Telehealth Informed Consent

1. Purpose of This Consent

This document provides informed consent for receiving healthcare services via telehealth through MyCare MD LLC ("MyCare MD," "we," "us," or "our"). The purpose of this consent is to ensure that you, the patient, are fully informed about the nature of telehealth services, including the benefits, risks, and limitations, before you receive care through our platform.

By using MyCare MD telehealth services, you acknowledge that you have read, understand, and voluntarily agree to the terms outlined in this Telehealth Informed Consent. You should read this document carefully and in its entirety. If you have any questions or concerns about any portion of this consent, you are encouraged to contact us at support@mycaremd.com or 941-499-7686 before proceeding with any telehealth consultation.

Your consent is required before any telehealth consultation can take place. You may withdraw your consent at any time as described in Section 7 of this document.

2. Definition of Telehealth

Telehealth is the delivery of healthcare services using electronic communications, information technology, and telecommunications when the patient and the healthcare provider are not in the same physical location.

MyCare MD telehealth services include, but are not limited to:

• Asynchronous (Store-and-Forward) Consultations: The primary mode of consultation on our platform, in which you complete health questionnaires and provide medical history, symptoms, and other relevant health information through the patient telehealth portal. Your healthcare provider reviews this information and responds with a clinical assessment, treatment recommendations, and, when clinically appropriate, a prescription.
• Secure Messaging: Communication between you and your healthcare provider through the patient telehealth portal for follow-up questions, care coordination, and ongoing management of your treatment.
• Synchronous (Real-Time) Consultations: When clinically indicated, your healthcare provider may request a live video or phone consultation to gather additional information, perform a visual assessment, or discuss your treatment plan in greater detail.

All telehealth services are conducted using secure, HIPAA-compliant technology platforms designed to protect the confidentiality and integrity of your health information. You access your healthcare provider through the MyCare MD patient telehealth portal.

Telehealth is not intended to replace all in-person healthcare services. There are circumstances in which your provider may determine that an in-person visit is necessary for proper evaluation and treatment.

3. Healthcare Providers

Medical consultations provided through MyCare MD are delivered by licensed healthcare providers within the Beluga Health physician network. All healthcare providers who deliver care through our platform are:

• Independently licensed physicians (MDs or DOs), nurse practitioners (NPs), or physician assistants (PAs) who hold active, unrestricted licenses in good standing.
• Licensed in your state at the time of consultation. All providers are licensed in the state where you, the patient, are physically located at the time of your telehealth consultation, in compliance with applicable state and federal telehealth regulations.
• Credentialed and vetted through the Beluga Health physician network to ensure they meet professional standards of care.

MyCare MD LLC facilitates the connection between patients and licensed healthcare providers but does not itself practice medicine, provide medical advice, or establish a provider-patient relationship. The provider-patient relationship is established between you and the treating healthcare provider who reviews your consultation and provides clinical care.

The treating provider exercises independent clinical judgment in evaluating your condition, recommending treatment, and determining whether a prescription is clinically appropriate.

4. Scope of Services

MyCare MD provides telehealth services that include the following:

• Online medical consultations for eligible conditions as determined by the treating healthcare provider.
• Review of medical history and health questionnaire responses submitted by you through the patient telehealth portal.
• Clinical assessment and treatment recommendations based on the information you provide, the provider's clinical expertise, and applicable standards of care.
• Prescription of medications when clinically appropriate, at the sole discretion of the treating healthcare provider. All prescriptions are dispensed and fulfilled by The Pharmacy Hub 2 LLC, located at 2750 Bridge Way, Unit 180, Davie, FL 33314.
• Follow-up care and medication management through the telehealth portal, including ongoing communication with your provider regarding your treatment plan, medication adjustments, and any questions or concerns.

Important Limitations on Scope:

MyCare MD telehealth services are NOT intended for emergency or life-threatening conditions. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room immediately. Do not use the telehealth portal to seek care for emergencies.

Not all medical conditions are appropriate for telehealth evaluation and treatment. Your healthcare provider may determine that your condition requires an in-person examination and may refer you to a local provider, specialist, or emergency facility as clinically indicated.

