Telehealth Consent & Medical Authorization

1. Purpose of This Consent

This Telehealth Consent and Medical Authorization (“Consent”) describes the terms under which Elevated Health RX, LLC (“Elevated Health RX,” “we,” “us,” or “our”) and its affiliated medical groups and licensed healthcare providers (“Providers”) deliver healthcare services to you through telehealth technology. Telehealth enables the delivery of healthcare services when an in-person visit is not necessary or practical, using electronic communications including secure asynchronous messaging, live video, and telephone consultations.

Elevated Health RX operates as a technology platform that connects you with independently licensed healthcare Providers who evaluate your medical history, assess your health needs, and determine appropriate treatment plans. The purpose of this Consent is to inform you about the nature, benefits, risks, and limitations of telehealth so that you can make an informed decision about whether to participate.

2. What Is Telehealth?

Telehealth is the delivery of healthcare services using electronic communications, information technology, and related tools. Through the Elevated Health RX platform, telehealth may include, but is not limited to:

• Asynchronous messaging: You complete a detailed medical intake questionnaire, which a licensed Provider reviews along with your health history, photographs (if applicable), and any other information you provide. The Provider may follow up with additional questions before making a clinical determination.
• Synchronous video consultations: Real-time, face-to-face video appointments conducted through secure, HIPAA-compliant technology.
• Telephone consultations: Voice-only consultations when video is not required or not available.
• Secure messaging: Ongoing communications between you and your Provider through the platform’s encrypted messaging system regarding your treatment, follow-ups, and medication adjustments.

During a telehealth encounter, your Provider reviews your medical intake information, health history, current medications, allergies, and any other clinically relevant information you provide. Based on this evaluation, the Provider exercises independent medical judgment to determine whether treatment is appropriate and, if so, what treatment plan to recommend.

3. Anticipated Benefits of Telehealth

Telehealth services through Elevated Health RX are designed to offer you the following benefits:

• Easier access to care: Connect with licensed Providers from the comfort and privacy of your home, without the need to travel to a clinic or doctor’s office.
• No waiting rooms: Eliminate the time spent in waiting rooms. Begin your consultation on your own schedule.
• Convenience: Complete your medical intake at any time that works for you. Asynchronous consultations do not require scheduling a specific appointment time.
• Discretion and privacy: Receive care for sensitive health conditions in a private setting, with medications shipped in discreet, unmarked packaging.
• Faster response times: Provider evaluations are typically completed within 24 hours of submitting your intake, and often much sooner.
• Continuity of care: Easily communicate with your Provider for follow-ups, dosage adjustments, and ongoing treatment management through the platform.

4. Potential Risks of Telehealth

As with any form of healthcare delivery, telehealth involves certain risks and limitations that you should understand before consenting:

• Technology failures: Telehealth relies on electronic communications and internet connectivity. Hardware malfunctions, software errors, network outages, or other technical difficulties may interrupt or prevent a telehealth session. In such cases, alternative means of communication (such as telephone) may be used, or the session may need to be rescheduled.
• Delays in evaluation or treatment: Although Providers strive to respond promptly, there may be delays in receiving or reviewing your medical information, which could result in delays in diagnosis or treatment.
• Inability to perform a physical examination: Telehealth consultations do not allow the Provider to conduct a hands-on physical examination. Certain conditions may require in-person evaluation, diagnostic testing, or laboratory work that cannot be performed remotely.
• Possible misdiagnosis or incomplete assessment: The absence of a physical examination and the limitations of remote evaluation may, in rare cases, lead to an incomplete assessment, misdiagnosis, or a failure to identify a condition that might have been detected during an in-person visit.
• Information security risks: While Elevated Health RX uses industry-standard encryption, security protocols, and HIPAA-compliant technology to protect your personal health information, no electronic system can guarantee absolute security. There is an inherent risk that unauthorized parties could intercept or access electronic communications, despite our safeguards.
• Limitations of electronic communication: Asynchronous messaging and questionnaire-based consultations may not fully capture the nuances of your condition. Important non-verbal cues that a Provider might observe during an in-person visit may be missed.

