ask questions about telehealth services. I consent to participate in telehealth consultations with my healthcare provider. By signing below, I am acknowledging that I agree to the privacy policy, clinical policies, consent for treatment, and telehealth consent.
PATIENT AGREEMENT
This Patient Agreement is between The Menopause Clinic (the practice, providers, us, or we) and (Patient, Member, or You).
Background. The Menopause Clinic offers ongoing menopause care to its members through a direct pay, membership model (DPC). In exchange for specific periodic fees, the Practice agrees to provide You with the Services described in this Agreement under the terms and conditions contained within. This Agreement, including the membership terms described below, becomes active and binding upon your enrollment in a paid membership following your initial visit. By signing this consent prior to your visit, you acknowledge and agree in advance to these terms as a condition of future enrollment, should you choose to join
Definitions
Services. In this Agreement, "services" means the collection of services, medical and non-medical, which are described in Appendix A (attached and incorporated by reference), which We agree to provide to You under the terms and conditions of this Agreement.
Patient In this Agreement, "patient," "member," "you" or "yours" means the persons for whom the Practice shall provide care, who have signed this Agreement.
Term. This Agreement shall remain in effect for the term of the membership.
Renewal. The Agreement will automatically renew each month of the Agreement unless either party cancels the Agreement by giving 10 days' written notice before the next charge.
Termination. Either party can cancel this Agreement at any time by giving 10 days' written notice (before the next charge) to the other of intent to terminate. Patient and Practice shall have the absolute and unconditional right to terminate the Agreement, without the showing of any cause for termination. The Patient may terminate the Agreement with 10 days prior written notice. The Practice shall give 10 days prior written notice to the Patient, and shall provide the Patient with a list of other Practices in the community in a manner consistent with local patient abandonment laws. Unless previously terminated as set forth above, at the expiration of the initial one-month term (and each succeeding monthly term), the Agreement will automatically renew for successive monthly terms upon the payment of the monthly fee at the end of the contract month. Examples of reasons the Practice may wish to terminate the Agreement with the Patient may include, but are not limited to: A. The Patient fails to pay applicable fees owed pursuant to this Agreement within 5 days of receiving billing. B. The Patient has performed an act that constitutes fraud. C. The Patient repeatedly fails to adhere to the recommended treatment plan, especially regarding the use of controlled substances as defined by the Controlled Substances Act and any state regulations related to controlled substances. D. The Patient is abusive or presents an emotional or physical danger to the staff.
Payments and Refunds. 1. Initial visit fees are refundable only if canceled at least 24 hours in advance. Memberships A. In exchange for the Services described in Appendix A, you agree to a monthly payment (or Membership Fee) in the amount that appears on our website. B. Thereafter, the Membership Fee shall be due on the day of the month on which you start the agreement. C. The Parties agree that the required method of payment shall be by automatic payment through a debit or credit card or automatic bank draft. D. Discounted or prepaid memberships are applied once the membership term begins and are non-refundable.
Non-Participation in Insurance. The Practice does not participate with any health plans, HMO panels, or any other third-party payor. As such, we may not submit bills or seek reimbursement from any third-party payors for the Services provided under this Agreement.
Payment Failure and Termination Policy. Membership fees are billed on a recurring basis as agreed upon at the time of enrollment. If a payment fails to process, you will be notified, and you will have five (5) business days to update your payment information and resolve the outstanding balance. If payment is not received within five business days, The Menopause Clinic reserves the right to terminate this agreement and discontinue care and access to membership services. Reinstatement after termination may require a re-enrollment process and additional fees, subject to clinic availability.
Courtesy Billing. The Practice may engage in courtesy billing as defined by sending a superbill and supporting documents to a Patient’s insurance company for reimbursement to the patient. This is at the discretion of the Practice. The Practice will not engage in courtesy billing for Medicaid or Medicare. All health insurance claims require at least one diagnosis code (to describe the reason for the visit/treatment) and one procedure code to describe what was performed (for example, “Established Patient Visit, 30 min). We will submit this information as part of your claim.
