Telehealth informed consent

This Telehealth Informed Consent ("Consent") describes the nature of telehealth services you may receive from the independent telehealth medical group referenced in your Insyght Membership Terms of Service (the "Telehealth Provider"). Please read this Consent carefully. You must accept it before receiving any service from the Telehealth Provider.

1. What telehealth is

Telehealth means the use of audio, video, or asynchronous electronic communication to allow a health care provider to evaluate, diagnose, treat, or advise a patient remotely, without an in-person physical examination. Depending on the service, your interaction with the Telehealth Provider may be synchronous (live video or audio) or asynchronous (for example, a written questionnaire and history reviewed by a physician who responds electronically).

2. Who is providing your care

Telehealth services are provided by the Telehealth Provider, an independently licensed medical group, and its affiliated physicians and clinicians, not by Insyght. Insyght is a technology company that facilitates your connection to the Telehealth Provider through its platform; Insyght does not employ, supervise, or direct the Telehealth Provider's clinicians, and has no role in any clinical decision made about your care.

3. Potential benefits and risks of telehealth

Potential benefits of telehealth include convenient access to care without travel, and timely evaluation. Telehealth also has limitations and risks you should understand, including:

• The clinician evaluating you does not have the benefit of a hands-on physical examination, which in some cases could result in information being missed that an in-person exam would reveal.
• Technical difficulties (connectivity loss, equipment failure) may delay or interrupt your evaluation.
• Information you provide electronically could, in rare cases, be intercepted or accessed by unauthorized parties, despite reasonable security measures.
• Your clinician may determine that your condition cannot be safely or adequately evaluated through telehealth, and may recommend in-person evaluation instead.

4. Not a substitute for primary care

Telemedicine Services do not replace your relationship with your primary care physician or any other personal physician you see. You are solely responsible for initiating and maintaining follow-up care with your primary care or personal physician for ongoing diagnosis, treatment, and management of your health. The Telehealth Provider's clinician may, in their sole discretion, decline your request for a consultation, or determine that your condition is not suitable for evaluation or treatment using telehealth technology, in which case you may need to seek care from a specialist or another provider outside of telehealth.

5. Emergencies

Telehealth is not appropriate for medical emergencies. If you believe you are experiencing a medical emergency, call 911 or go to the nearest emergency room. Do not use telehealth or the Platform to seek emergency care.

6. Confidentiality

Information disclosed during your telehealth encounter is subject to the same confidentiality protections as an in-person visit, as described in the Telehealth Provider's own privacy notice and Insyght's HIPAA Notice of Privacy Practices. As with any electronic communication, there is a small residual risk of unauthorized access despite reasonable safeguards.

7. Your right to decline or withdraw

Your consent to telehealth is voluntary. You may decline telehealth services, or withdraw this Consent at any time, without penalty or loss of any benefit to which you are otherwise entitled. If you decline or withdraw, the Telehealth Provider may recommend an in-person alternative, which may or may not be available or covered under your Membership.

8. Your acknowledgment

By accepting this Consent, you acknowledge that:

• You have read and understand this Consent, and had the opportunity to ask questions before proceeding.
• You understand that the Telehealth Provider, not Insyght, is responsible for your clinical care.
• You understand the potential benefits and risks of telehealth described above.
• You consent to receiving care from the Telehealth Provider by telehealth, on the terms described in this Consent, and agree that you may receive a diagnosis and/or treatment recommendation via telehealth technology.
• You are requesting or consenting to Telemedicine Services voluntarily, without influence or pressure from any other party, including Insyght.

You accept this Consent electronically as part of your intake, recorded with your member name and the date of acceptance.