Telehealth Informed Consent

01What telehealth is

Telehealth is the delivery of health care using communications technology when you and your clinician are in different locations. At Reborn Rx, telehealth may include:

Asynchronous ("store-and-forward") review

You complete a structured medical intake, upload documents or photographs, and your clinician reviews them and responds without a live conversation.

Synchronous audio-video visits

A real-time video consultation with your clinician.

Audio-only visits

A real-time telephone consultation, where permitted by your state and clinically appropriate.

Secure messaging

Ongoing non-urgent communication with your care team through the patient portal.

Which modality is used is not your choice alone. Some states require a live audio-video visit before a prescription may be issued. Your clinician may also require a live visit regardless of the state minimum, based on your history. You will be told which applies to you before you are charged.

02Potential benefits

• Access to a licensed clinician without travel or time away from work;
• Shorter waits than many in-person appointments;
• Care from your own home, which some patients find easier for discussing weight and body image;
• Structured, written intake that gives your clinician a more complete history than a rushed office visit often allows;
• Continuous access to your care team between visits through secure messaging.

03Risks and limitations you should understand

Other limitations and risks:

• Incomplete information. Your clinician relies on what you report. If your history is incomplete or inaccurate, the evaluation and any treatment decision may be wrong or unsafe.
• Delays. Asynchronous review is not immediate. Responses may take one or more business days. Telehealth is not appropriate for anything urgent.
• Technology failure. Connectivity problems, equipment failure, or poor image quality may interrupt a visit or degrade the information available to your clinician.
• Security. We use encryption and access controls, but no electronic transmission is perfectly secure. In rare cases a breach could result in unauthorized access to your information.
• Referral may still be needed. Laboratory testing, imaging, vital signs, and any physical examination require in-person services that you must obtain locally.
• Continuity. You may not always communicate with the same clinician, although your full record is available to whoever is treating you.

04No guarantee of a prescription or of any outcome

Completing the intake and submitting payment details does not mean you will be prescribed medication. Your clinician exercises independent professional judgment and may decline to prescribe, may prescribe something other than what you expected, may require laboratory testing or a live visit first, or may determine that telehealth is not an appropriate setting for your care.

No clinician can predict how you will respond to treatment. No specific outcome is promised or implied.

05When telehealth is not appropriate

Your clinician will direct you to in-person care if, in their judgment, remote evaluation is not adequate or safe. This is more likely if you report:

• Active cancer, or a previous cancer diagnosis without oncology clearance;
• Current pregnancy, an attempt to conceive, or breastfeeding;
• Severe kidney or liver disease;
• Acute critical illness, recent major surgery, or respiratory failure;
• Symptoms that require examination, imaging, or urgent evaluation;
• A clinical picture that is inconsistent, incomplete, or that cannot be verified remotely.

Being referred to in-person care is a clinical decision made for your safety, not a rejection. There is no charge for an evaluation that ends this way.

06Emergencies

You agree to inform your clinician of the address where you are physically located during each visit, so that emergency services can be directed to you if needed.

07Records, recording, and who is present

Everything relevant to your care — your intake, messages, visit notes, orders, and prescriptions — is documented in your medical record and protected under HIPAA as described in the Notice of Privacy Practices.

We do not record video or audio visits unless we tell you in advance and obtain your consent. You may not record a visit without your clinician's consent. Your clinician will tell you if anyone else, such as a trainee or interpreter, is present, and you may ask that they leave.

Interpretation services are available at no cost to you. Ask your care team in advance.

08Your rights as a telehealth patient

• You may withdraw this consent at any time, in writing to your care team, without affecting your right to future care or your standing with us.
• You may request an in-person visit instead at any point. We will help you find local care, though we cannot provide it ourselves.
• You may request a different clinician without giving a reason.
• You may access and obtain a copy of your medical record.
• You may know the name, credentials, and state license number of any clinician who treats you. These appear in your patient portal. See Our Clinicians for how to verify a license.
• You may refuse any recommended treatment and be told the likely consequences of doing so.
• You may have your prescription sent to a pharmacy of your choosing.

09Your consent

By checking the consent box in your intake, you confirm that:

• You have read and understood this document and have had the opportunity to ask questions;
• You understand the benefits, risks, and limitations of telehealth described above, including that no physical examination can be performed;
• You understand that no prescription and no outcome is guaranteed;
• You are at least 18 years old and physically located in the United States;
• The information you have provided is true and complete to the best of your knowledge; and
• You consent to receive health care services from the Medical Group by telehealth.