This Consent to Telehealth Services explains the use of telehealth in connection with healthcare services made available through NU MD. Please read this document carefully before participating in a telehealth consultation.

WHAT IS TELEHEALTH?

Telehealth involves the delivery of healthcare services through electronic communications and technology when the patient and healthcare provider are in different physical locations.

Telehealth services may include:

• Video or audio consultations with a licensed healthcare provider
• Electronic review of health questionnaires, medical history, photographs, laboratory results, diagnostic information, and other health records
• Secure electronic communications between patients and healthcare providers
• Evaluation, diagnosis, treatment recommendations, prescriptions, follow-up care, and health education when medically appropriate
• Coordination with laboratories, pharmacies, healthcare facilities, and other authorized service providers

Telehealth services may be provided through real-time video, telephone, secure messaging, store-and-forward technology, or other legally permitted communication methods.

PROVIDER RELATIONSHIP

Healthcare services are provided by appropriately licensed healthcare professionals authorized to practice in the state where the patient is physically located at the time of the consultation.

NU MD may provide administrative, technology, scheduling, communication, and care-coordination support. Medical decisions are made solely by the licensed healthcare provider responsible for the patient’s care.

The identity and professional credentials of the treating provider will be made available to the patient as required by applicable law.

PATIENT LOCATION AND IDENTIFICATION

At the beginning of each telehealth encounter, I may be asked to:

• Confirm my identity and date of birth
• State my current physical location
• Provide accurate contact information
• Identify other individuals present during the consultation
• Provide emergency contact information when appropriate

I understand that I must be physically located in a state where the treating provider is authorized to practice. If I change locations during a consultation, I will immediately inform the provider.

BENEFITS OF TELEHEALTH

Potential benefits of telehealth may include:

• Improved access to healthcare services
• Greater convenience and reduced travel
• More timely communication with healthcare providers
• Access to providers who may not be located nearby
• Improved coordination and continuity of care

I understand that these benefits are not guaranteed.

RISKS AND LIMITATIONS

I understand that telehealth has potential risks and limitations, including:

• The provider’s inability to conduct a complete in-person physical examination
• The possibility that the information available through telehealth may be insufficient to make a diagnosis or treatment decision
• Delays or interruptions caused by equipment failure, internet problems, software issues, or other technical difficulties
• Unauthorized access, security breaches, or loss of electronic health information despite reasonable safeguards
• Miscommunication caused by poor video, audio, image quality, or incomplete information
• Delays in medical evaluation or treatment
• The need for laboratory testing, imaging, an in-person examination, emergency care, or referral to another healthcare professional
• The possibility that a provider may determine that telehealth is not appropriate for my condition

The provider may discontinue or reschedule a telehealth encounter if the technology is inadequate, patient safety may be affected, or an in-person examination is medically necessary.

ALTERNATIVES TO TELEHEALTH

I understand that alternatives to telehealth may include seeking care from an in-person healthcare provider, urgent care center, hospital, emergency department, or another qualified healthcare professional.

I may decline telehealth services and seek an in-person evaluation. Declining telehealth will not prevent me from obtaining care from another provider, although NU MD may not be able to provide the requested service through its platform.

EMERGENCY AND URGENT CONDITIONS

Telehealth services offered through NU MD are not intended for medical emergencies.

If I believe I am experiencing a medical emergency, including severe chest pain, difficulty breathing, loss of consciousness, signs of a stroke, severe allergic reaction, suicidal thoughts, or another potentially life-threatening condition, I will immediately call 911 or go to the nearest emergency department.

I understand that messages sent through a website, patient portal, email, or other electronic system may not be reviewed immediately and should not be used for emergency communication.

PRESCRIPTIONS AND TREATMENT DECISIONS

I understand that submitting an assessment or participating in a telehealth consultation does not guarantee that I will receive a diagnosis, prescription, medication, laboratory order, or particular treatment.