5. Benefits of Telehealth

Telehealth services offer a number of potential benefits, including but not limited to:

• Convenient access to healthcare from your home or any private location with internet access, without the need for travel to a physical clinic or office.
• Reduced travel time and associated costs, eliminating the need for transportation, parking, and time away from work or family obligations.
• Timely access to medical evaluation and treatment, with the ability to submit a consultation and receive a clinical response without the delays often associated with scheduling in-person appointments.
• Access to qualified providers who may not be available in your local area, expanding your options for medical care.
• Secure and private communication with healthcare providers through HIPAA-compliant technology, allowing you to discuss sensitive health matters in the comfort and privacy of your chosen location.
• Continuity of care through the patient telehealth portal, where your medical history, previous consultations, and treatment plans are maintained for ongoing management of your health.

6. Risks and Limitations

While telehealth offers significant benefits, there are inherent risks and limitations that you should understand before consenting to telehealth services:

Technology-Related Risks:

• Telehealth requires a reliable internet connection and a compatible electronic device (computer, tablet, or smartphone). Service quality may be affected by the speed and stability of your internet connection.
• There is a possibility of technology failure, including but not limited to software errors, hardware malfunctions, internet outages, or disruptions in service that may delay or interrupt your consultation.
• Despite the use of secure, encrypted platforms, no electronic communication system can guarantee absolute security. There is a small risk that your health information could be intercepted or accessed by unauthorized parties.

Clinical Limitations:

• Your healthcare provider cannot perform a hands-on physical examination during a telehealth consultation. This limits the provider's ability to detect certain physical findings that may be relevant to your diagnosis and treatment.
• The information transmitted electronically may not be sufficient for medical decision-making in all cases. Your provider relies on the information you provide, and incomplete or inaccurate information may affect the quality of your care.
• Delays in medical evaluation and treatment could occur due to technology failures, incomplete questionnaire submissions, or the need for additional information.

Provider Determinations:

Your healthcare provider may determine that telehealth is not appropriate for your condition and may take one or more of the following actions:

• Recommend that you seek an in-person visit with a local healthcare provider.
• Refer you to a specialist for further evaluation or treatment.
• Refer you to emergency services if your condition appears urgent or life-threatening.
• Decline to prescribe medication if the provider determines it is not clinically appropriate, safe, or indicated based on the information available.

General Limitations:

• Telehealth is not a substitute for in-person medical care when a physical examination is required for proper evaluation and diagnosis.
• Telehealth is not appropriate for medical emergencies. If you are experiencing a medical emergency, call 911 or go to your nearest emergency room immediately.
• As with any medical consultation, there is no guarantee of a specific diagnosis, treatment, or outcome.

7. Patient Rights

As a patient using MyCare MD telehealth services, you have the following rights:

• Right to withdraw consent. You have the right to withhold or withdraw your consent to telehealth services at any time, for any reason, without penalty or prejudice to your future care. Withdrawal of consent will not affect your ability to seek healthcare services through other means.
• Right to access medical records. You have the right to request a copy of your medical records generated during your telehealth consultations, in accordance with applicable federal and state laws.
• Right to privacy and confidentiality. You have the right to privacy and confidentiality of your Protected Health Information (PHI) as provided under the Health Insurance Portability and Accountability Act (HIPAA) and applicable state privacy laws.
• Right to be informed. You have the right to be informed about who will be involved in your care, including the identity and qualifications of the healthcare provider conducting your consultation.
• Right to request alternative care. You have the right to request an in-person visit with a healthcare provider instead of receiving care through telehealth.
• Right to ask questions. You have the right to ask questions about the telehealth process, your diagnosis, your treatment plan, and any other aspect of your care at any time.
• Right to copies of telehealth records. You have the right to request copies of all records generated during your telehealth consultations, including consultation notes, treatment plans, and prescription records.

To exercise any of these rights, contact us at support@mycaremd.com or 941-499-7686.

8. Patient Responsibilities

As a patient using MyCare MD telehealth services, you agree to the following responsibilities:

• Provide accurate and complete information. You are responsible for providing truthful, accurate, and complete medical history, including all current medications (including over-the-counter drugs, supplements, and herbal remedies), known allergies, pre-existing medical conditions, and any other information relevant to your care. Inaccurate or incomplete information may result in inappropriate treatment or adverse health outcomes.
• Maintain a private environment. You are responsible for being in a private, secure location during any telehealth consultation, particularly during synchronous (live) video or phone consultations, to protect your own confidentiality.
• Use a secure connection. You are responsible for using a secure, private internet connection when accessing the telehealth portal. Avoid using public or unsecured Wi-Fi networks when transmitting health information.
• Follow your treatment plan. You are responsible for following all treatment plans, medication instructions, and clinical recommendations provided by your healthcare provider. If you have questions or concerns about your treatment, contact your provider through the telehealth portal.
• Report adverse reactions. You are responsible for reporting any adverse reactions, side effects, or changes in your medical condition promptly to your healthcare provider through the telehealth portal or by contacting MyCare MD directly.
• Use emergency services for emergencies. You are responsible for contacting emergency services (call 911) or going to the nearest emergency room if you experience a medical emergency. Do not use the telehealth portal to seek emergency care.
• Protect your account credentials. You are responsible for keeping your telehealth portal login credentials confidential and secure. Do not share your username, password, or account access with any other person.
• Disclose all medications. You are responsible for informing your healthcare provider of all medications you are currently taking, including those prescribed by other providers, to avoid potentially dangerous drug interactions.

9. Prescription Medications

The following terms apply to prescription medications ordered through MyCare MD:

• Clinical discretion. All medications are prescribed at the sole clinical discretion of the treating healthcare provider. The decision to prescribe, or not prescribe, medication is based on the provider's independent medical judgment, your medical history, the information you provide, and applicable standards of care.
• No guarantee of prescription. There is no guarantee that any consultation will result in a prescription for medication. Your healthcare provider may determine that medication is not appropriate for your condition, that additional information or evaluation is needed, or that an alternative treatment approach is indicated.
• Dispensing pharmacy. All prescriptions issued through MyCare MD are fulfilled, dispensed, and shipped by The Pharmacy Hub 2 LLC, located at 2750 Bridge Way, Unit 180, Davie, FL 33314. The Pharmacy Hub 2 LLC is a licensed pharmacy that operates in compliance with all applicable federal and state pharmacy regulations.
• Medication instructions. You are responsible for reading all medication guides, package inserts, and instructions provided with your prescription. Follow all dosing instructions as prescribed by your healthcare provider. Do not adjust your dosage or discontinue your medication without consulting your provider.
• Controlled substances. Controlled substances (as defined by the U.S. Drug Enforcement Administration schedules) are NOT prescribed through this platform.
• Adverse reactions. You must report any adverse reactions, unexpected side effects, or worsening of your condition to your healthcare provider immediately through the telehealth portal or by contacting MyCare MD at support@mycaremd.com or 941-499-7686.
• Drug interactions. Inform your provider of all medications, supplements, and over-the-counter products you are taking to help prevent potentially harmful drug interactions.

10. Privacy and Confidentiality

MyCare MD is committed to protecting the privacy and confidentiality of your health information in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and all applicable state and federal privacy laws.

• Secure platforms. All telehealth consultations are conducted over secure, HIPAA-compliant technology platforms that use encryption and other security measures to protect your health information during transmission and storage.
• Protected Health Information (PHI). Your PHI is collected, used, maintained, and disclosed in accordance with HIPAA regulations and our Notice of Privacy Practices.
• Permitted disclosures. Your health information may be shared as necessary for treatment (with your healthcare provider), payment (processing your transaction), and healthcare operations (quality assurance, compliance, and administrative functions), as permitted by HIPAA.
• Business Associate Agreements. MyCare MD maintains Business Associate Agreements (BAAs) with Beluga Health (physician network) and The Pharmacy Hub 2 LLC (dispensing pharmacy) to ensure that all parties who handle your PHI are contractually obligated to protect it in accordance with HIPAA requirements.
• Privacy Policy. Our full privacy practices, including detailed information about how your PHI is collected, used, disclosed, and protected, are described in our Privacy Policy, available at mycare.md/legal/privacy.
• Security limitations. Despite the implementation of reasonable administrative, technical, and physical safeguards, no method of electronic transmission or storage is completely secure. While we take every reasonable precaution to protect your information, we cannot guarantee absolute security of data transmitted electronically.

