Telehealth Informed Consent

1. What telehealth means

Telehealth is the delivery of healthcare services using electronic communications rather than an in-person office visit. Through the Platform, telehealth generally consists of you submitting a written medical intake and other requested information electronically. A licensed healthcare professional affiliated with the applicable Medical Practice reviews your submitted information, exercises independent professional judgment, and determines whether you are an appropriate candidate for the limited wellness services offered by that Medical Practice.

If appropriate, a prescription may be issued and transmitted to a licensed pharmacy. If not, your request may be declined or additional information may be requested.

2. Asynchronous (store-and-forward) telehealth

The Platform primarily utilizes asynchronous, or store-and-forward, telehealth. This means you and your treating healthcare professional generally do not communicate in real time. As a result, responses may not be immediate. Instead: you submit information electronically; your treating healthcare professional reviews your submitted information and medical history independently; and a clinical determination is communicated to you through the Platform.

If additional information is necessary, your treating healthcare professional may request it before making a clinical determination. If sufficient information cannot be obtained or telehealth is not appropriate, services may be declined.

3. Identity verification

To protect patient safety, comply with applicable law, and help prevent fraud, we reserve the right to request government-issued identification or other information to verify your identity before providing care or prescribing medication.

4. Telehealth is not emergency care

The Platform does not provide emergency medical services. Do not use the Platform if you are experiencing a medical emergency, chest pain, difficulty breathing, severe allergic reactions, stroke symptoms, severe bleeding, suicidal thoughts or a mental health crisis, or any condition requiring immediate medical attention.

If you are experiencing a medical emergency, call 911 or immediately go to the nearest emergency department. If you are experiencing a mental health crisis, call or text 988. The Platform is also not intended for urgent medical conditions requiring immediate evaluation.

5. Benefits of telehealth

Potential benefits include:

• Convenient access to licensed healthcare professionals.
• Ability to receive services without traveling to a medical office.
• Electronic review of your submitted information.
• Secure communication through the patient portal.
• Home delivery of prescribed medications, when applicable, through a licensed pharmacy.

6. Risks and limitations

Telehealth has limitations that differ from in-person medical care, including:

• Your treating healthcare professional cannot perform a hands-on physical examination.
• Telehealth may not allow your treating healthcare professional to observe or assess certain physical findings that could be identified during an in-person examination.
• Some medical conditions cannot be appropriately evaluated through telehealth.
• Technical failures may interrupt or delay communications or services.
• Although reasonable safeguards are used, electronic communications cannot be guaranteed to be completely secure.
• Your treating healthcare professional may determine that telehealth is not appropriate for your situation.

Telehealth may not be appropriate for every individual or every requested wellness service.

7. Your responsibilities

You agree to:

• Provide truthful, accurate, complete, and current information.
• Disclose all medications, allergies, medical conditions, symptoms, and other information requested.
• Promptly notify the Medical Practice of any changes to your health, medical history, medications, allergies, symptoms, or other information that may affect your eligibility for the limited wellness prescribing services or the safety or appropriateness of any prescribed medication.
• Respond promptly to requests for additional information made by your treating healthcare professional.
• Use prescribed medications only as directed.
• Not share prescription medications with others.
• Maintain an ongoing relationship with a primary care provider and obtain specialty medical services when appropriate for healthcare needs outside the limited wellness prescribing services offered through the Platform.
• Seek emergency services when appropriate rather than using the Platform.

If you enroll in recurring medication shipments, you agree to promptly notify the Medical Practice before any scheduled shipment of any significant changes to your health, medical history, medications, allergies, or symptoms that may affect the safety or appropriateness of any prescribed medication. If you report a significant change, or if the Medical Practice otherwise becomes aware of one, your treating healthcare professional may require additional information or an additional clinical evaluation related to the limited wellness prescribing services before any further medication is prescribed.

Your treating healthcare professional relies upon the information you provide when determining whether the limited wellness prescribing services remain appropriate for you. Providing inaccurate, incomplete, misleading, or outdated information, or failing to disclose a significant change, may delay the prescribing process, require additional information or clinical evaluation, or result in a determination that telehealth is not appropriate or that the limited wellness prescribing services cannot be safely or appropriately provided.

8. Privacy and medical records

Protected Health Information ("PHI") submitted through the secure intake process is maintained within the applicable Medical Practice's HIPAA-compliant electronic health record. Your telehealth encounters become part of your medical record and may be used and disclosed as permitted by applicable law and the applicable Medical Practice's Notice of Privacy Practices. Public informational webpages on the Platform are not intended for the transmission of PHI. Additional information is available in the applicable Medical Practice's Notice of Privacy Practices and the Yuvia Privacy Policy.

9. Electronic communications

You consent to receive communications through the patient portal, secure messaging, email, telephone, text message, or other electronic means, as permitted by applicable law, regarding requests for additional information, eligibility determinations, administrative matters, billing, account notifications, and other communications relating to your requested wellness services. Clinical communications containing PHI may be provided through the secure patient portal or other secure methods. Electronic communications should not be used for medical emergencies or urgent medical concerns.

10. Licensing and patient location

Healthcare services may only be provided where the applicable Medical Practice and your treating healthcare professional are authorized to provide services. You certify that you are physically located in a jurisdiction where your treating healthcare professional is authorized to provide telehealth services at the time your submission is reviewed. You agree to promptly notify the Medical Practice if your physical location changes before services are provided or if any location information becomes inaccurate. If you are located in a jurisdiction where services cannot legally be provided, your request may be delayed or declined.

11. Specialist consultation and emergency care

If medically appropriate, your treating healthcare professional may recommend consultation with another healthcare professional or immediate emergency medical evaluation. You agree to follow those recommendations.

12. No guarantee of services or prescriptions

Submitting an intake, creating an account, or paying applicable fees does not guarantee: establishment of a provider-patient relationship; approval for any requested wellness service; issuance of any prescription; continued eligibility for services; or availability of any requested medication. All clinical decisions are made solely by your treating healthcare professional using independent professional judgment.

13. Alternatives to telehealth

You are not required to receive services through telehealth. Alternatives include seeking care from your primary care provider, another qualified healthcare professional, an urgent care center, or a hospital or emergency department when appropriate.

14. Withdrawal of consent

You may withdraw this consent at any time by contacting the applicable Medical Practice or discontinuing your request for telehealth services before services are provided. Withdrawal of consent will not affect services already rendered, prescriptions already issued, medications already dispensed, or fees already incurred.

15. Your acknowledgment and consent

By electronically accepting this Telehealth Informed Consent, submitting an intake, or requesting telehealth services, you acknowledge and agree that:

• You are at least eighteen (18) years of age or otherwise legally authorized to consent to treatment.
• You have read and understand this Telehealth Informed Consent, including the nature, benefits, risks, and limitations of telehealth.
• You understand that telehealth has limitations compared with in-person medical care and may not be appropriate for every individual or every requested wellness service.
• You understand that your treating healthcare professional may request additional information, and may decline to provide services or prescribe medication when clinically appropriate.
• You understand that submission of an intake does not guarantee services or prescriptions.
• You understand that you may withdraw this consent at any time before services are provided.
• You voluntarily consent to receive telehealth services through the Platform.

Questions regarding telehealth services may be directed to the applicable Medical Practice using the contact information provided on the Platform.