Telehealth Consent

ASYNCHRONOUS TELEMEDICINE INFORMED CONSENT

Thank you for choosing Rejuve Meds, a brand operated by Rejuve, Inc., and Beluga Health, P.A. (“Beluga”).

You are viewing this form because you have elected to engage in asynchronous telemedicine visits with a Beluga healthcare practitioner through the Rejuve Meds platform. Your practitioner is a board-certified physician licensed in your state.

By clicking “I Agree,” I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THE TERMS PRESENTED BELOW, UNDERSTAND THE RISKS AND BENEFITS OF ASYNCHRONOUS TELEMEDICINE, AND BY ACCEPTING THESE TERMS I HEREBY GIVE MY INFORMED CONSENT TO PARTICIPATE IN ASYNCHRONOUS TELEMEDICINE UNDER THESE TERMS.

What is Telemedicine?

Telemedicine is the delivery of healthcare services, including examination, consultation, diagnosis, and treatment, through electronic communication technologies when you (the patient) are located in a different location than your healthcare practitioner. Beluga allows you to receive treatment from a healthcare practitioner without having to travel to another location or schedule a separate appointment and helps you avoid long wait times that you might otherwise experience during an in-person visit.

What is Asynchronous Telemedicine?

Asynchronous telemedicine is one method of delivering telemedicine. It is often referred to as “store-and-forward” communication, where participants submit and review information at different times.

Examples include telemedicine encounters involving the transmission of photos, video, questionnaires, or other communications via secure forms, email, or text message. “Asynchronous” means the interaction does not occur in real time and differs from “synchronous” telemedicine, which typically involves live audio or video communication.

Healthcare practitioners may use asynchronous telemedicine when real-time or in-person interaction is not necessary or feasible.

Beluga’s platform (the “Platform”), accessed through Rejuve Meds, enables the following asynchronous telemedicine services:

1. Text-based healthcare practitioner–patient interactions via short message service (“SMS”) and multimedia messaging service (“MMS”); and
2. Secure information collection through asynchronous, store-and-forward patient questionnaires.

Possible Risks of Asynchronous Telemedicine

As with any medical treatment, there are potential risks associated with asynchronous telemedicine. While Beluga believes the likelihood of these risks is low, they may include, without limitation:

• Delays in evaluation, consultation, or treatment due to equipment failure, internet outages, or poor data quality. You may reschedule if interruptions occur.
• Security failures that could result in a breach of personal medical information.
• Incomplete disclosure of your medical history, medications, supplements, or allergies may increase the risk of adverse outcomes, drug interactions, or allergic reactions.
• Asynchronous telemedicine services are NOT emergency services, and your Personal Data (as defined in the Beluga Privacy Policy) IS NOT MONITORED 24/7. If you believe you are experiencing a medical emergency, CALL 911 IMMEDIATELY.

THE CARE YOU RECEIVE IS AT THE SOLE DISCRETION OF THE BELUGA HEALTHCARE PRACTITIONER. THERE IS NO GUARANTEE OF DIAGNOSIS, TREATMENT, OR PRESCRIPTION. THE PRACTITIONER WILL DETERMINE WHETHER YOUR CONDITION IS APPROPRIATE FOR CARE VIA ASYNCHRONOUS TELEMEDICINE.

Your Rights and Acknowledgements

By agreeing to this consent, you acknowledge and understand the following:

• You have the same privacy rights via asynchronous telemedicine as you would during an in-person visit. Identifiable information will not be shared without your written consent, except as permitted by law. For details, please review the Beluga Privacy Policy.
• Asynchronous telemedicine may involve the electronic transmission of your medical information to healthcare practitioners who may be located in a different state.
• You may expect benefits from asynchronous telemedicine, but no results are guaranteed.
• All information you submit to Beluga, including via text message, and all information entered by your healthcare practitioner into the Platform, becomes part of your medical record. You may request access by emailing admin@belugahealth.com.
• Your healthcare practitioner’s initial message will include their name and credentials and will be recorded as part of your medical record.
• You may withdraw your consent and request deletion of your patient profile at any time by emailing admin@belugahealth.com.
• Your healthcare information may be disclosed as required by law, including:
  • In response to a valid court order
  • To report suspected abuse, neglect, or domestic violence
  • To prevent or reduce a serious threat to health or safety

Call, Email, and Text Messaging Consent

You expressly consent to allow Beluga Health, P.A. or its healthcare practitioners to call, email, or text you (via SMS and/or MMS) regarding Personal Data, appointments, or matters related to your telemedicine care using the contact information you provide.

Messages may be sent using an autodialer or prerecorded or artificial voice, even if your number is on a do-not-call list. Carrier rates may apply. This consent is not a condition of purchase and may be revoked at any time by emailing admin@belugahealth.com.

This Asynchronous Telemedicine Informed Consent remains valid throughout your course of treatment with Beluga Health, P.A.