Telehealth Consent & Open Payments Notice

This Consent to Telehealth Services ("Consent") describes the telehealth services made available to Corivo Health members and asks for your informed consent to receive care through telehealth. The medical services described here are provided by licensed, independent healthcare providers practicing with Corivo (your "Providers"). Corivo Health (Corivo, LLC) is not a healthcare provider, does not practice medicine, and is not a party to your provider-patient relationship; Corivo is a third-party beneficiary of this Consent and may enforce it. Capitalized terms not defined here have the meanings given in the Corivo Terms and Conditions.

Nature of Telehealth Services

Telehealth is the delivery of healthcare services using electronic communications between a provider and a patient who are not in the same physical location. Telehealth may be used for evaluation, diagnosis, treatment, follow-up, and patient education, and may involve:

• Electronic transmission of your medical records, intake questionnaire responses, photographs, and other health information between you and your Provider.
• Asynchronous (store-and-forward) review, in which your Provider evaluates the information you submit and communicates with you through the platform without a scheduled live visit.
• Interactions with your Provider by messaging, audio, or video, where offered or where required by the law of your state.
• Use of data from connected devices, images, and other files you provide.

The systems used to deliver telehealth incorporate network and software security protocols designed to protect the privacy and security of your health information and to safeguard your data against corruption or unauthorized access.

Provider Relationship

Your provider-patient relationship is with your Providers, not with Corivo. Your Providers exercise independent professional judgment in evaluating your health information and determining whether any treatment, including prescription medication, is clinically appropriate for you. You understand and agree that:

• Your Provider may determine, in the Provider's sole discretion, that your condition is not suitable for treatment through telehealth or through this platform, and may direct you to seek care in person or from another source. Membership fees and payment do not guarantee that you will receive a prescription or any particular treatment.
• Telehealth services enable coordination and communication with a Provider and do not replace your relationship with any existing physician or primary care provider. You are encouraged to keep your primary care provider informed about the care you receive through telehealth.
• You are responsible for providing accurate, complete, and current information about your health, medications, and medical history, and for updating your Providers when it changes. Your Providers' clinical judgments depend on the accuracy of the information you provide.
• You will receive communications from your Providers electronically, including through your account, email, or text message, and it is your responsibility to read them.

Risks & Benefits

Telehealth can offer meaningful benefits, including easier access to care, convenience, and more efficient evaluation and follow-up. As with any healthcare service, telehealth also involves potential risks, which include:

• Information transmitted may be insufficient (for example, poor image quality or incomplete history) to allow appropriate clinical decision-making, or delays in evaluation or treatment may occur due to technology failures or transmission problems.
• A remote evaluation does not include a physical examination, which in rare cases could result in a Provider not identifying a condition that an in-person examination would detect.
• Although security protocols are used, no electronic transmission can be guaranteed to be completely secure, and in rare instances security protocols could fail, resulting in unauthorized access to your health information.

Telehealth is not a substitute for in-person care in all cases, and no specific results are guaranteed. By consenting, you acknowledge that you understand and accept these risks.

Open Payments Notice

For informational purposes, the Open Payments database is a federal tool used to search payments made by drug and device companies to physicians and teaching hospitals. It can be found at https://openpaymentsdata.cms.gov.

Consent to Treatment

By accepting this Consent, you attest and agree that:

• You are at least 18 years old, you have read and understand this Consent, and you have had the opportunity to ask questions about telehealth and have had them answered to your satisfaction.
• You voluntarily consent to receive healthcare services from your Providers through telehealth, including asynchronous evaluation where permitted in your state, and you authorize your Providers to deliver care, including issuing prescriptions where clinically appropriate, based on the information you provide.
• You consent to the collection, use, and disclosure of your information, including your identifiable health information, as described in the applicable privacy policies and notices of privacy practices, including disclosures among your Providers, fulfilling pharmacies, and Corivo as needed for treatment, payment, and healthcare operations.
• You understand that you have the right of access to your health information relating to your telehealth care in accordance with applicable law.

YOU UNDERSTAND THAT YOU CANNOT OBTAIN EMERGENCY CARE THROUGH TELEHEALTH. IF YOU ARE EXPERIENCING A MEDICAL EMERGENCY, CALL 911 OR GO TO THE NEAREST EMERGENCY ROOM.

Withdrawal of Consent

Your consent to telehealth is voluntary. You may withhold or withdraw your consent at any time without affecting your right to future care or treatment, by notifying your Provider or contacting support@corivohealth.com. Withdrawing consent will end your ability to receive services through telehealth on this platform, and your Providers will remain subject to applicable legal and professional obligations regarding your records and any continuing care. Withdrawal of consent does not by itself cancel your Corivo membership; membership cancellation is described in the Terms and Conditions.

Contact

Questions about this Consent or your telehealth care:
Corivo
For membership questions: Corivo Health, support@corivohealth.com