Medicare. The patient understands that the doctors, nurse practitioners, and staff at this practice have not opted out of Medicare and Medicaid at this time. As a result, under federal regulations, the practice is prohibited from entering into a private Direct Patient Care (DPC) agreement with patients who are currently enrolled in Medicare or Medicaid. This restriction is mandated by federal law and applies regardless of whether the patient wishes to pay out-of-pocket.
This Agreement Is Not Health Insurance. The Patient has been advised and understands that this Agreement is not an insurance plan. It does not replace any health coverage that the Patient may have, and it does not fulfill the requirements of any federal health coverage mandate. This Agreement does not include hospital services, emergency room treatment, or any services not personally provided by the Practice or its staff. This Agreement comprises only those Services identified in Exhibit A. If a Service is not explicitly listed in Appendix A, it is expressly excluded from this Agreement. The Patient acknowledges that we have advised them to obtain health insurance that will cover catastrophic care and other services not included in this Agreement. Patients are always personally responsible for the payment of any medical expenses incurred for services not included under this Agreement.
Insurance Coverage. The Practice does not verify insurance coverage for testing, laboratory services, or medications. The patient should be aware of their insurance coverage and all related policies.
Communications. The Practice endeavors to provide Patients with the convenience of a wide variety of electronic communication options. Although we are careful to comply with patient confidentiality requirements and make every attempt to protect your privacy, communications via email, facsimile, video chat, cell phone, texting, and other electronic means cannot be guaranteed as secure or confidential methods of communication. By placing your signature at the end of this agreement, you acknowledge the above and indicate that you understand and agree that by initiating or participating in the above means of communication, you expressly waive any guarantee of absolute confidentiality concerning their use. You further understand that participation in the above means of communication is not a condition of membership in this Practice, and that you have the option to decline any particular means of communication.
Email and Text Usage. It is highly recommended to communicate through the patient portal. If you use text or email to reach the practice, you acknowledge by the act of sending the text or email to further communication in that form of communication. Furthermore, you acknowledge that text or email is not necessarily secure in sending and receiving “Protected Health Information” (PHI). Furthermore, by sending a text or email, you permit our providers to respond to your message, even if it contains PHI. Finally, by signing this document, you acknowledge that our providers may refer you back to the portal or respond via the portal if they deem it necessary.
Technical Failure. Neither the Practice nor its staff will be liable for any loss, injury, or expense arising from a delay in responding to the Patient when that delay is caused by technical failure. Examples of technical failures: (i) failures caused by internet or cell phone service outages; (ii) power outages; (iii) failure of electronic messaging software, or email outages of the providers; (iv) failure of the Practice's computers or computer network, or faulty telephone or cable data transmission; (iv) any interception of email communications by a third party which is unauthorized by the Practice; or (v) Patient's failure to comply with the guidelines for use of email or text messaging, as described in this Agreement.
Use of Artificial Intelligence (AI): As part of our commitment to providing high-quality, efficient, and personalized care, our clinic may utilize artificial intelligence (AI) technologies to support clinical decision-making, documentation, patient communication, and administrative tasks. his includes the use of an AI-powered phone system that may answer, route, or respond to incoming calls to the Practice. These tools are designed to support — not replace — the judgment of our licensed healthcare providers. By signing this agreement, you acknowledge and consent to the use of AI technologies as part of your care. AI technology does not make medical decisions; only our providers make medical decisions.
Provider Absence. From time to time, due to factors such as vacations, illness, or personal emergencies, the providers may be temporarily unavailable. When the dates of such absences are known in advance, the Practice shall give notice to Patients so that they may schedule non-urgent care accordingly. During unexpected absences, Patients with scheduled appointments shall be notified as soon as practicable, and appointments shall be rescheduled at the Patient's convenience. If, during the provider's absence, the Patient experiences an acute medical issue requiring immediate attention, the Patient should proceed to an urgent care facility or other suitable location for care. Charges from Urgent Care or any other outside provider are not included under this Agreement and are the Patient's responsibility. The Patient may, however, submit such charges to their health plan for reimbursement consideration or request that the outside provider do the same. The Patient is responsible for understanding the coverage rules of their health plan, and we cannot guarantee reimbursement.
