OUR PROVIDERS DO NOT ADDRESS MEDICAL EMERGENCIES

DO NOT PROCEED WITH CLINICAL SERVICES USING THE REGNR8RX PLATFORM IF YOU BELIEVE YOU ARE HAVING A MEDICAL EMERGENCY. IF YOU BELIEVE YOU ARE EXPERIENCING A MEDICAL EMERGENCY, YOU SHOULD DIAL 9-1-1 AND/OR GO TO THE NEAREST EMERGENCY ROOM.

I. Introduction

You are reviewing and acknowledging this Telehealth Informed Consent because you are seeking Healthcare Services utilizing telehealth technologies by REGNR8RX, LLC. facilitated through the REGNR8RX, LLC. website, iOS mobile app, web mobile app or other telehealth technologies collectively the “REGNR8RX Platform.” This Telehealth Informed Consent does not modify or supersede any Terms of Use, Privacy Policy, or Notice of Privacy Practices of REGNR8RX or the Providers, rather it supplements these terms and documents.

By creating an account, starting a consult, clicking “I consent to telehealth,” checking a related box to signify your acceptance, or using any other acceptance protocol presented through the REGNR8RX, LLC, you indicate that you have reviewed the risks as described herein of receiving services utilizing telehealth technologies and consent to receiving the services. A record of this Telehealth Informed Consent is maintained in the files and records of the applicable Provider delivering your services, and your on-going participation in services by the REGNR8RX, LLC using telehealth technologies serves as an on-going acknowledgement of your acceptance of this Telehealth Informed Consent and updates at such time the representations you provide herein.

REGNR8RX, LLC refers to a network of medical professional organizations affiliates, its employed and contracted health providers (the “Providers”).

II. What is Telehealth?

Telehealth involves the delivery of health and wellness services using electronic communications, information technology, or other means between a licensed, certified, or registered healthcare professional at one location and a patient in another location about a clinical matter. Telehealth may be used for diagnosis, treatment, follow-up and/or patient education. These telehealth services may involve various modalities, including asynchronous interactions, real-time (synchronous) video and audio encounters, and interactive audio with store and forward. This “Telehealth Informed Consent” informs the patient (“patient,” “you,” or “your”) concerning the treatment methods, risks, and limitations of utilizing telehealth to meet your health and wellness needs.

III. What are the Possible Benefits of Telehealth?

Benefits of telehealth include being easier and more efficient for you to access health and wellness services. You can obtain health and wellness services at times that are convenient for you without the necessity of an in-office appointment, including follow-up care related to your treatment. If you need follow-up care, please contact us through the REGNR8RX, LLC. call center at 561-527-2339 or [email protected].

IV. What are the Possible Risks of Telehealth?

Information transmitted to your health professional may not be sufficient to allow for appropriate health or wellness services to meet your need. Some clinical needs may not be appropriate for a telehealth visit and your Provider will make that determination. The technology necessary to interact with your health professional may fail and delay your services. If a technical failure prevents you from communicating with your Providers, you should call the following number: 561-527-2339 or [email protected].

In rare events, a lack of access to complete medical records, and/or the quality of transmitted data could result in adverse drug interactions, allergic reactions, and/or other clinical judgment errors. You may stop or decline any on-going Healthcare Services provided by REGNR8RX, LLC. using telehealth technologies at any time, although you acknowledge that applicable fees may apply if a medical consultation has occurred prior to request to cancel services and REGNR8RX, LLC. has no obligation for your on-going care or selection of separate healthcare services in such circumstances.

I understand that certain diagnostic testing services, including laboratory products and services offered through the REGNR8RX Platform to support the Healthcare Services of Providers, may contain defects, including ones which may limit functionality or produce erroneous results, any, or all of which could limit or otherwise impact the quality, accuracy and/or effectiveness of the medical care or other services that I receive from my Provider(s).

V. Patient Acknowledgments

By accepting this Telehealth Informed Consent, you acknowledge you understand and consent to the following:

1. You have reviewed this Telehealth Informed Consent carefully, and understand there are risks, limitations, and benefits of utilizing telehealth.
2. You understand that the electronic nature of the telehealth services means that there is a greater risk to the privacy of my health information.
3. In some cases, my Provider may be a nurse practitioner or physician assistant and not a physician.
4. Persons may be present during the telehealth visit other than my Provider to operate the telehealth technologies and/or for language translation assistance, if requested. If another person is present during the telehealth visit, I will be informed of the individual’s presence and his or her role.
5. I understand that information I provide as part of any telehealth offering is viewed as accurate, true, and complete.
6. I understand that in certain instances, and in compliance with applicable law, my Provider may determine that it is appropriate to provide my Healthcare Services asynchronously via store-and-forward technology. In such instances, my Provider and I will communicate electronically through the REGNR8RX platform and not via telephone or video. I agree that if my provider makes that determination, I would like to receive Healthcare Services in this manner.
7. I understand that there is no guarantee that I will be given a prescription and that the decision of whether a prescription is appropriate will be made in the professional judgment of my Provider.
8. I understand that while the use of telehealth may provide benefits to me, no such benefits or specific results can be guaranteed, and my condition may not improve.
9. I understand there is a risk of technical failures during the telehealth encounter beyond the control of REGNR8RX, LLC. and my Provider(s). I AGREE TO HOLD HARMLESS REGNR8RX, LLC. AND ITS EMPLOYEES, CONTRACTORS, AGENTS, DIRECTORS, MEMBERS, MANAGERS, SHAREHOLDERS, OFFICERS, REPRESENTATIVES, ASSIGNS, PREDECESSORS, AND SUCCESSORS, INCLUDING REGNR8RX AND ITS EMPLOYEES, CONTRACTORS, AGENTS, DIRECTORS, MEMBERS, MANAGERS, SHAREHOLDERS, OFFICERS, REPRESENTATIVES, ASSIGNS, PARENTS, PREDECESSORS, AND SUCCESSORS FOR DELAYS IN EVALUATION OR FOR INFORMATION LOST DUE TO SUCH TECHNICAL FAILURES.
10. I understand that certain diagnostic testing services, including laboratory products and services offered through the REGNR8RX Platform to support the Healthcare Services of Providers, may contain defects, including ones which may limit functionality or produce erroneous results, any, or all of which could limit or otherwise impact the quality, accuracy and/or effectiveness of the medical care or other services that I receive from my Provider(s).
11. I understand the REGNR8RX, LLC. makes available a specific set of services and I may need to seek other resources for my other health needs.
12. I understand that by using the REGNR8RX Platform I am not always speaking or messaging with my Provider in real-time, and there may be a delay before my messages or information is reviewed.

VI. Additional State-Specific Disclosures

The following disclosures apply to users accessing the REGNR8RX Platform for the purposes of participating in a telehealth visit as required by the states listed below:

• Iowa - I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here: https://medicalboard.iowa.gov/consumers/filing-complaint.
• Kentucky - I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here: https://kbml.ky.gov/grievances/Pages/default.aspx.
• Maine - I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here: https://www.maine.gov/md/complaint/file-complaint.
• New York - I have been informed that to get information regarding your rights and how to report professional misconduct, I should visit here: https://www.health.ny.gov/professionals/doctors/conduct.
• Oregon - I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here: https://www.oregon.gov/omb/investigations/pages/how-to-file-a-complaint.aspx.
• Rhode Island - I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here: https://health.ri.gov/complaints/.
• Texas - I have been informed of the following notice: NOTICE CONCERNING COMPLAINTS- Complaints about physicians, as well as other licensees and registrants of the Texas Medical Board, including physician assistants, acupuncturists, and surgical assistants may be reported for investigation at the following address: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018. Assistance in filing a complaint is available by calling 1-800-201-9353.
• Vermont - I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here: http://www.healthvermont.gov/health-professionals-systems/board-medical-practice/file-complaint.
• Wyoming - I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here: http://wyomedboard.wyo.gov/consumers/file-a-complaint.