All treatment and prescribing decisions are made by the licensed healthcare provider based on professional medical judgment, the information available, applicable laws, and whether the requested treatment is medically appropriate.

A provider may require additional records, laboratory testing, identity verification, an in-person examination, or consultation with another healthcare professional before providing treatment.

Prescriptions will not be issued when prohibited by law or when the provider determines that a medication or treatment is not medically appropriate.

PATIENT RESPONSIBILITIES

I agree to:

• Provide complete, current, and truthful information concerning my identity, location, symptoms, medical history, medications, allergies, laboratory results, and other relevant health information
• Inform the provider of changes in my health or medications
• Ask questions when I do not understand information or instructions
• Follow treatment instructions and complete requested testing or follow-up care
• Participate from a reasonably private and safe location
• Avoid driving or operating machinery during a telehealth consultation
• Seek emergency or in-person care when instructed or when my condition worsens

I understand that inaccurate, incomplete, or misleading information may result in inappropriate treatment, delayed treatment, denial of services, or termination of the provider-patient relationship.

PRIVACY AND SECURITY

My health information will be collected, used, maintained, and disclosed in accordance with applicable privacy laws, the NU MD Privacy Policy, and the applicable Notice of Privacy Practices.

Reasonable administrative, physical, and technical safeguards are used to protect health information. However, no electronic communication or information system can be guaranteed to be completely secure.

I am responsible for taking reasonable steps to protect my privacy, including participating from a private location, securing my device and passwords, and preventing unauthorized individuals from viewing or hearing the consultation.

Individuals other than the treating provider may participate in or have access to information from the consultation when reasonably necessary for treatment, healthcare operations, technical support, interpretation, care coordination, pharmacy services, laboratory services, or other legally permitted purposes.

RECORDING

Telehealth consultations will not be photographed, recorded, or reproduced by NU MD or the treating provider without obtaining any authorization required by applicable law, except where recording is legally permitted or required.

I agree not to photograph, record, distribute, livestream, or reproduce a telehealth consultation without the prior written consent of the provider and all other participants.

FINANCIAL RESPONSIBILITY

I understand that I am responsible for all disclosed charges associated with telehealth services, laboratory testing, medications, pharmacy services, shipping, and other requested services unless otherwise stated in writing.

NU MD does not guarantee that telehealth services, medications, laboratory testing, or related expenses will be covered or reimbursed by an insurance plan, health savings account, or flexible spending account.

NO GUARANTEE OF RESULTS

Healthcare outcomes differ among individuals. I understand that no provider or representative of NU MD has guaranteed any particular diagnosis, treatment outcome, medication result, weight loss, hormone level, symptom improvement, or other medical result.

RIGHT TO ASK QUESTIONS AND WITHDRAW CONSENT

I have the right to ask questions about telehealth services before or during my consultation.

I may withdraw my consent to telehealth at any time by notifying NU MD or my healthcare provider. Withdrawal will not affect services already provided or actions already taken in reliance on my consent. Withdrawal may prevent NU MD or the provider from continuing to provide services remotely.

A provider may also discontinue telehealth services when telehealth is no longer medically appropriate or legally permitted.

STATE-SPECIFIC REQUIREMENTS

I understand that additional disclosures, limitations, or consent requirements may apply based on the state where I am physically located. Any applicable state-specific notices or supplemental terms are incorporated into this consent.

CONSENT AND ACKNOWLEDGMENT

By signing electronically or selecting the consent checkbox below, I acknowledge and agree that:

I have read and understand this Consent to Telehealth Services.

I have had the opportunity to ask questions.

I understand the benefits, risks, limitations, and alternatives associated with telehealth.

I voluntarily consent to receive healthcare services through telehealth.

I authorize the electronic transmission and review of my health information as reasonably necessary to provide and coordinate my care.

I understand that telehealth is not appropriate for medical emergencies.

I understand that no particular treatment, prescription, medication, or outcome is guaranteed.