Pharmacy. Pharmacies, whether mail order or otherwise, have their own rules, regulations, and processes. We are not responsible for delays related to any pharmacy's policies or procedures.
Labs, Prescriptions, and Insurance Responsibility. As part of your membership, The Menopause Clinic may provide lab requisitions and send prescriptions to your preferred pharmacy. However, we do not guarantee that your insurance will cover any tests, services, or medications. By signing this agreement, you acknowledge that it is your responsibility to verify coverage and confirm any potential costs with your insurance provider, pharmacy, or lab before proceeding. The Menopause Clinic does not assume financial responsibility for charges related to uncovered or out-of-network services, tests, or prescriptions.
Treatment Plan and Medication Adherence. As a member of The Menopause Clinic, you agree to follow the treatment plan that has been developed collaboratively through shared decision-making with your provider. This plan is tailored to your specific needs and based on clinical guidelines and professional judgment. You acknowledge that making changes to your medication, such as adjusting the dose, frequency, or stopping a drug, without first communicating with your provider, can pose health risks and compromise your care. You agree not to alter your prescribed treatment without prior discussion and approval from your provider. Failure to adhere to the agreed-upon treatment plan may impact your care and could result in reassessment of your membership eligibility.
Acceptance of Patients - We reserve the right to accept or decline patients based on our ability to provide appropriate care for their needs.
Dispute Resolution. Each party agrees not to make any inaccurate or untrue and disparaging statements, oral, written, or electronic, about the other. We strive to deliver only the best of personalized patient care to every Member, but occasionally misunderstandings arise. We welcome sincere and open dialogue with our members, especially when we fall short of expectations. We are committed to resolving all Patient concerns. Therefore, if a member is dissatisfied with, or has concerns about, any staff member, service, treatment, or experience arising from their membership in this Practice, the Member and the Practice agree to refrain from making, posting or causing to be posted on the internet or any social media, any untrue, unconfirmed, inaccurate, disparaging comments about the other. Instead, the Parties agree to engage in the following process: 1. Member shall first discuss any complaints, concerns, or issues with the Medical Director 2. The Medical Director shall respond to each of the Member's issues or complaints 3. If, after such response, the Member remains dissatisfied, the Parties shall enter into arbitration and attempt to reach a mutually acceptable solution. A.)Arbitration will be binding in nature B.)The member will cover the cost of arbitration C.)All parties agree to follow the rules of the American Arbitration Association
Monthly Fee and Service Offering Adjustments. If the Practice finds it necessary to increase or adjust monthly fees before the termination of the Agreement, the Practice shall give 30 days' written notice of any adjustment. If the Patient does not consent to the modification, the Patient shall terminate the Agreement in writing before the next scheduled monthly payment. If the practice must stop a service, it will provide a 30-day notice when it can be done so practicably. By signing this document, you acknowledge that there are instances beyond the control of the Practice that might not allow a 30-day notice before stopping a service.
Re-enrollment fee. If you cancel your membership and later choose to rejoin, a re-enrollment fee of $99 will apply to reactivate your account. If you cancel and rejoin more than once, a higher re-enrollment fee of $199 may apply. Please note that re-enrollment is subject to provider availability and is not guaranteed.
Change of Law. If there is a change of any relevant law, regulation, or rule that affects the terms of this Agreement, the parties agree to amend it only to the extent that it shall comply with the law.
Severability. If any part of this Agreement is found to be legally invalid or unenforceable by a court of competent jurisdiction, that part will be modified as necessary to make it enforceable. The remainder of the Agreement will remain in effect as initially written.
Amendment. Except as provided within, no amendment of this Agreement shall be binding on a party unless it is in writing and signed by all the parties.
Assignment. Neither this Agreement nor any rights arising under it may be assigned or transferred without the agreement of the Parties.
Legal Significance. The Patient acknowledges that this Agreement is a legal document that gives the parties certain rights and responsibilities. The Patient agrees that they are not suffering from a medical emergency and have had a reasonable amount of time to seek legal advice regarding the Agreement. They have either chosen not to do so or have done so and are satisfied with the terms and conditions of the Agreement.