11. Emergency Situations

MyCare MD telehealth services are NOT designed for, and should NOT be used in, medical emergencies.

If you are experiencing a medical emergency, including but not limited to chest pain, difficulty breathing, severe bleeding, loss of consciousness, stroke symptoms, severe allergic reactions, or any other condition that may be life-threatening:

• Call 911 immediately or have someone call on your behalf.
• Go to the nearest emergency room for immediate in-person medical attention.

If you or someone you know is experiencing a mental health crisis or thoughts of self-harm or suicide:

• Call the 988 Suicide and Crisis Lifeline by dialing or texting 988 for immediate support.
• Call 911 if there is an immediate risk of harm.

Your healthcare provider may, during the course of a telehealth consultation, determine that your condition requires emergency medical attention. In such cases, the provider may direct you to call 911 or proceed to the nearest emergency room and may discontinue the telehealth consultation.

Do not delay seeking emergency care by attempting to use the telehealth portal.

12. Cost and Payment

MyCare MD operates on a cash-pay model. Services provided through our platform are not billed to health insurance, Medicare, Medicaid, or any other third-party payer.

• Fee disclosure. All fees for telehealth consultations and related services are disclosed to you prior to your consultation. By proceeding with a consultation, you agree to pay the stated fees.
• Payment. Payment is collected at the time of service through the payment methods accepted on our platform.
• No insurance billing. MyCare MD does not bill insurance companies on your behalf. You are responsible for the full cost of services. You may submit receipts to your insurance provider for potential reimbursement at your own discretion, but MyCare MD makes no representations regarding insurance reimbursement.
• Refund policy. Our refund policy, including the terms and conditions under which refunds may be issued, is available at mycare.md/legal/refund-policy.

13. Recording and Documentation

• Clinical documentation. All telehealth consultations are documented in your medical record as part of standard clinical practice. This documentation may include the information you provide, the provider's clinical assessment, diagnosis, treatment plan, and any prescriptions issued.
• No audio or video recording without consent. Telehealth consultations are not recorded (audio or video) without the explicit, informed consent of all parties involved, including you and the healthcare provider.
• Patient recording. You may not record any telehealth consultation (audio, video, or otherwise) without the prior consent of your healthcare provider. Unauthorized recording may violate applicable state and federal laws.

14. Acknowledgment and Consent

By proceeding with telehealth services through MyCare MD, you confirm and acknowledge the following:

• I have read and understand this Telehealth Informed Consent in its entirety.
• I understand the potential risks, benefits, and limitations of receiving healthcare services via telehealth as described in this document.
• I voluntarily consent to receiving healthcare services via telehealth through MyCare MD and the Beluga Health physician network.
• I understand that telehealth is not a substitute for emergency medical care, and I will call 911 or go to the nearest emergency room if I experience a medical emergency.
• I understand that a prescription is not guaranteed as a result of any telehealth consultation, and the decision to prescribe medication rests solely with the treating healthcare provider.
• I agree to provide accurate, complete, and truthful health information to my healthcare provider, including all current medications, allergies, and pre-existing conditions.
• I have had the opportunity to ask questions about the telehealth process, and any questions I had have been answered to my satisfaction.
• I understand that I may withdraw my consent to telehealth services at any time, without penalty or prejudice to my future care.
• I understand that my health information will be handled in accordance with HIPAA and MyCare MD's Privacy Policy.
• I acknowledge that all prescriptions, if issued, will be fulfilled by The Pharmacy Hub 2 LLC.

This consent remains in effect for the duration of your use of MyCare MD telehealth services unless withdrawn by you in writing.

15. Contact Us

If you have questions, concerns, or wish to withdraw your consent, please contact us: