Telemedicine Disclosure

Telehealth Informed Consent & Disclosure

I understand that ShedRx has arranged a telehealth consultation for me and an independent and duly licensed medical provider (the “Provider”) utilizing its telehealth platform. There are two primary methods for such telehealth consultations:
First, I may be able to conduct an asynchronous telehealth consultation, in which I will provide the requisite personal health information to my Provider in a digital format; based on that health information, my Provider may be able to diagnose and prescribe treatment upon review of the information that I have provided. I acknowledge, however, that I may not be a good candidate for asynchronous consultations and that either the Provider or ShedRx may require that I engage in a live, interactive video consultation with the Provider prior to beginning any treatment.
Second, if required to conduct–or if I choose to conduct–an interactive video consultation with my Provider, I will be able to consult with the Provider about my health and wellness concerns in real time via a live video connection through the ShedRx platform.
ShedRx has explained to me how telehealth will be used to do such consultation and how else we will use telehealth to connect with the Provider while working together, utilizing the telehealth platform.
I understand there are potential risks with this technology:
· The video connection may not work or it may stop working during the consultation.
· The video picture or information transmitted may not be clear enough to be useful for the consultation.
· My personal health information may be misreported or inaccurately stored, making asynchronous or live video consultations difficult, inaccurate, or impossible. I acknowledge, however, that I have an obligation to accurately and truthfully present my personal health information to ShedRx and the Provider and that any treatment provided based on inaccurate information will be my sole responsibility and liability.
The benefits of a telehealth consultation are:
· I do not need to travel to the consult location.
· I can meet with a Provider quickly and efficiently.
· I have access to a specialist Provider through this consultation.
I also understand other individuals may need to use the telehealth platform and that they will take all reasonable and necessary steps to maintain confidentiality of the information I provide. I have read this document and understand the risk and benefits of the telehealth consultation and have had my questions regarding the procedure explained and I hereby consent to participate in telehealth sessions under the conditions described in this document.
I have further read and agree to the terms below in association with my telehealth sessions and treatment with and through my Provider and ShedRx.

Accurate Information
A member of my Provider team assessed my medical condition and made a clinical treatment determination, taking into account the information I provided. If I forgot to provide or incorrectly provided certain information related to my health, there is a possibility that the Provider may misdiagnose or fail to diagnose conditions that I may have which could affect their recommendation for treatment. If I need to clarify or update any information about my health, I must message my Provider team through the ShedRx platform as soon as possible.

Treatment Failure
The treatments that I may be prescribed are not 100% effective for all patients. Any such treatment may not work or may only partially resolve the condition for which I am seeking treatment. Likewise, treatments may result in adverse side effects, varying in severity from mild to severe. If I do not see any signs of improvement or if I am experiencing new or worsening symptoms, I will message a Provider through the ShedRx platform, contact my regular healthcare provider, or go to an urgent care center as appropriate. If it is an emergency, I understand that I should call 911 or seek immediate help in-person at my nearest hospital, clinic, or healthcare provider.

Misdiagnosis or Delayed Diagnosis
I acknowledge that there is a risk that the Provider may misdiagnose or fail to diagnose conditions that I may have which could affect the recommendation for treatment. The healthcare Providers providing treatment through the ShedRx platform use evidence-based guidelines as well as clinical decision-making to try to minimize these risks.

Accepting or Declining the Recommendation
The Provider who recommended or may recommend this treatment for me did so with my consent and because the potential benefits outweigh the risks in their estimation, based on their clinical judgment, training, and experience. I should evaluate this information and any input from my in-person healthcare team, and any other relevant information to decide if this treatment plan is appropriate for me. I understand that I am free to not follow the treatment recommendations I received from the Provider through the ShedRx platform.

Share with My In-Person Healthcare Team
I can request a copy of my health records anytime. ShedRx strongly recommends that I update my in-person healthcare team about any new medicines that I am taking or other changes in my health. I can also ask questions anytime by messaging a Provider through the ShedRx platform who can help me share any information about my health with my in-person healthcare team.

Following My Prescribed Treatment
If I begin treatment through ShedRx at the direction of my Provider, I acknowledge and agree that I must follow the prescribed treatment plan from my Provider team and ShedRx. All prescription medication must be taken and used only as prescribed. If I do not follow my treatment plan precisely as prescribed and directed by the Provider team and/or ShedRx, ShedRx cannot and will not be liable for my care and may terminate my current and future treatment plan(s).

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