FISHTOWN MEDICINE - TERMS OF USE & COMMUNICATION CONSENT

These Terms of Use ("Terms") describe your rights and responsibilities when interacting with or receiving care from Fruition Medicine PLLC d/b/a Fishtown Medicine ("Fishtown," "we," "us," "our"). You hereby grant agency authority to any party who clicks on any "I Agree" button or otherwise indicates acceptance to these Terms on your behalf. By creating an account, accessing our site, communicating with us, scheduling care, or receiving services, you agree to these Terms and all referenced policies.

We work at the pace of your trust.

1. Eligibility & Licensure Scope

Clinical services are available only to adults (18+) who are physically located in a U.S. state where our clinicians hold an active license at the time of the visit.

2. Consent to Treatment & Telehealth

2.1 General Consent

By receiving services, you consent to diagnosis, treatment, and the use and disclosure of your protected health information ("PHI") for treatment, payment, and healthcare operations as permitted by HIPAA and state law. If you withdraw consent, we must end the care relationship because PHI is required to deliver and document clinical care.

2.2 Consent to Telehealth

Our care is delivered primarily via telehealth, meaning video visits, audio-only calls, asynchronous messaging, remote monitoring, and other digital tools. By scheduling or participating in a telehealth visit, you consent to receiving care this way, and you understand and accept the following:

How it works. Your clinician evaluates and treats you through live video or audio, secure messaging, and information you share electronically. Your clinician is physically located in Pennsylvania or another state where they hold an active license, and you must be physically located in a state where they are licensed at the time of the visit.
Expected benefits. Care without travel, faster access, easier follow-up, and continuity between visits.
Possible risks. Technology can fail or be interrupted mid-visit; information transmitted electronically can be delayed, degraded, or in rare cases accessed without authorization despite our safeguards; and some conditions cannot be fully evaluated without an in-person exam, which can delay diagnosis or treatment.
Alternatives. In-person evaluation is always an alternative. If an exam, procedure, or imaging study is medically necessary, we direct you to an appropriate local provider (see 2.3).
Your right to refuse or stop. You may decline telehealth, or stop a telehealth visit, at any time without losing access to care we can deliver another way. Withdrawing from telehealth does not end your care relationship, though it may limit which services we can provide.
Emergencies. Telehealth is never for emergencies. Call 911 or go to the nearest emergency department; for a mental health crisis, call or text 988 (see section 7).

Home visits, where included as part of a membership tier, are offered subject to clinician availability, scheduling, and geographic feasibility, and are not guaranteed for any specific visit.

2.3 When In-Person Evaluation Is Required

If an in-person exam, procedure, or imaging study is medically necessary, we will direct you to an appropriate local provider.

2.4 Electronic Signatures & Consents

We collect agreements, consents, and authorizations electronically through a secure e-signature service. Your electronic signature has the same legal force as a handwritten one under the federal ESIGN Act and Pennsylvania's Uniform Electronic Transactions Act. You can download a copy of anything you sign, and you may request a paper copy at any time.

3. Technology Notice: AI Scribe, Recording, and Observers

3.1 Use of AI Clinical Scribe

We use an AI-enabled clinical scribe during all visits. The scribe processes audio in real time to draft documentation. It does not make diagnoses or determine treatment. A clinician reviews and finalizes all notes. Audio processing can be paused upon request, though pausing may reduce documentation completeness.

3.2 Clinic Recording of Telehealth Visits

We may record audio or video visits for documentation, training, quality improvement, compliance, and fraud prevention. These recordings are PHI and stored securely. External disclosure occurs only with your written authorization or when required by law. Recording may be paused or stopped upon request, but in some cases this may limit our ability to provide or document care.

3.3 Patient Right to Record Visits

You may record any visit for personal use. You may store, replay, or process recordings (including with personal AI tools).

You are responsible for complying with your state's recording-consent laws.
If mutual consent is required, you must notify us before recording; continued participation reflects our consent.
Your personal recordings are not part of your medical record and may lose HIPAA protection once stored outside our systems.

