Telemedicine Consent

Consent to Telehealth Services

By using the Strut Health platform and services, you acknowledge and agree to the following terms regarding telemedicine/telehealth services provided by Titan Medical Group and its affiliated healthcare providers.

What is Telehealth?

Telehealth involves the use of electronic communications, information technology, and telecommunications technologies to enable healthcare providers at different locations to share individual patient medical information for the purpose of providing clinical care, diagnosis, consultation, treatment, therapy, and education.

The telehealth services available through Strut Health may include:

• Asynchronous (store-and-forward) consultations using secure messaging and questionnaires
• Synchronous (real-time) video consultations with healthcare providers
• Remote monitoring and follow-up care
• Electronic prescription services
• Medical advice and health education

Expected Benefits of Telehealth

The use of telehealth services can provide a number of benefits, including but not limited to:

• Improved Access to Care: Receive medical consultations from the comfort of your home
• Convenience: Eliminate travel time and waiting rooms
• Efficiency: Streamlined evaluation and management of your health conditions
• Continuity of Care: Easier follow-up and ongoing monitoring
• Access to Specialists: Connect with qualified healthcare providers regardless of geographic location

Possible Risks and Limitations of Telehealth

While telehealth services offer many advantages, you should be aware of the following potential risks and limitations:

• Technology Failures: Equipment, internet connection, or software failures could cause delays in evaluation or treatment
• Quality Limitations: Transmission quality (video, image, or audio) may be inadequate for proper medical decision-making, which may require rescheduling or in-person follow-up
• Incomplete Information: The healthcare provider will not have access to your complete medical history unless you provide it or authorize records transfer, which may result in adverse drug interactions, allergic reactions, or other medical errors
• Security Risks: Despite security protocols, there is a rare possibility of privacy breach or unauthorized access to your protected health information
• Diagnostic Limitations: Physical examination limitations may affect the provider's ability to diagnose certain conditions
• Emergency Situations: Telehealth is not appropriate for emergency medical conditions

Your Rights and Responsibilities

As a Patient, You Have the Right To:

1. Choose Your Provider: Review the credentials and qualifications of the healthcare provider who will be providing your telehealth services
2. Privacy Protection: Expect that all medical information shared during telehealth consultations will be kept confidential and protected under federal and state privacy laws, including HIPAA
3. Informed Consent: Ask questions about the telehealth services, how they work, and what to expect
4. Withdraw Consent: Withdraw your consent to telehealth services at any time without affecting your right to future care or treatment, or risking the loss or withdrawal of any program benefits to which you would otherwise be entitled
5. Alternative Options: Be informed of alternative treatment options, including in-person consultations
6. Access Your Records: Request copies of your medical records in accordance with applicable laws

As a Patient, You Are Responsible For:

1. Accurate Information: Providing complete and accurate medical history, current medications, allergies, and other health information
2. Honest Communication: Answering all questions truthfully and completely
3. Compliance: Following the treatment plan prescribed by your healthcare provider
4. Environment: Ensuring you are in a private, quiet location during video consultations
5. Technical Requirements: Having the necessary technology (smartphone, computer, internet connection) to participate in telehealth services
6. Emergency Situations: Understanding when to seek emergency care instead of using telehealth services

Provider Relationship and Licensure

Strut Health is a technology platform and does not provide medical services. All medical services are provided by independent healthcare providers who are part of or affiliated with Titan Medical Group. These providers are:

• Licensed to practice medicine in your state
• Responsible for making all clinical decisions regarding your care
• Acting independently and not as employees or agents of Strut Health

You acknowledge that the healthcare provider, not Strut Health, is solely responsible for the quality and appropriateness of the care provided to you.

Recording and Documentation

By consenting to telehealth services, you agree that:

• Your consultations may be recorded (audio/video) for quality assurance, training, and evaluation purposes
• All medical information exchanged will be documented in your electronic medical record
• Third parties (such as medical assistants, nurses, or administrative staff) may be present during your consultation for scheduling, billing, or clinical support purposes
• You will be informed if any third parties are present during your consultation

Prescriptions and Controlled Substances

Healthcare providers delivering telehealth services through Strut Health:

• Will only prescribe medications when clinically appropriate based on their professional judgment
• Do NOT prescribe DEA controlled substances, scheduled medications, or certain other drugs with high potential for abuse
• Reserve the right to deny prescriptions if there is concern about misuse of services
• May require in-person follow-up before prescribing certain medications
• Will electronically transmit prescriptions to the pharmacy of your choice or to Strut Health's partner pharmacy

No Guaranteed Results

You understand and acknowledge that:

• Medicine is not an exact science, and no healthcare provider can guarantee specific results from treatment
• The use of telehealth services does not guarantee that your condition will be cured or improved
• There may be side effects or complications from prescribed treatments
• You may require in-person medical care as a follow-up to telehealth consultations

Limitation of Liability

You agree to hold harmless Strut Health, Titan Medical Group, and their respective officers, directors, employees, and agents from any liability arising from:

• Technical failures of equipment or internet connectivity
• Delays in evaluation or treatment due to technology issues
• Breaches of security protocols despite reasonable safeguards
• The clinical judgment and decisions of your healthcare provider (which are the sole responsibility of the provider)

Strut Health is not responsible for:

• The medical advice, treatment, or decisions made by healthcare providers
• Any harm or injury resulting from the clinical care provided by healthcare providers
• Technology or network failures beyond our reasonable control

Emergency Situations

TELEHEALTH SERVICES ARE NOT APPROPRIATE FOR EMERGENCY MEDICAL CONDITIONS.

