Virtual Care Telehealth Consent

Introduction

Somi Health provides healthcare services through telehealth technologies ("Virtual Care"), allowing patients to communicate with licensed healthcare providers remotely using secure electronic communications, including video conferencing, telephone, messaging, electronic questionnaires, and other digital platforms.

By signing this consent, you acknowledge that you have read, understood, and agree to the terms outlined below regarding the use of telehealth services provided by Somi Health.

1. Nature of Telehealth Services

Telehealth involves the delivery of healthcare services through electronic communications and technology when the patient and healthcare provider are not in the same physical location.

Telehealth services may include:

• Medical evaluations and consultations
• Diagnosis and treatment recommendations
• Prescription management and medication refills (when clinically appropriate)
• Follow-up care and monitoring
• Review of medical records, laboratory results, and imaging reports
• Health education and counseling

Telehealth services may be provided through video visits, telephone calls, secure messaging, electronic questionnaires, or other approved technologies.

2. Potential Benefits

Potential benefits of telehealth include:

• Improved access to healthcare services
• Reduced travel time and expenses
• Increased convenience and flexibility
• Improved continuity of care
• Timely access to medical advice and treatment

3. Potential Risks and Limitations

I understand that telehealth has limitations and risks, including but not limited to:

• Technical failures, interruptions, poor audio/video quality, or loss of internet connectivity.
• Delays in medical evaluation due to technology issues.
• The inability of a provider to perform a comprehensive physical examination.
• The possibility that my condition may require an in-person evaluation, laboratory testing, imaging, or referral to another healthcare provider.
• Risks associated with electronic transmission of health information despite reasonable security measures.

I understand that no guarantees have been made regarding treatment outcomes or results.

4. Patient Responsibilities

I agree to:

• Provide accurate, complete, and truthful medical information.
• Update Somi Health regarding changes to my health status, medications, allergies, and contact information.
• Participate in telehealth visits from a safe and private location whenever possible.
• Follow treatment recommendations and seek emergency care when advised.
• Contact emergency services (911) or go to the nearest emergency room for any medical emergency.

5. Privacy and Confidentiality

Somi Health is committed to protecting the privacy and confidentiality of your health information in accordance with applicable federal and state laws, including the Health Insurance Portability and Accountability Act (HIPAA).

I understand that:

• My medical information will be maintained in a secure electronic medical record.
• Telehealth communications may involve electronic transmission of protected health information.
• While Somi Health uses reasonable safeguards to protect my information, no electronic system can guarantee absolute security.

6. Prescriptions

If a Somi Health provider determines that a prescription is medically appropriate, an electronic prescription may be sent to my preferred pharmacy.

I understand that:

• Prescriptions are issued solely at the provider's professional discretion.
• Certain medications may require an in-person evaluation before they can be prescribed.
• Somi Health does not guarantee that any specific medication will be prescribed.
• Somi Health does not prescribe controlled substances through its Virtual Care services unless otherwise permitted by applicable law and provider policy.

7. Emergency Situations

Telehealth services are not intended for medical emergencies.

If I experience any emergency symptoms, including but not limited to chest pain, severe shortness of breath, stroke symptoms, loss of consciousness, severe allergic reactions, or thoughts of self-harm, I will immediately call 911 or seek care at the nearest emergency department.

8. Consent to Electronic Communications

I consent to receiving communications from Somi Health electronically, including:

• Appointment reminders
• Treatment recommendations
• Prescription notifications
• Billing communications
• Secure messages related to my care

I understand that standard message and data rates may apply.

9. Right to Withdraw Consent

I understand that I may withdraw my consent for telehealth services at any time by notifying Somi Health in writing. Withdrawal of consent will not affect any healthcare services already provided prior to withdrawal.

10. Financial Responsibility

I understand that I am financially responsible for charges associated with services provided by Somi Health, including consultations, treatments, laboratory services, medications, and pharmacy-related fees that are not otherwise covered by insurance or third parties.

11. Medication Refill – Terms of Service

By requesting a medication refill through our telehealth platform, you acknowledge that all refill requests are subject to review and approval by a licensed healthcare provider based on your current medical history, reported symptoms, medication adherence, and clinical appropriateness. Submission of a refill request does not guarantee that a prescription will be issued. Additional documentation, laboratory testing, pharmacy verification, or a follow-up visit may be required before a refill can be approved. We do not prescribe, refill, or manage controlled substances through this service. Requests for controlled medications will be declined and should be directed to your established prescribing provider.

You are responsible for providing complete, accurate, and up-to-date medical information, including your current medications, allergies, pharmacy information, and any changes in your health status. Failure to respond to requests for additional information or to complete required follow-up care may delay or prevent prescription approval. You agree to use medications only as prescribed and understand that prescriptions may be modified, denied, or discontinued if deemed medically necessary, if continued treatment is determined to be unsafe, or if the requested medication is not appropriate for telehealth management.

12. Everyday Health – Terms of Service

The Everyday Health service is intended to provide convenient access to general healthcare services, including evaluation and management of common acute illnesses, preventive care, and select chronic health concerns through telehealth. Healthcare providers will use their professional clinical judgment to determine whether your condition can be safely managed through telemedicine. Certain medical conditions may require an in-person examination, diagnostic testing, specialist referral, or emergency medical evaluation, and you agree to follow these recommendations when provided.

You acknowledge that telehealth has limitations and is not a substitute for emergency medical care or ongoing comprehensive healthcare when clinically indicated. If you experience symptoms such as chest pain, severe shortness of breath, stroke symptoms, uncontrolled bleeding, or any other medical emergency, you should call 911 or seek immediate emergency care. By using this service, you consent to receiving medical care via telehealth and agree to provide accurate health information to support safe and appropriate clinical decision-making.

13. Direct Primary Care – Terms of Service

Direct Primary Care provides comprehensive primary care services through a combination of telehealth and other available care modalities, including preventive care, chronic disease management, medication management, health screenings, and coordination of care when appropriate. While we strive to provide continuous, high-quality medical care, participation in this program does not guarantee immediate access to appointments, prescription approvals, specialist referrals, or diagnostic testing. All medical recommendations and treatment decisions remain at the discretion of the treating licensed healthcare provider based on accepted standards of care.

You agree to actively participate in your healthcare by providing accurate medical information, completing recommended laboratory testing, attending follow-up appointments, and communicating any changes in your medical condition or medications. Failure to comply with recommended monitoring or treatment plans may affect your eligibility for continued services. Direct Primary Care is not intended to replace emergency medical services, and you should seek immediate emergency care for any life-threatening or urgent medical condition.

14. Subscription Cancellation

You may cancel your subscription to Medication Refill, Everyday Health, or Direct Primary Care at any time. Cancellations can be made directly through your patient portal or by submitting a written request via email to info@joinsomi.com. Your cancellation will become effective at the end of your current billing period unless otherwise specified. Cancellation will prevent future recurring charges but does not entitle you to a refund for services already rendered or for the current billing period, except as required by applicable law.

15. Acknowledgment and Consent

By checking the box, I acknowledge that:

• I have read and understood this Telehealth Consent.
• I have had the opportunity to ask questions regarding telehealth services.
• I understand the risks, benefits, and limitations of telehealth.
• I voluntarily consent to receive healthcare services through Somi Health's Virtual Care platform.
• I understand that telehealth services may not be appropriate for all medical conditions and that in-person care may be recommended when clinically necessary.