3.4 Use of Personal AI Tools

You may use personal AI tools during visits. These tools are not HIPAA-covered unless you have a separate BAA with the vendor. We are not responsible for the privacy, accuracy, or security practices of your external tools.

3.5 Right to an Observer

You may invite an observer to any visit, including a support person, advocate, trainee, or AI-based observer. Before the visit you must notify us, ensure the observer understands confidentiality, and authorize disclosure of PHI during the visit. Observers may be asked to leave if they interfere with care or compromise safety.

3.6 Required Notice to Observers

Observers must be informed that they may not use or disclose PHI without permission, may not offer clinical advice unless licensed and acting within scope, and may report concerning conduct to the appropriate State Medical Board.

3.7 Effect on the Medical Record

The clinician's finalized documentation is the authoritative medical record. Personal recordings or AI-generated summaries do not modify or replace the official record.

4. Communication Preferences & Consent

4.1 SMS Text Messaging

Opt-in allows us to send non-marketing, care-related text messages that may contain PHI. Standard carrier rates apply. SMS is not encrypted after delivery. Text STOP to opt out.

4.2 Phone Calls & Voicemail

You consent to care-related calls, which may include PHI. You are responsible for protecting your voicemail.

4.3 Email & Secure Portal

Clinical information is primarily sent through our secure portal, which is our encrypted, HIPAA-compliant channel and is always available to you.

4.4 Consent to Unencrypted Communications

Some of the ways we can reach you, standard email and SMS text messaging in particular, are not encrypted once they leave our systems, and messages there can be read by anyone with access to your inbox, your phone, or the networks in between. By corresponding with us through these channels, or opting in to them, you consent to your health information traveling over them, and you accept those risks. You can withdraw this consent at any time by telling us in writing, and we will move your clinical communication to the secure portal without it affecting your care. Nothing requires you to use unencrypted channels; the secure portal covers everything.

5. Website Content Disclaimer

Information on our website or educational materials is general and not a substitute for professional medical judgment or individualized treatment.

6. Privacy Practices

Our HIPAA Notice of Privacy Practices (NPP), available at https://www.fishtownmedicine.com/about/privacy-policy, describes how we use, disclose, and protect PHI and outlines your rights.

7. Emergencies & Service Limitations

We do not provide emergency services.

Call 911 or go to the nearest emergency department for any medical or mental-health emergency.
For mental-health crises, call or text 988.

We may refer you to urgent care or specialists when needed.

8. Financial & Subscription Terms

This agreement does not provide comprehensive health insurance coverage. This agreement only provides for the health care services specifically described.

Nothing Fishtown Medicine sells is insurance. Neither a membership nor a care package is health insurance, a health plan, a health maintenance organization, a discount health plan, or any other product regulated as insurance. Nothing you buy here satisfies a requirement to maintain health coverage, and nothing you buy here pays a third party on your behalf. What you are buying is direct access to a physician and the clinical services this practice provides itself. Care from anyone else, including hospitals, emergency departments, specialists, laboratories, imaging centers, and pharmacies, is billed to you by those providers under your own insurance or cash-pay arrangement. We strongly encourage every patient to carry health insurance for everything outside this practice.

8.1 What Your Membership Is (and Is Not)

Your membership is a recurring subscription that provides access to the practice and its clinical services during each paid billing period. Fees are billed period by period as the membership continues; each payment covers the current billing period.

Your membership is not health insurance, is not a health plan, and does not satisfy any requirement to maintain health insurance. It does not cover care from other providers, hospitals, emergency services, labs, imaging, or prescriptions, and we encourage you to hold insurance coverage for services outside this practice.

What "unlimited" means. Where we describe visits or messaging as unlimited, we mean there is no per-visit charge, no copay, and no cap on the medically appropriate care your situation calls for. It is a commitment about how we bill rather than a promise of unrestricted access to a clinician at any hour. Unlimited does not include:

services outside our scope of practice (section 14) or outside your clinician's licensure;
care your clinician judges to be medically inappropriate, or better delivered by a different provider or in a different setting;
a guarantee of availability at a specific hour, on a specific day, or from a specific clinician, since visits and responses are scheduled by clinical urgency and availability;
use of our time or communication channels in a way that materially interferes with our ability to care for other patients.