Miscellaneous. This Agreement is to be construed without regard to any rules requiring that it be construed against the drafting party. The captions in this Agreement are only for the sake of convenience and have no legal meaning.
Entire Agreement. This Agreement contains the entire Agreement between the parties and supersedes any earlier understandings and Agreements, whether written or oral.
No Waiver. Either party may choose to delay or not to enforce a right or duty under this Agreement. Doing so shall not constitute a waiver of that duty or responsibility, and the party shall retain the absolute right to enforce such rights or obligations at any time in the future.
Jurisdiction. This Agreement shall be governed and construed under the laws of the State of Louisiana. All disputes arising out of this Agreement shall be settled in the court of the proper venue and jurisdiction for the Practice.
Notice. Written Notice, when required, may be achieved either through electronic means at the email address provided by the party to be noticed or through first-class US Mail. All other required notices must be delivered by first-class U.S. mail to the Practice at 201 St. Charles Ave, New Orleans, LA 70170, and to the Patient at their address provided in the Patient Portal.
The Parties agree that throughout this agreement and its attachments, an electronic signature is the same as a handwritten signature.
APPENDIX A
SERVICES
Medical Services. Medical Services offered under this Agreement are those consistent with the provider's training and experience, and as deemed appropriate under the circumstances, at the sole discretion of the provider. The Patient is responsible for all costs associated with any medications, laboratory testing, and specimen analysis related to these Services unless otherwise noted. The specific Medical Services provided under this Agreement include the following:
Menopause treatment
Hormone management in relation to menopause care
Referrals in relation to menopause care, such as but not limited to pelvic floor physical therapy and sexual health.
This agreement does not cover the following services and care. This list is not meant to be inclusive of all services not covered, but serves as guidance to some common questions:
UTI diagnosis and treatment
Sexually transmitted Infections diagnosis and treatment
Emergency care
PAP smears, cervical cancer diagnosis, and treatment
Mammograms and breast abnormalities diagnosis and treatment.
From time to time, the medical services covered may be updated. The Practice will send out a new Appendix A attachment before services are updated.
2. Communication and Follow-Up Care. The Patient understands and agrees to the following communication and follow-up protocols:
A. Emergent or Urgent Needs: The Practice does not provide emergency or urgent care services. If the Patient is experiencing an emergency or requires urgent medical attention, the Patient agrees to call 911 or seek care at the nearest emergency room or urgent care facility.
B. New or Concerning Issues: If the Patient experiences a new medical concern, treatment side effect, or other important issue, they agree to notify the Practice by sending a secure message through the patient communication platform with the subject line “Important.” This method is the most direct and timely way to communicate with the Provider.
C. Routine Follow-Up: The Patient is responsible for scheduling follow-up appointments at intervals recommended in their individualized treatment plan. These appointments are intended for routine care and management of ongoing concerns.
3.Treatment Initiation and Education: If the Patient is beginning a new medication or wishes to review their treatment plan in more detail, they agree to schedule a follow-up appointment for demonstration, education, and/or clarification.
4. Non-Medical, Personalized Services. The Practice shall also provide Members with the following non-medical services: A. Asynchronous Access. Subject to the limitations of paragraph 14, messages from Members will be answered promptly, usually within 72 hours. B. Telehealth. Telehealth (virtual visits) will be available for your self-scheduling through the patient portal. Furthermore, when deemed necessary by our providers, you will be asked to self-schedule an appointment that is convenient for you from our calendar when asynchronous care is not appropriate for further care.
5. Basic Medical Care. It is the patient’s responsibility to continue with all non-menopause-related medical care. We highly encourage patients to undergo and maintain all necessary health screenings and care, including but not limited to cervical cancer screenings, breast cancer screenings, colorectal cancer screenings, STI screenings, diabetes screenings, cholesterol screenings, lung cancer screenings, and any other screenings recommended by your primary care provider (PCP) or other healthcare providers.
