QuickMD’s Peer Support Group Terms

I understand that by submitting my interest and by attending QuickMD’s Peer Support Group Sessions (“Group Sessions”), my Protected Health Information, including but not limited to my name and/or identity, may be revealed to other Peer Support Group Members (“Members”) attending the Group Sessions for the sole purpose of participating in peer support group sessions. Additionally, I understand that I may be exposed to other people’s Protected Health Information during Group Sessions. I understand that I may leave at any point of my choosing. I release QuickMD from liability for the exposure of any Protected Health Information, including my name and/or identity, that was shared in these Group Sessions, both during and after the completion of these Group Sessions.

About Our Group Sessions

QuickMD offers two group formats: the Peer Support Group with Kelli and the Community Peer Support Group. Both are voluntary, peer-to-peer conversations hosted and moderated by QuickMD staff. The Peer Support Group with Kelli also includes Kelli, QuickMD’s Member Advocate, who shares her own lived experience in recovery. Group Sessions are not clinical services, are not therapy or medical care, and are not part of your treatment plan. Participation is entirely optional and will have no effect on your continued care at QuickMD.

Because Group Sessions involve open discussion among attendees, by attending, your identity and any information you choose to share will be visible to other participants. By signing the required consent prior to attending, you acknowledge this limitation and voluntarily accept it.

By joining Group Sessions, you waive any expectation of confidentiality as to your identity and voluntary disclosures within the group setting. QuickMD strongly encourages all attendees to respect one another’s privacy, but cannot guarantee confidentiality within the group setting.

Your signed consent is required before attending any Group Session and constitutes acknowledgment of the above.

Confidentiality

QuickMD respects each and every Member’s right to privacy and confidentiality, and shall take precautions to ensure that discussions that take place within Group Sessions are confidential. However, please understand that this is not absolute and is limited as provided by law.

Certain limitations are as follows:

• Threatening one’s self or another that will likely result in physical harm;
• An act of physical or emotional abuse against a child or any other person;
• Sexual abuse against a child where the child is living with the abuser;
• Summons by court order to disclose information against a participant.
• In a medical emergency, as permitted by 42 CFR § 2.51.

However, we shall notify you and let you exercise your privilege in the right to be heard; and your prior written consent to release records.

I understand that the following information will be disclosed: (1) the fact that I am/was at one point a QuickMD patient and a participant in a group for people receiving care that may include substance use disorder treatment; (2) my name or chosen display name, image, and voice as I choose to present them on the video platform; and (3) anything I choose to say or write during a session. I understand I may limit (2) and (3) at my discretion.

I may revoke this consent at any time by written notice to QuickMD at [email protected]. Revocation takes effect when QuickMD receives it. It will stop me from being admitted to future Group Sessions, but it cannot undo disclosures already made, and QuickMD cannot retrieve information other Members learned while I participated.

This consent expires 12 months from the date signed, or earlier if I withdraw from the Group Sessions or revoke it in writing.

Rules of Conduct

To protect Members of the QuickMD Peer Support Group program as much as possible, all Members are expected to fully comply with the following rules of conduct:

1. What’s shared in group stays in group. Discussions that occur within Group Sessions may not be shared outside the group with any Member or non-Member. Federal law (42 CFR Part 2) prohibits you from further disclosing any information that identifies another Member as a person who has or had a substance use disorder, unless that Member gives written consent or the law otherwise permits it. Federal law also restricts using this information to investigate or prosecute any Member for a crime. Violating these rules may be a federal offense;
2. While certain sessions may involve emotional and potentially difficult conversations, Members are asked to attempt to stay positive and to not induce disrespect among other Members;
3. Members are expected to maintain absolute sobriety prior to and during all sessions;
4. Members shall maintain conduct that is respectful to fellow Members’ thoughts, emotions, stories, and behaviors; and
5. Members shall not communicate, or attempt to communicate, with other Members outside of Group Sessions without the consent of all parties involved. Failure to respect the privacy of other Members outside of Group Sessions will result in immediate dismissal from all future Group Sessions. If consenting group Members wish to communicate outside of Group Sessions, they are free to do so. However, QuickMD will not be liable for the release of any information that occurs outside of a Group Session, nor will QuickMD be liable for any event or action that occurs outside of a Group Session. Additionally, due to the technical limitations of Google Meet, please note that coordinating communication with a fellow Group Member during a Group Session will likely result in your information being revealed to the entire Group as well as your intended audience. Please proceed at your own risk.

By expressing interest in a Peer Support Group with QuickMD, I affirm that I have read all the aforementioned information and release QuickMD from liability for the exposure of any Protected Health Information that was willingly shared by me to other Members attending Group Sessions.