We schedule and respond based on clinical need. If someone's use of the practice becomes materially disproportionate to any clinical need, we will raise it with them directly and work out a plan together before taking any other step.

The specific services your membership includes. Membership is offered in more than one tier. Everything below is included in every tier, so this list is the floor rather than the ceiling; a higher tier may include more, and what it includes is described to you before you enroll. These are the services covered by your membership fee, and they are what you are entitled to for as long as your membership is paid and active:

Unlimited medically appropriate visits, by phone, video or in person, with no per-visit charge.
Unlimited direct messaging with your physician, answered same day or next business day under our published access standard.
Same-day or next-day care for acute problems.
An annual comprehensive physical of roughly 90 minutes, including a preventive-focused biomarker panel (such as ApoB, Lp(a), fasting insulin, hs-CRP, full thyroid, A1c, vitamin D, B12, and ferritin).
Records and laboratory review visits without a fixed time limit, typically 60 to 120 minutes.
Ongoing management of chronic conditions within our scope of practice (section 14), including cardiovascular risk, metabolic health, hormone care, and the medication side of mental health.
Prescribing and prescription management, routed to the pharmacy you choose. We do not dispense medications on site.
Ordering and interpretation of laboratory testing and imaging. The laboratory or imaging center bills you or your insurer separately for the test itself; the ordering, interpretation, and follow-up are included here.
Referral to and coordination with specialists, including outreach on your behalf and review of what comes back.
Review of wearable and continuous glucose monitor data as part of your care.
Home visits within greater Philadelphia, subject to clinician availability, scheduling, and geographic feasibility. Some membership tiers extend in-person visits to where you are staying while you travel; any such visit can only take place in a state where your clinician holds an active license at the time of the visit (section 1). Home visits are a membership benefit and are not included with a care package.

Anything not listed here, and anything excluded by section 14, is outside what your membership fee pays for. Care delivered by anyone other than this practice is billed by that provider.

8.2 Membership Billing

Memberships (monthly, quarterly, or annual) renew automatically at the end of each billing cycle. There are no initiation fees or cancellation fees.

8.3 Cancellation

You may cancel your membership at any time through your billing portal at your account. Upon cancellation, your access continues through the end of the current billing cycle. You will not be charged again after the cycle ends. No partial refunds are issued for unused portions of a billing cycle.

8.4 Packages

A package is a fixed number of clinical sessions with your physician, purchased in advance. A package is not health insurance and does not satisfy any requirement to maintain health coverage. It pays for the sessions described and nothing else; it does not pay for care delivered by anyone other than this practice.

The specific services a package includes. The Reset is 3 sessions; The Strategic Roadmap is 5. Either one includes:

A 90-minute physician deep dive.
The remaining sessions as follow-ups of 30 to 60 minutes each.
A complete review of your medical records and laboratory results before your first session.
A written action plan delivered within 24 hours of the deep dive.
Treatment, prescribing, second opinions, and specialist referrals as the plan requires, within our scope of practice (section 14).
Care for acute issues related to the problem we are working on, between sessions.

Home visits, unlimited visits, and unlimited messaging are membership benefits and are not included with a package.

Packages are billed as a single payment and renew every 12 months to maintain continuity of care. Package benefits are yours to use once purchased. No partial refunds are issued for packages. You may cancel auto-renewal at any time through your billing portal at your account; cancellation must be completed before the renewal date to stop the next charge.

8.5 Plan Changes

You may upgrade, downgrade, or cancel your plan at any time through your billing portal at your account. Some plans are offered on a single annual billing cycle and so have no other cadence to switch to in the portal; to move to or from one of those, contact us and we will make the change with you.

8.6 Chargebacks & Disputes

If you dispute a charge with your bank or credit card company instead of contacting us directly, we reserve the right to suspend services until the dispute is resolved. Please reach out to us first; we will work with you.

8.7 Fee Changes

We may adjust membership or package pricing with at least 30 days' written notice before the change takes effect. Existing billing cycles are honored at the original rate.

