Fluconazole
H&P Certification — Fluconazole
KosherMedications.com
Health & Physical (H&P) Self-Assessment Declaration
By completing my purchase of Fluconazole through KosherMedications.com, I certify under penalty of perjury that the following statements are true and correct to the best of my knowledge and belief. I understand that a licensed healthcare provider will rely upon this information when determining whether a prescription is clinically appropriate.
General Information
I affirm that I:
am 18 years or older, completing this assessment for myself, voluntarily, and providing accurate identifying information including my full name, address, and contact details.
will use this service and any prescribed medication solely for myself and will not share or distribute it to others.
understand that medications are dispensed only if medically appropriate, based on my self-assessment and provider review.
acknowledge that a licensed healthcare provider may contact me for clarification or additional information before approval.
have reviewed and accepted KosherMedications.com’s Terms of Service and Consent to Telehealth, which govern my use of this platform and related care.
Consent to Telehealth
I understand and acknowledge that:
This service uses an asynchronous telehealth model, allowing me to provide health information online for review by a licensed provider.
A valid provider-patient relationship is created for this encounter and may include follow-up communication if needed.
Telehealth is a supplemental mode of care and does not replace in-person evaluation or follow-up with my primary provider.
Because of the nature of telemedicine, the reviewing provider cannot continuously monitor my condition, lab values, or side effects. I accept these limitations and associated risks.
All personal and medical information will be transmitted and stored securely, in compliance with HIPAA and applicable privacy laws.
In the event of a medical emergency, I will call 911 or seek immediate in-person emergency care and will not rely on telehealth communication for urgent or life-threatening issues.
Clinical Information Related to Fluconazole
I confirm that I:
am using or requesting this medication for susceptible Candida infections (e.g., vulvovaginal candidiasis or oropharyngeal candidiasis) as deemed appropriate by a licensed provider; I understand that this service is not intended for systemic or life-threatening fungal infections (e.g., cryptococcal meningitis).
have not experienced allergic or hypersensitivity reactions to fluconazole or other azole antifungals.
do not have a personal history of prolonged QT interval, significant arrhythmias, or other heart conditions that could be worsened by QT prolongation.
am not taking contraindicated CYP3A4 substrates that prolong the QT interval (for example, erythromycin, pimozide, or quinidine).
understand that fluconazole is a moderate inhibitor of CYP2C9, CYP2C19, and CYP3A4 and can raise levels of certain medications; I will disclose all medicines, supplements, and herbals to the provider and pharmacist.
am not taking medicines that lower potassium or magnesium, which can increase QT-related risk, or I will discuss necessary monitoring with my provider.
do not have known liver disease or previous hepatic injury related to azole antifungals; I understand that fluconazole can cause hepatotoxicity ranging from asymptomatic enzyme elevations to liver failure.
do not have significant renal impairment; if I do, I will inform the provider because dose adjustment may be required.
understand possible serious skin reactions (e.g., Stevens–Johnson syndrome, toxic epidermal necrolysis, DRESS) and will seek care if rash, mucosal lesions, fever, or systemic symptoms occur.
understand fluconazole may cause dizziness or seizures and will use caution with driving or operating machinery if affected.
will take the medication exactly as prescribed and complete the recommended regimen; I understand that inappropriate or prolonged use can promote resistance or secondary infections.
am not pregnant or breastfeeding; I understand fluconazole has pregnancy risks and will avoid use during pregnancy unless a provider determines the benefits outweigh the risks. I will stop and inform a provider immediately if I become pregnant.
Health Status & Representations
I attest that I:
am in generally good health, apart from the condition for which I am seeking care.
have truthfully disclosed all relevant medical history, medications, and allergies.
understand that my submission may be reviewed by a licensed provider, who may reach out for clarification before issuing a prescription.
confirm that this certification represents all relevant information I would disclose during an in-person medical visit.
General Information About Prescription Medications
I understand that:
This certification does not list every possible precaution, risk, or side effect related to fluconazole.
I can find more detailed information at:
I will review the Medication Guide included with my prescription and consult my healthcare provider if I have further questions.
Pharmacy & Fulfillment Information
I acknowledge that:
KosherMedications.com partners with licensed pharmacies to dispense medications in accordance with state and federal law.
Reviewing providers act independently and are not employees of the pharmacy.
I consent to receive education materials, refill notifications, and updates electronically.
I am responsible for reviewing this certification and contacting support@koshermedications.com with any concerns prior to taking my medication.
Emergency Disclaimer
I understand that KosherMedications.com and its affiliated providers do not provide emergency medical services.
In the event of an emergency or severe reaction, I will call 911 or seek immediate in-person care at the nearest emergency department.