5. Limitations of Telehealth Services

You understand and acknowledge the following limitations:

• Telehealth is not appropriate for all medical conditions. If your Provider determines that your condition requires an in-person evaluation, physical examination, diagnostic imaging, laboratory testing, or any other service that cannot be provided remotely, they will advise you accordingly and may refer you to a local healthcare provider or facility.
• Telehealth services provided through Elevated Health RX are not a replacement for your primary care physician or any specialist care you may require. You are encouraged to maintain an ongoing relationship with a primary care provider and to inform them of any treatments received through our platform.
• Telehealth services are not intended for use in emergency situations, including but not limited to chest pain, difficulty breathing, severe allergic reactions, loss of consciousness, severe bleeding, or any other life-threatening condition.
• Providers on the Elevated Health RX platform exercise independent medical judgment. A Provider may determine, at their sole discretion, that treatment is not appropriate for you based on your medical history, current health status, or other clinical factors. In such cases, the Provider may decline to prescribe medication or may recommend alternative treatment options.
• The availability of telehealth services may vary based on your geographic location and applicable state laws and regulations governing the practice of telemedicine.

6. Emergency Situations

7. Authorization to Use and Disclose Medical Information

By consenting to telehealth services, you authorize Elevated Health RX, its affiliated medical groups, Providers, and their respective agents, employees, and contractors to use and disclose your protected health information (“PHI”) for the following purposes:

• Treatment: To evaluate your medical condition, determine an appropriate treatment plan, prescribe medications, and provide ongoing care management. This includes sharing your medical information with the prescribing Provider and any consulting healthcare professionals involved in your care.
• Payment: To process payments for services rendered, submit claims to third-party payers if applicable, and manage billing and collections activities related to your treatment.
• Healthcare operations: To conduct quality assurance reviews, compliance audits, training, credentialing of Providers, and other administrative and operational activities necessary to maintain and improve the quality of care delivered through the platform.
• Prescription fulfillment: To transmit your prescription information to our partner pharmacies for the purpose of compounding, dispensing, and shipping your prescribed medications. This includes sharing your name, date of birth, shipping address, prescription details, and relevant medical information required by the pharmacy to safely fulfill your order.
• Communication about your care: To contact you via email, text message, phone, push notification, or secure messaging through the platform regarding your treatment, prescription status, shipping updates, refill reminders, follow-up consultations, and other communications related to your healthcare.
• Quality improvement and research: To use de-identified or aggregated data to analyze treatment outcomes, improve our services, develop new programs, and contribute to medical research. Any use of your information for research purposes will comply with applicable laws and regulations, and individually identifiable information will not be disclosed for research without your separate written consent.

8. Data Privacy and Security

Elevated Health RX is committed to protecting the privacy and security of your personal health information. Our electronic systems and telehealth technology incorporate the following safeguards:

• Encryption: All data transmitted between your device and our servers is protected using industry-standard TLS (Transport Layer Security) encryption. Data at rest is encrypted using AES-256 encryption.
• Network and infrastructure security: Our systems are hosted on HIPAA-compliant cloud infrastructure with multi-layered security controls, including firewalls, intrusion detection systems, and regular security audits.
• Access controls: Access to your health information is restricted to authorized personnel on a need-to-know basis. All access is logged and monitored.
• HIPAA compliance: We maintain administrative, physical, and technical safeguards in compliance with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and its implementing regulations, including the Privacy Rule, Security Rule, and Breach Notification Rule.

For complete information about how we collect, use, store, and protect your personal and health information, please review our Privacy Policy. Your medical records are maintained securely in accordance with applicable federal and state laws, and are retained for the period required by law in your state of residence.

9. Prescription Medications

If your Provider determines that prescription medication is appropriate for your condition, the following applies:

• Compounded medications: Medications prescribed through Elevated Health RX may be compounded by FDA-regulated 503A outsourcing pharmacies. Compounded medications are customized formulations prepared according to your Provider’s specific prescription. Compounded medications are not individually reviewed or approved by the U.S. Food and Drug Administration (FDA), though the individual active pharmaceutical ingredients used in compounding may be FDA-approved. 503A outsourcing pharmacies are registered with and inspected by the FDA and must comply with current Good Manufacturing Practices (cGMP).
• Independent prescribing authority: Your Provider retains full, independent authority over all prescribing decisions. Elevated Health RX does not influence, direct, or override a Provider’s clinical judgment regarding whether to prescribe, what to prescribe, or at what dosage. A Provider may decline to prescribe medication if they determine it is not medically appropriate for you.
• Medication information: Your Provider and/or the dispensing pharmacy will provide you with information about your prescribed medication, including proper use, expected effects, potential side effects, drug interactions, and contraindications. It is your responsibility to read and understand this information before taking any medication.
• Discreet shipping: All medications are shipped in plain, unmarked packaging with no indication of the contents or the nature of the products inside. Shipping labels display only the pharmacy’s return address and your delivery address.
• Adverse reactions: If you experience any adverse reaction, unexpected side effect, or change in your condition after taking a prescribed medication, you should discontinue use and contact your Provider through the platform or seek immediate medical attention as appropriate.

10. Your Rights

You have the following rights in connection with your use of telehealth services through Elevated Health RX:

• Right to withhold or withdraw consent: Your participation in telehealth is entirely voluntary. You have the right to withhold consent or to withdraw your consent to telehealth services at any time, without affecting your right to future care or treatment, and without risking the loss or withdrawal of any benefits to which you would otherwise be entitled.
• Withdrawal does not affect prior care: If you withdraw your consent, such withdrawal will not affect any care, treatment, or services that were provided to you prior to the withdrawal, nor will it affect the validity of any prescriptions already issued.
• Right to access your medical records: You have the right to request access to your medical records and to obtain copies of your health information maintained by Elevated Health RX and its affiliated Providers, in accordance with applicable federal and state laws.
• Right to request restrictions: You have the right to request that your health information not be shared with certain individuals or entities. We will make reasonable efforts to honor such requests, subject to legal, regulatory, and clinical limitations. Certain disclosures may be required by law regardless of your request.
• Right to request amendments: You have the right to request amendments to your medical records if you believe the information is inaccurate or incomplete.
• Right to an accounting of disclosures: You have the right to request an accounting of certain disclosures of your health information made by Elevated Health RX, as provided under HIPAA.

To exercise any of these rights, please contact us using the information provided in the Contact Information section below.

11. Your Acknowledgments

By using the telehealth services provided through Elevated Health RX, clicking “I Agree,” submitting your medical intake form, or otherwise indicating your acceptance, you acknowledge and agree to the following:

• Your participation in telehealth services is voluntary. No one has pressured, coerced, or compelled you to consent.
• All medical and health information you provide through the platform, including your medical intake questionnaire, health history, current medications, allergies, and any other information, is accurate, complete, and truthful to the best of your knowledge. You understand that providing inaccurate or incomplete information may result in inappropriate treatment, adverse health consequences, or other harm.
• You have read and understand the potential risks, anticipated benefits, and limitations of telehealth as described in this Consent.
• You consent to receiving healthcare services via telehealth, including asynchronous consultations, video visits, telephone consultations, and secure messaging.
• You authorize Elevated Health RX, its affiliated medical groups, Providers, and partner pharmacies to use and disclose your medical information as described in Section 7 of this Consent.
• You understand that your Provider exercises independent medical judgment in all clinical and prescribing decisions. Elevated Health RX does not guarantee that you will receive a prescription, and the Provider may determine that treatment is not appropriate for you.
• You understand that telehealth is not a substitute for emergency medical care, and you agree to seek emergency services by calling 911 if you experience a medical emergency.
• You have been given the opportunity to ask questions about telehealth and this Consent, and your questions have been answered to your satisfaction.
• You understand that you may withdraw this consent at any time by contacting Elevated Health RX.

12. Affiliated Pharmacies Disclosure

Elevated Health RX, LLC has a commercial relationship with partner pharmacies that fulfill prescriptions written by Providers on the platform. These partner pharmacies are licensed, FDA-regulated 503A outsourcing facilities that compound and dispense medications in accordance with applicable federal and state laws. Elevated Health RX may receive compensation in connection with prescription fulfillment through its partner pharmacies. This commercial relationship does not influence the independent clinical judgment of your Provider, who retains sole authority over all prescribing decisions. Your Provider is not required to prescribe from any particular pharmacy, and you may request that your prescription be sent to a pharmacy of your choice, subject to availability and the nature of the compounded medication.

13. Governing Law

This Consent shall be governed by and construed in accordance with the laws of the State of Florida, without regard to its conflicts of law provisions, and applicable federal laws including HIPAA. The telehealth services provided through Elevated Health RX are subject to the laws and regulations of the state in which you are located at the time of your consultation.

14. Changes to This Consent

Elevated Health RX reserves the right to modify or update this Consent at any time. If we make material changes, we will update the “Last updated” date at the top of this page and, where required by law, notify you via email or through the platform. Your continued use of telehealth services after any changes constitutes your acceptance of the updated Consent. We encourage you to review this Consent periodically.

15. Contact Information

If you have any questions, concerns, or requests regarding this Telehealth Consent and Medical Authorization, or if you wish to exercise any of your rights described herein, please contact us: