Last updated: November 14, 2024

INFORMED CONSENT REGARDING USE OF TELEHEALTH

BY CLICKING “I AGREE,” CHECKING A RELATED BOX TO SIGNIFY YOUR ACCEPTANCE, USING ANY OTHER ACCEPTANCE PROTOCOL PRESENTED THROUGH THE SERVICE OR OTHERWISE AFFIRMATIVELY ACCEPTING THIS CONSENT, YOU ACKNOWLEDGE THAT YOU HAVE READ, ACCEPTED, AND AGREED TO BE BOUND BY THIS CONSENT. IF YOU DO NOT AGREE TO THIS CONSENT, DO NOT CREATE AN ACCOUNT OR USE THE SERVICE. YOU HEREBY GRANT AGENCY AUTHORITY TO ANY PARTY WHO CLICKS ON THE “I AGREE” BUTTON OR OTHERWISE INDICATES ACCEPTANCE TO THIS CONSENT ON YOUR BEHALF.

IF YOU ARE EXPERIENCING A LIFE-THREATENING SITUATION SUCH AS CONTEMPLATING SUICIDE, CALL 911 OR THE 988 SUICIDE & CRISIS LIFELINE AT 988.

Purpose

The purpose of this consent form ("Consent") is to provide you with information about telehealth and to obtain your informed consent to the use of telehealth in the delivery of healthcare and/or mental health services to you by physicians, physician assistants, nurse practitioners, and/or mental health professionals ("Providers") using the online platforms owned and operated by Zyvyo ("Service"). In this Consent, the terms "you" and "yours" refer to the person using the Service, or in the case of a use of the Service by or on behalf of an individual minor between the ages of thirteen (13) and eighteen (18) or higher age of majority under applicable state law, "you" and "yours" refer to and include (i) the parent or legal guardian who provides consent to the use of the Service by such minor or uses the Service on behalf of such minor, and (ii) the minor for whom consent is being provided or on whose behalf the Service is being utilized.

Use of Telehealth

Telehealth involves the delivery of healthcare and/or mental health services using electronic communications, information technology or other means between a healthcare or mental health provider and a patient who are not in the same physical location. Through Zyvyo's platform, telehealth may be used for diagnosis, treatment, follow-up and/or patient education, and may include, but is not limited to, one or more of the following:

• Electronic transmission of medical records

• Photo images, personal health information or other data between you and your provider

• Real-time interactions with your provider via audio and video communications

• Secure messaging and email communications

• Review and sharing of medical device data, sound files, and video files

• Remote monitoring and assessment of health conditions

Alternative methods of care may be available to you, such as in-person services, and you have the right to choose an alternative method of care at any time. We encourage you to discuss all available treatment options with your Provider to determine the most appropriate care plan for your specific situation.

Anticipated Benefits

The use of Zyvyo's telehealth services may offer you several possible benefits. Our platform makes it easier and more efficient for you to access medical care and treatment for conditions managed by your Provider(s), while allowing you to obtain these services at times that are most convenient for you. You can receive care from the comfort and privacy of your chosen location, eliminating the need for travel and reducing exposure to other patients and potential illnesses. The platform enables continuous access to your healthcare team through secure messaging, fostering more frequent and consistent communication with your Provider(s).

For mental health services specifically, participation may help reduce stress and anxiety, assist in managing and decreasing negative thoughts, and support improved relationships and communication skills. Many patients find that telehealth services increase their comfort and confidence in various settings, provide valuable tools for better emotional regulation, and enable more consistent access to mental health support. The convenience and accessibility of telehealth often leads to better engagement with treatment and improved overall outcomes.

Potential Risks

While Zyvyo's telehealth services offer many advantages, it's important to understand that there are potential risks associated with the use of telehealth and related technology. The quality, accuracy, or effectiveness of services you receive from your Provider could be affected by the limitations of virtual care. Our technology platform, like any digital service, may experience technical issues including system bugs or errors that could limit functionality, affect data transmission, or temporarily make services unavailable.

The virtual nature of care means your Provider(s) cannot perform physical examinations or conduct certain tests that might be possible during in-person visits. This limitation may affect their ability to diagnose or treat some conditions, and in some cases, they may need to refer you to in-person care or emergency services. For instance, without the ability to directly assess vital signs or perform hands-on examinations, your Provider(s) may have a more limited ability to identify certain medical conditions or emergency situations.

Technology-related challenges could lead to delays in medical evaluation or treatment. These might occur due to provider unavailability, technical difficulties, or equipment failures. While we maintain robust security measures, there is always a risk that electronic systems or security protocols could be compromised, potentially affecting the privacy of your medical information. Electronic storage and communication of health information, including through email, may be more vulnerable to unauthorized access compared to traditional paper records.

Your treatment options may be limited by regulatory requirements in certain jurisdictions, particularly regarding prescriptions and controlled substances. Without complete access to all your medical records, there is a potential risk of adverse drug interactions, allergic reactions, or other medical judgment errors.

For mental health services specifically, it's important to note that you may temporarily experience increased discomfort or emotional difficulty as therapy progresses – this is a normal part of the therapeutic process, but the virtual format may present unique challenges in managing these feelings.

Additionally, telehealth services rely heavily on information you provide directly to your Provider(s). The accuracy and completeness of this information significantly impacts the quality of care we can deliver. If you are unable to effectively communicate your symptoms or concerns through our virtual platform, this could affect the quality of care you receive.

LIFE THREATENING AND OTHER EMERGENCY SITUATIONS; FOLLOW-UP CARE If you are experiencing a life-threatening situation such as contemplating suicide, call 911 or the 988 Suicide and Crisis Lifeline at 988.

If the situation is an emergency, call 911.
In some situations, telehealth is not an appropriate method of care. If you require immediate or urgent care, you must seek care at an emergency room facility or other provider equipped to deliver urgent or emergent care. Providers may not respond promptly to communications you submit through the Service. If you are not experiencing an emergency or do not require immediate or urgent care, you can communicate with Providers through the secure message service in the Service.

Data Privacy & Protection

The electronic systems used in the Service will incorporate network and software security protocols to protect the privacy and security of your information and will include measures to safeguard data against intentional or unintentional corruption. Personal information that identifies you or contains protected health information will not be disclosed to any third party without your consent, except as authorized by law for the purposes of consultation, treatment, payment/billing, certain administrative purposes, and as required by law to disclose to other persons and agencies certain information obtained during the provision of mental health services (e.g., danger to self or others; mandatory reporting of child, elder, or vulnerable adult abuse) or as otherwise set forth in your Provider's Notice of Privacy Practices. Use of the Service may include email communications to and from you that may include your protected health information. You understand that Hims & Hers does not and cannot guarantee the security or privacy of the services you use to receive communications, including for example your email service provider.

Laboratory Products & Services
Certain healthcare services provided to you by Providers via Zyvyo's Service may require that you complete an at-home diagnostic test. These diagnostic tests are provided by third-party laboratories, and neither Zyvyo nor your Provider(s) can guarantee the accuracy or reliability of these tests. Like all medical tests, these laboratory tests may occasionally provide false negative, false positive, or inconclusive results that could impact your Provider(s) ability to correctly diagnose or treat your medical conditions.

It's important to understand that any failure or defect in these tests, or errors in sample collection, could affect your Provider(s) ability to accurately diagnose or treat your conditions. We work with reputable laboratory partners, but as with any medical testing, there are inherent limitations and risks that you should be aware of when using at-home diagnostic services. Your Provider will help you understand your test results and may recommend additional testing or in-person evaluation if necessary to ensure accurate diagnosis and appropriate treatment.

Open Payments Notice
For informational purposes only, a link to the federal Centers for Medicare and Medicaid Services Open Payments web page is provided here. The federal Physician Payments Sunshine Act requires that detailed information about payment and other payments of value worth over ten dollars ($10) from manufacturers of drugs, medical device, and biologics to physicians and teaching hospitals be made available to the public. 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.

Contacting Us

If you have any questions about this Privacy Policy, please contact us by email at privacy@zyvyo.com

© 2024 Zyvyo. All rights reserved. ZYVYO and the ZYVYO logo are trademarks of Zyvyo, Inc.