6. Breast Cancer Risk and Estrogen Therapy. Current research indicates that estrogen therapy does not cause breast cancer; however, it may increase the rate of growth of an existing, undiagnosed tumor. For this reason, patients are strongly encouraged to undergo age-appropriate breast cancer screening, such as a mammogram, prior to initiating estrogen therapy, if applicable. By signing this agreement, the patient acknowledges understanding of this information and agrees to follow recommended screening guidelines.
7. Testosterone. When a Patient starts testosterone treatment, the Patient acknowledges the following practice guidelines, recommendations, and protocols:
From time to time, an in-person visit will be necessary between the Patient and the Provider. The interval between these visits is at the Provider's discretion, but must be no less than once per year. One in-person visit must occur before testosterone will be prescribed. Lab work is required before a prescription and regularly. Video visits are also needed regularly.
Testosterone is a Schedule III controlled substance under the Controlled Substances Act.
Pharmacies have specific rules around filling Testosterone that are beyond the control of the Practice.
Testosterone is often reported to the Prescription Monitoring Program. https://www.pharmacy.la.gov/page/prescription-monitoring-program-pmp-information
Most insurances do not cover testosterone, and thus, patients will have to pay cash, but the Practice will help you find the most reasonable product available.
The Practice will not do a prior authorization on testosterone.
The Practice will electronically send a script to the pharmacy of your choice.
It is highly recommended that you shop around for prices of this medication before deciding on a pharmacy and consider the advice of our providers when choosing a pharmacy; however, the final decision is patient-driven.
If an issue with the first pharmacy necessitates the use of a second pharmacy, the Patient will be provided with a paper script sent to them by email or fax that they will print and take to the pharmacy. Multiple electronic prescriptions will not be sent.
8. Medication Refills. If you are on monthly membership, your prescriptions will be refilled every month. You are responsible for requesting refills. There may be times when we provide extra refills for your convenience. Please note that if your membership is cancelled, refills that have not been picked up from the pharmacy will be automatically cancelled, and you will no longer have access to them if you are not under the care of The Menopause Clinic. Prescriptions require an active membership and are discontinued immediately upon cancellation. To ensure your safety and support the individualized nature of hormone therapy, we are thoughtful when we approve 90-day medication supplies.
Patients on a 3-month plan may be eligible when their dosages are stabilized
We typically wait to approve extended supplies until your treatment regimen is well-established to avoid sending excess medication that may need adjustment.
Patients on a month-to-month plan will receive month-to-month clinically appropriate prescriptions as requested as long as they remain active
All prescriptions, including prescriptions sent to the pharmacy but not picked up, will be automatically cancelled if your membership ends.
9. Vitamins and supplements. The Practice generally does not recommend vitamins or supplements to treat menopause symptoms. We refer all patients to the Full Script Store on our website for all their vitamin needs.
10. This Agreement is for ongoing menopause care, not emergency or urgent care.
By signing this consent, you acknowledge that you understand and agree to the following terms related to membership status, medical records, and portal access at The Menopause Clinic:
Active Membership RequirementOngoing care, communication, and prescription management at The Menopause Clinic require an active membership. Once membership is canceled or expires, the patient–provider relationship is considered ended unless reactivated.
Portal Access Access to the patient portal (for messaging, scheduling, and care updates) is available only to active members.When membership ends, portal access will be disabled within 24–48 hours. This ensures clear boundaries and protects your privacy and clinical safety.
Prescription and Refill Policy All active prescriptions and refills will be discontinued upon membership cancellation or expiration. Ongoing hormone or medication management requires an active provider relationship.In rare cases, and at the provider’s discretion, a short-term refill (up to 30 days) may be provided to ensure safe transition of care.
Access to Medical RecordsThe Menopause Clinic maintains all patient records in compliance with federal and state laws.Former patients may request copies of their medical records or a summary of care at any time by emailing info@menopauselouisiana.com.Record requests are typically processed within 10 business days and will always be fulfilled within 30 days, in accordance with HIPAA and the 21st Century Cures Act.
Re-Establishing Care If you wish to return to care after cancellation, you may do so by re-enrolling in an active membership plan (see terms stated above). A new intake or restart visit will be required to safely resume treatment.