8.8 Good-Faith Estimate

Under the No Surprises Act, uninsured or self-pay patients are entitled to a Good-Faith Estimate of expected charges. You may request one at any time by contacting us.

8.9 No Copays, Deductibles, or Coinsurance

We do not bill insurance. All clinical services described in your membership or package are included in your membership fee or package price. You will not receive separate copays, deductibles, or coinsurance charges from us. Services obtained from third-party providers (such as labs, pharmacies, imaging centers, and hospitals) are billed by those providers directly under your insurance or out-of-pocket arrangement with them.

8.10 Laboratory Billing

Because we do not bill insurance, laboratory tests we order may be billed to your insurance directly by the lab, or offered on a cash-pay basis where you prefer or where state law requires it. Patients residing in New York and New Jersey have the right, under their respective state patient billing laws, to request an itemized price list from Fishtown Medicine for their laboratory tests.

9. Patient Responsibilities

You agree to provide accurate health information, maintain updated contact and payment information, follow agreed care plans, and seek emergency help when advised.

9.1 Respectful Conduct

Our clinicians and staff are entitled to a workplace free of abuse, and we hold ourselves to the same standard in how we treat you. You agree to communicate respectfully in every channel: visits, messages, phone calls, email, and public forums. The following are never acceptable and may end the care relationship immediately under section 19.2:

threats, intimidation, stalking, or violence directed at any clinician, staff member, or their family;
harassment, or discriminatory, demeaning, or sexually inappropriate conduct or language, including conduct based on race, ethnicity, national origin, religion, sex, gender identity, sexual orientation, disability, or age;
repeated contact intended to intimidate or exhaust rather than to obtain care;
knowingly giving false information to obtain a prescription, a controlled substance, a diagnosis, documentation, or payment from a third party;
recording or publishing our communications in a way that violates section 3 or applicable law.

9.2 Controlled Substances and Diversion

Obtaining controlled substances from multiple prescribers without telling us, diverting or selling a prescribed medication, or falsifying a drug screen ends the care relationship immediately and may be reported where the law requires it.

10. Technology Requirements & Security

You must maintain secure devices, updated software, and reliable internet or cellular service. We are not responsible for breaches originating from insecure personal devices.

Technology Disclaimer: Our platforms and third-party tools may contain bugs, errors, or service interruptions that could result in loss of data, incorrect records, or delays in diagnosis and treatment. By using the Service, you acknowledge and accept these inherent technological risks.

11. Third-Party Services & Disclosures

Independent labs, imaging centers, pharmacies, EHR vendors, e-signature services, and communication platforms operate under their own terms. BAAs exist for HIPAA-covered vendors. Cookie, tracking-pixel, and accessibility notices are maintained on our website.

11.1 Open Payments Notice

For informational purposes, the federal Centers for Medicare and Medicaid Services (CMS) Open Payments database is a federal tool used to search payments made by drug and device companies to physicians and teaching hospitals. It can be found at https://openpaymentsdata.cms.gov.

12. Product & Supplement Disclosures

We accept no compensation of any kind in exchange for clinical recommendations. Fishtown Medicine receives no commissions, kickbacks, affiliate revenue, or referral fees from pharmaceutical companies, device makers, laboratories, imaging centers, specialists, supplement vendors, or any other product company.

Any discount we negotiate on professional-grade supplements, laboratory testing, or imaging passes through to you in full. Our margin on the professional supplement service is set to zero, so you pay the professional price and the Practice retains none of the difference. No supplement or product purchase is ever required as a condition of care, and you are free to buy anything we recommend from any vendor you choose.

A small number of the product links we share carry the vendor's own referral code within the web address. Those codes record clicks and do not pay the Practice. If that arrangement ever changes, the Practice commits to directing all such funds toward purchasing those products for patients who need them and cannot afford them, and to disclosing the change on our public Disclosures page.

We do not sell supplements, devices, or other products, and we do not dispense medications on site. Prescriptions are routed to the pharmacy of your choice.

13. Controlled Substance Policy

We do not prescribe opioids for pain.
Benzodiazepines and stimulants are prescribed only under strict clinical criteria.