If you are experiencing a medical emergency, you should:

• Call 911 immediately, or
• Go to the nearest emergency room, or
• Call the National Suicide Prevention Lifeline at 988 (for mental health emergencies)

Examples of medical emergencies include but are not limited to:

• Chest pain or difficulty breathing
• Severe bleeding or trauma
• Loss of consciousness
• Severe allergic reactions
• Stroke symptoms (facial drooping, arm weakness, speech difficulty)
• Suicidal or homicidal thoughts

For urgent but non-emergency medical concerns outside of our platform hours, contact your primary care physician or visit an urgent care center.

Contact Information for Questions or Concerns

If you have questions about telehealth services or need assistance, you may contact us at:

Strut Health Customer Support

• Website: struthealth.com/contact-us

For Medical Emergencies: Call 911 immediately

State-Specific Information

Texas Residents

If you are a Texas resident and have a complaint about the medical services you received, you may file a complaint with the Texas Medical Board:

Texas Medical Board

• Address: P.O. Box 2018, MC-263, Austin, TX 78768-2018
• Phone: 1-800-201-9353
• Website: www.tmb.state.tx.us

Other States

Residents of other states should contact their respective state medical boards with any complaints regarding medical services.

Geographic Limitations

Telehealth services through Strut Health are only available to patients located within the United States at the time of the consultation. By using our services, you acknowledge that:

• You are physically located in the United States during your consultation
• Your healthcare provider is licensed in the state where you are located
• Accessing telehealth services from outside the United States may not comply with local laws and regulations

Consent Agreement

BY USING STRUT HEALTH'S TELEHEALTH SERVICES, YOU ACKNOWLEDGE THAT:

1. ✓ I have read and understand this Telemedicine Consent document
2. ✓ I understand what telehealth/telemedicine services are and how they work
3. ✓ I have been given the opportunity to ask questions about telehealth services
4. ✓ I understand the potential benefits, risks, and limitations of telehealth services
5. ✓ I understand that I have the right to withdraw consent for telehealth services at any time
6. ✓ I am aware that in-person medical care is an alternative to telehealth services
7. ✓ I consent to the use of telehealth services for my medical care
8. ✓ I consent to the recording of my consultations for quality assurance and training purposes
9. ✓ I understand that a healthcare provider, not Strut Health, is responsible for my medical care
10. ✓ I understand that controlled substances and certain other medications will not be prescribed via telehealth
11. ✓ I understand that telehealth services are not appropriate for emergency medical conditions
12. ✓ I have been informed of how to request copies of my medical records
13. ✓ I understand the limitations of liability as described in this consent
14. ✓ I am located in the United States at the time of my telehealth consultation
15. ✓ I understand that I may be subject to state-specific regulations regarding telehealth services

Lab Testing Telehealth Consent (Junction / OpenLoop Healthcare)

The following section applies specifically to lab testing services facilitated through Junction (Adept Labs, Inc.) and its affiliated healthcare providers. Lab orders placed through Strut Health are reviewed and managed by Junction's provider network, which is separate from the Titan Medical Group providers referenced above.

I understand that Telehealth is a mode of delivering health care services via communication technologies (e.g., internet or cellphone) to facilitate diagnosis, consultation, treatment, education, care management, and self-management of a patient's health care.

By acknowledging my consent below, I understand and agree to the following:

1. I understand that Junction and affiliate Openloop Healthcare Partners, PC offer Telehealth consultations, which are conducted through videoconferencing, telephonic, and asynchronous technology and my Telehealth provider will not be present in the room with me.
2. I understand there are potential risks to the use of Telehealth technology, including but not limited to, interruptions, delays, unauthorized access, and or other technical difficulties. I understand that either my Telehealth provider or I can discontinue the Telehealth appointment if the technical connections are not adequate for my visit.
3. I understand that I could seek an in-office visit rather than obtain care from a Telehealth provider, and I am choosing to participate in a Telehealth consultation with Junction, an affiliate of Openloop Healthcare Partners, PC, Openloop Healthcare Partners, PC, Openloop Healthcare Partners California, PC, Openloop Healthcare Partners Colorado, PC, Openloop Healthcare Partners New Jersey, PC, Openloop Healthcare Partners Wisconsin SC, Reliant.MD Medical Associates, PLLC, Reliant.MD Medical Associates California, PC, Reliant.MD Medical Associates Colorado, PC, Reliant.MD Medical Associates New Jersey, PC, Reliant.MD Medical Associates Wisconsin, SC, MECNB Physician Services, PC, MECNB Physician Services California, PC, MECNB Physician Services Colorado, PC, MECNB Physician Services New Jersey, PC, and MECNB Physician Services, SC.
4. To protect the confidentiality of my health information, I agree to undertake my Telehealth consultation in a private location, and I understand that my Telehealth provider will similarly be in a private location.
5. I understand that I am responsible for payment of any amounts due and owing resulting from my Telehealth visit.
6. In an emergent situation, I understand that the responsibility of my Telehealth provider may be to direct me to emergency medical services, such as an emergency room.

By acknowledging below, I certify:

• That I have read this form and/or had it explained to me
• That I understand the risks and benefits of a Telehealth appointment
• That I have been given the opportunity to ask questions and that such questions have been answered to my satisfaction

Effective as of February 21, 2023

Updates to This Consent

We may update this Telemedicine Consent from time to time to reflect changes in our practices, technology, or legal requirements. Material changes will be communicated through our website or via email. Your continued use of telehealth services after such changes constitutes your acceptance of the updated consent.

Contact Information

Strut Health

• Website: https://struthealth.com
• Privacy Policy: https://struthealth.com/privacy-policy
• Terms of Service: https://struthealth.com/terms-and-conditions

By proceeding with registration or consultation on the Strut Healthplatform, you confirm that you have read, understood, and agree to this Telemedicine Consent.