I have been prescribed medicines by my doctor and been provided professional advice on the diagnosis and treatment of my medical condition. I would like, however, to know more about the medicine and avail of patient care related services such as treatment schedule reminders and follow-up calls after drug administration, and order placement. Therefore, I am voluntarily joining the Patient Assistance Program (“Program”). This Program and my participation in this Program were clearly and thoroughly explained to me by my doctor and I understand that joining this Program may help me sustain treatment adherence and thus achieve better health outcomes.

MedGrocer acknowledges and respects the privacy of individuals.

I understand that:

1. MedGrocer is the administrator of the Program;
2. MedGrocer's Coordinators will provide me with more information on the mechanics and benefits of the Program;
3. The MedGrocer Coordinator may collect, use, and process my personal information, including health and medical information, for my enjoyment of the benefits of the Program. I acknowledge that any information relayed to me by MedGrocer is for informative purposes only and not meant to replace the professional advice of my doctor;
4. MedGrocer will collect, use, and process my personal information and my contact person with full and strict confidentiality in accordance with MedGrocer’s Privacy Policy and in compliance with Republic Act No. 10173 or the “Data Privacy Act of 2012”, its Implementing Rules and Regulations, and the applicable issuances of the National Privacy Commission;
5. MedGrocer will share my relevant personal information and my contact person, such as name and contact details, to MedGrocer’s authorized business partners, service providers, pharmacies, and distributors to enable the latter to assist MedGrocer in the implementation of the Program, including the delivery of ordered placements;
6. I and my contact person have the right to access, correct, update, and object to the processing personal information of myself and my contact person, respectively, at any time by submitting a written request to the Data Protection Officer of MedGrocer and, in appropriate cases, to lodge a complaint before the National Privacy Commission. For any data privacy related questions, comments, concerns, or complaints, I may contact MedGrocer’s Data Privacy Officer at dpo@medgrocer.com;
7. The MedGrocer Coordinator will email, call, and/or send me and my contact person text messages to provide reminders, and updates on the Program and we can contact the MedGrocer Coordinator to clarify any concerns about the Program and to correct any personal information we have given;
8. I will comply with all guidelines of the Program to enjoy its benefits; otherwise, my enrollment in the Program may be terminated;
9. MedGrocer reserves the right to terminate any of the benefits available under the Program or the Program itself at any time without prior notice. In the event of any such termination, I can coordinate with MedGrocer on a proper transition plan for exiting the Program; and
10. I acknowledge that I have been advised to immediately notify my doctor and arrange for medical consultation as may be required should I experience any adverse event or side effects after using the prescribed medicine/s under the Program. MedGrocer, as Program administrator, and Johnson & Johnson (Philippines), Inc. (“JJPI”), as the distributor of the medicines under the Program, are obliged to collect details of any adverse events or product quality complaints that I may experience with the prescribed medicines included in the Program during the conduct of the Program and throughout my treatment. If an adverse event or product complaint is identified, I agree that JJPI and/or MedGrocer will collect this information from either me and/or my doctor for safety reporting and/or pharmacovigilance purposes only. I am aware that if I provide adverse event or product quality complaint information, it may be shared with regulatory agencies, JJPI, JJPI’s affiliates worldwide, and business partners with whom JJPI has contractual agreements for pharmacovigilance purposes only. JJPI may call my doctor and I consent to my doctor sharing personal information, including health and medical information, if more information is needed.
11. I allow MedGrocer to: a. disclose my personal information to regulatory agencies or other third parties, as may be required under applicable laws; b. when circumstances warrant, transfer or transmit my personal information to an authorized service provider only for the purpose of continuing the administration of the Program and in which I am enrolled; c. perform the upload or transition of personal information into an existing or future PAP via its platform/processing system; and d. transfer of the information to jurisdictions located outside my country of residence, including the United States, which may provide for different data protection rules than in my country. Appropriate contractual and other measures are in place to protect my personal information when it is transferred.
12. I have been advised by my doctor that I am suitable for treatment with prescribed medicine and meet the clinical eligibility criteria of the Program.
13. There is no guarantee that I may derive clinical benefit from the prescribed medicine and my doctor has explained the risks and potential benefits of prescribed medicine for my condition.
14. My doctor has explained the details of the Program.
15. Unless otherwise terminated by the program owner, my participation in this Program continues until (a) my doctor believes that I am not experiencing clinical benefit from the prescribed medicine, or (b) I withdraw from the Program.
16. Any other medications prescribed by my doctor will need to be dispensed from my usual pharmacy according to my doctor's instructions.
17. After I commence my treatment, I need to visit my doctor to receive a new prescription or as per my doctor's advice.
18. I acknowledge receipt of a patient information booklet explaining the Program.

I hereby represent and warrant that all personal information that myself and my contact person have provided for/will provide in connection with my application for and enrollment in this Program are correct, accurate, and complete. I confirm that my participation in this Program is voluntary and I am free to withdraw at any time based on my own decision or as recommended by my doctor and as such I will inform the MedGrocer Coordinator of my withdrawal from the Program by emailing careplus@medgrocer.com.

Patient Authorization. Once and while enrolled in the Program, I consent to and authorize my attending physician’s sharing with or disclosure to MedGrocer of my personal data, including health and medical information, relevant to my availment of the benefits under the Program, including the ordering and procurement by my attending physician of prescribed pharmaceutical products and/or medical device for my use.

In the course of my participation in this Patient Access Program (PAP), I represent and warrant:

1. That I shall strictly adhere to the terms and conditions of this PAP and the corresponding MedGrocer Terms and Conditions;
2. That I shall not sell, transfer or cause the sale and/or the transfer of the medicines made available under the PAP to any third parties; and
3. My compliance with all applicable laws, regulations, orders and any requirements of any governmental authority relating to, without limitation, all operations or practices whatsoever which may directly or indirectly relate to my participation in this PAP.

I hereby agree to indemnify and hold MedGrocer, Johnson & Johnson (Philippines), Inc. and its partners free and harmless from any and all losses, claims, demands, suits and actions due to or as a consequence of any acts or omissions resulting in any failure to comply with the terms and conditions of this Program, applicable laws, rules and regulations and any failure on my end to uphold the representations and warranties required to be made hereunder.