14. Scope of Practice - Services Not Provided

We do not provide obstetric care, neonatal or pediatric care, chronic opioid or benzodiazepine management, transplant care, surgery, or disability determinations.

15. Medicare, Medicaid & No-Insurance Billing

15.1 We Hold No Contracts With Insurers

Fruition Medicine PLLC d/b/a Fishtown Medicine has no participation agreement, network contract, or provider agreement with any health insurer, health plan, HMO, PPO, or managed care organization for the services it delivers. We submit no claims to any plan, we accept no payment from any plan, and nothing this practice provides is in-network under any policy.

That means your plan's network rules do not reach our fee, and it also means your plan will not cover it. If you are enrolled in an HMO or another plan that requires care be delivered by a designated in-network primary care provider, membership here does not satisfy that requirement and does not change whom your plan has assigned. Keeping your plan in good standing, including any designated-provider or referral requirements it imposes, remains yours to manage.

Care you receive elsewhere is unaffected. Labs, imaging, prescriptions, specialists, and hospitals bill you or your plan directly under your own arrangement with them.

15.2 We Do Not Serve Medicare or Medicaid Beneficiaries

We do not participate in, bill, or accept reimbursement from Medicare or Medicaid, and we do not provide services to beneficiaries of either program.

Our services are not covered by Medicare or Medicaid, and neither program will pay or reimburse for them.
You agree not to submit our charges, or any claim arising from our services, to Medicare or Medicaid for payment or reimbursement.
Membership fees are not reimbursable by Medicare or Medicaid, and time with us does not count toward any of their requirements.

15.3 Your Obligation to Tell Us, and Why It Is Yours

This is the most important patient responsibility in these Terms, because it is the one thing we cannot see for ourselves. We do not interact with insurers at all, so we have no way of learning that your coverage changed unless you tell us.

You agree to tell us in writing, promptly and in any case within 30 days, if any of the following becomes true while you are a patient here:

You enroll in Medicare Part A, Part B, Part C (Medicare Advantage), or Part D.
You enroll in Medicaid or Medical Assistance, in any state.
Either program becomes a secondary, supplemental, or dual-eligible source of coverage for you, including Medigap alongside Medicare, a D-SNP, or Medicaid picking up costs behind another plan.
You become eligible for either program and intend to enroll.

Secondary and supplemental coverage counts. People often think of themselves as "on" their commercial plan while Medicaid or Medicare quietly sits behind it. For our purposes there is no difference: if either program is in your coverage picture in any position, we need to know.

Watch the lab and imaging path in particular. This is where it happens by accident. You may pay us directly and never think about insurance again, but when you hand a card to a laboratory or an imaging center for something we ordered, that facility bills whatever coverage the card shows. If that turns out to be Medicare or Medicaid, a federal program has paid for care arising from a relationship it does not permit, and neither of us intended it. So while you are a patient here, do not present a Medicare or Medicaid card for any test, study, or prescription we have ordered.

What happens when you tell us. We will end the membership, refund the unused portion of your current billing period and any unused package sessions under section 19.1, transfer your records at no charge to whichever practice you choose, and point you toward primary care built for your coverage. Telling us is not a penalty and it is not something we will make awkward. Telling us late is the version that causes harm.

We may ask you to confirm your coverage status periodically. Confirming it honestly is part of your responsibilities under section 9.

16. Data Retention & Destruction

PHI is retained for at least seven years or as required by law, then securely destroyed.

17. Laboratory Products & Results Waiver

Certain services include laboratory testing. You understand that tests can provide false negative, false positive, or inconclusive results.

Direct Access Waiver: You hereby elect to exercise your direct right of access to test results under federal law. You knowingly waive any state-specific release delays and affirm your desire to receive testing results as soon as the testing report is complete, even if your provider has not yet reviewed them.

18. Children's Privacy (<16)

Our services and site are not directed to individuals under 16.

19. Right to Decline or End Care

A care relationship works in both directions, and either side may end it. This section says how, and what we owe you when it happens, because ending a relationship badly is how patients get hurt.

19.1 Ending Care With Notice

You may leave whenever you choose by cancelling under section 8.3.

We may end the relationship with 30 days' written notice when, in our clinical or professional judgment, continuing is no longer workable. Grounds include non-payment or repeated payment failure, repeated missed appointments, ongoing non-adherence to an agreed plan in a way that makes safe care impossible, a need for care outside our scope, a breakdown in the working relationship, or the conduct described in section 9.1.

During those 30 days you are still our patient. We continue urgent and emergency-related guidance, refill medications as clinically appropriate to bridge you to your next clinician, send your records at no charge to whomever you name, and point you toward practices, urgent care, or community resources that fit your situation. Section 8.3 gives no partial refund when you cancel; when we end a membership mid-cycle, we refund the unused portion of the current billing period. If you hold unused package sessions when we end the relationship, we refund those sessions at the per-session rate.

19.2 Ending Care Immediately

We may end the relationship without the 30-day notice period when continuing would put our clinicians, our staff, or other patients at risk, or where the law requires it. That includes threats or acts of violence, stalking, harassment, weapons brought onto our premises or into a visit, the conduct in section 9.2, payment or insurance fraud, and any conduct that makes continuing unsafe or unlawful.

Even then you are not left without a path. We tell you in writing, transfer your records at no charge, refund the unused portion of your current billing period and any unused package sessions, and direct you to emergency services (911), urgent care, and crisis resources (988) where relevant. What we will not do is continue a relationship that is unsafe for the people in it.

19.3 Declining to Begin Care

We may decline to establish a care relationship, including after a discovery call or a completed intake, when your needs fall outside our scope of practice (section 14), when we cannot safely take on your care, when you are enrolled in Medicare or Medicaid (section 15), or when we are not accepting new patients. If you have paid and we decline to begin, we refund you in full.

19.4 What We Will Never End Care Over

We will not end a care relationship because of your race, ethnicity, national origin, religion, sex, gender identity, sexual orientation, disability, age, or source of payment. We will not end it because you sought a second opinion, declined a recommendation, asked hard questions, or requested your records. We will not end it because you filed a complaint with us, a licensing board, or a regulator.

19.5 Your Records Either Way

Ending the relationship never affects your right to your medical record. Records go to you or to the clinician you name at no charge, in the format you ask for when we can produce it, under the timelines in our Notice of Privacy Practices.

20. Indemnification

You agree to indemnify Fishtown Medicine for claims arising from misuse of services or violation of these Terms.

21. Force Majeure

Neither party is liable for delays or interruptions caused by events beyond reasonable control.

22. Feedback License

Suggestions or testimonials may be used to improve services. PHI is never used publicly without permission.

23. Intellectual Property

Site and service content is owned or licensed by Fishtown and may be used only for personal, non-commercial purposes.

24. Disclaimers & Limitation of Liability

Services are provided "as-is" and "as-available." Liability is limited to the amount paid for services giving rise to the claim.

25. Severability & Waiver

Invalid provisions do not affect remaining terms. Non-enforcement of rights is not a waiver.

26. Changes to These Terms

We may update these Terms to reflect legal or operational changes. Continued use constitutes acceptance.

27. Governing Law & Dispute Resolution

These Terms are governed by Pennsylvania law unless federal law applies. Disputes are resolved through binding arbitration in Philadelphia, PA except where prohibited by law.

28. HIPAA Breach Notification & Security Program

We notify affected individuals of any breach of unsecured PHI within 60 days of discovery and maintain a detailed security program consistent with federal requirements.

29. AI-Generated & Automated Content Disclosure

AI tools assist with drafting educational materials and automating reminders. A licensed clinician reviews all patient-specific content before release.

Our public website also offers a chat answered by an AI assistant. The assistant is a computer program, not a licensed clinician, and it does not provide medical advice, diagnosis, or treatment. It shares information about how the practice works, drawing on our published materials, and it can point you to scheduling a call. It does not speak for your clinician, and decisions about your care are made only by your clinician.

30. Contact Information

Compliance Officer - Fishtown Medicine 2418 E York St, Philadelphia, PA 19125 Phone: (267) 360-7927 Email: compliance@fishtownmedicine.com