Telehealth Informed Consent

Telehealth is the delivery of clinical care using electronic information and communication technology, where the patient and the treating clinician are in different physical locations. A telehealth encounter may include the exchange of medical intake information, the transmission of images or laboratory results, real-time audio and video consultation, the issuance of a prescription where clinically appropriate, and follow-up communication through secure messaging.

This Telehealth Informed Consent (the "Consent") explains the ways clinical care is delivered through the pep'd platform, the expected benefits and potential risks of that mode of delivery, and your rights and responsibilities as a patient. By checking the acceptance box during enrollment and continuing to a consultation, you confirm that you have read and agreed to this Consent.

Pep'd, Inc. ("pep'd") is a management services organization that coordinates non-clinical administrative, technology, and support services. pep'd does not provide medical services and is not a party to the clinician–patient relationship. Clinical services are delivered by an independently licensed professional entity (the "Provider Group") and the individually licensed clinicians it employs or engages (each, a "Provider"). Medications prescribed through the platform are dispensed by an independently licensed pharmacy (the "Pharmacy"). Each Provider will be licensed in the state in which you are located at the time of the consultation and will exercise independent clinical judgment in accordance with applicable law.

The following categories of electronic transmission may occur during your care through the platform:

• Account creation, identity verification, and appointment scheduling.
• Completion, exchange, and review of medical intake forms and health history.
• Secure transmission and clinical review of photographs, video, laboratory results, and other clinically relevant information.
• Synchronous two-way video, two-way audio, or two-way audio with store-and-forward communications during a consultation.
• Asynchronous secure messaging between you and the Provider or care team.
• Issuance of clinical recommendations, diagnosis notes, treatment plans, and prescriptions where clinically appropriate.
• Prescription refill reminders, follow-up prompts, and clinical check-ins.
• Other transmissions reasonably necessary for the provision of your clinical care.

• Improved access to care by allowing you to be evaluated from your home or another preferred location.
• Convenient follow-up communication through the secure messaging feature of the platform.
• More efficient evaluation, treatment planning, and care management for conditions that can be appropriately addressed by telehealth.
• Reduced time and cost associated with travel to in-person appointments.

Telehealth differs from in-person care in several ways that you should understand before consenting to treatment.

• No physical examination. The Provider cannot physically examine you. Some conditions require hands-on evaluation or in-person diagnostic testing; where this is the case, the Provider will advise you and may decline to prescribe or may refer you for in-person care.
• Technology failure. Internet interruptions, device issues, or service outages may delay, interrupt, or prevent a consultation. Alternative arrangements will be offered when practical.
• Image or data quality. If transmitted information is of inadequate quality for clinical assessment, your Provider may reschedule the consultation or recommend in-person care.
• Security. Although the platform uses industry-standard safeguards, no electronic system is fully immune to interception, misrouting, or unauthorized access. Messages and attachments sent outside the platform, for example by unencrypted email or text, are more vulnerable than those sent within it.
• Not for emergencies. The platform is not designed for medical emergencies. If you are experiencing an emergency, including severe symptoms, suicidal ideation, or imminent risk of harm, call 911 or go to the nearest emergency department immediately; do not rely on platform messaging.
• Local primary care remains important. Telehealth is a supplement to, not a substitute for, an ongoing relationship with a local primary care provider. You are encouraged to maintain a primary care provider.

By consenting to telehealth care through the platform, you acknowledge and agree that:

• I will be given an opportunity to be connected to an available Provider, and I have been, or will be, provided information sufficient to identify the Provider and verify that the Provider is licensed in my state of residence.
• If I am experiencing a medical emergency, I will call 911 or go to the nearest emergency department. I understand that pep'd and the Provider are not able to connect me to local emergency services through the platform.
• I may decline telehealth and seek services from a clinician with in-person availability as an alternative.
• I have the right to withhold or withdraw consent to telehealth at any time without affecting my right to seek future care or treatment.
• Federal and state laws protect the confidentiality and security of my health information. I am entitled to the full privacy protections afforded by those laws. Records of my telehealth encounter are part of my medical record.
• My health information may be electronically transmitted to other licensed clinicians or entities involved in my care, which may be located in other states.
• My personally identifiable images or information will not be shared with researchers or educational institutions without my separate affirmative consent.
• I accept the risk of technology or equipment failure during a telehealth visit, which may cause delay in evaluation or loss of information, and I release the Provider and pep'd from liability for delays or information loss attributable to such failures, to the fullest extent permitted by law.
• Certain services associated with my care, such as laboratory testing or blood draws, may be performed at another location, for example a commercial laboratory, collection site, or at-home kit, at the Provider's direction.
• A person other than my Provider may be present during a telehealth visit to operate the telehealth technology. I will be informed of any such person's presence and role. I may omit personally sensitive details, ask nonclinical personnel to leave, and/or terminate the consultation at any time.
• My Provider will explain any diagnosis or recommended treatment and the risks and benefits of available options. I have the opportunity to ask questions before deciding whether to proceed.
• I may request a copy of my medical records by emailing support@pepd.com or by using the secure messaging function in the platform. pep'd operates the support@pepd.com inbox solely as administrative support and routes records requests to the Provider Group, which maintains the medical record. The Provider Group will respond within the timeframes required by applicable law. A reasonable fee for copying, shipping, and delivery may apply as permitted by law.
• There is no guarantee that I will be issued a prescription. Whether a prescription is clinically appropriate is the Provider's independent determination. If a prescription is issued, I may have it filled at the pharmacy engaged through the platform or, where applicable, at a pharmacy of my choice.
• I consent to receive invitations, appointment notifications, clinical reminders, and related communications from the Provider Group and pep'd via email, in-platform message, automated telephone dialing systems, prerecorded or artificial voice messages, and, where I have separately opted in, text messages. I will promptly notify pep'd of any change to my contact information.
• I understand that I may receive multiple messages per day, that standard message and data rates may apply, and that automated messages and unsecured email or text communications may not be encrypted end-to-end. I may opt out of non-clinical automated communications at any time, consistent with the SMS Terms of Service and Privacy Policy, without affecting my eligibility for care.
• pep'd and the Provider Group use reasonable physical, technical, and administrative safeguards to protect the privacy of my personal information. I understand the limitations of unencrypted email and text and may request alternative communication methods by contacting legal@pepd.com.

The pep'd platform and the clinicians who provide care through it do not furnish emergency medical services. If you are experiencing a medical emergency — including severe chest pain, difficulty breathing, signs of stroke, severe allergic reaction, suicidal thoughts, or any condition you believe is life-threatening — call 911 or proceed immediately to the nearest emergency department. In a mental health crisis, you may also call or text 988 to reach the Suicide and Crisis Lifeline.

The federal Physician Payments Sunshine Act requires drug, device, and biologic manufacturers and group purchasing organizations to report certain payments and transfers of value made to physicians and teaching hospitals. Reported information is publicly searchable on the federal Open Payments database maintained by the Centers for Medicare & Medicaid Services (CMS) at openpaymentsdata.cms.gov. This disclosure is provided for informational purposes only. Neither this disclosure nor the existence of any payment on the Open Payments database establishes any conflict of interest or improper conduct by your Provider.

You may withdraw your consent to telehealth at any time by notifying your Provider through secure messaging or by emailing support@pepd.com. Withdrawal of consent does not affect care already provided and does not by itself cancel any scheduled medication shipment or recurring membership.

The disclosures below apply to patients who reside in or receive care while located in the states identified. Each state imposes its own combination of records-sharing rights, complaint-filing notices, and other patient-rights disclosures. Where a state in which you receive care is not specifically listed, the general protections described in Sections 1 through 9 apply.

• 10.1 Alaska: Alaska residents have the right to receive a copy of their telehealth encounter records and to share those records with their primary care physician. Complaints about an Alaska-licensed clinician may be filed with the Alaska Division of Corporations, Business and Professional Licensing.
• 10.2 Connecticut: Connecticut residents have the right to share copies of their telehealth encounter records with their primary care physician.
• 10.3 Florida: Florida residents are entitled to the protections set forth in the Florida Patient's Bill of Rights and Responsibilities, codified at Florida Statutes § 381.026.
• 10.4 Iowa: Complaints about an Iowa-licensed clinician may be filed with the Iowa Board of Medicine.
• 10.5 Idaho: Complaints about an Idaho-licensed clinician may be filed with the Idaho Board of Medicine through its consumer complaint portal.
• 10.6 Indiana: Complaints about an Indiana-licensed clinician may be filed with the Indiana Professional Licensing Agency.
• 10.7 Kansas: Kansas law provides that, where a Kansas patient designates a primary care or treating physician, a report of the telemedicine encounter shall be sent to that physician within three (3) days of the patient's consent.
• 10.8 Kentucky: Complaints about a Kentucky-licensed clinician may be filed with the Kentucky Board of Medical Licensure.
• 10.9 Maine: Complaints about a Maine-licensed M.D. clinician may be filed with the Maine Board of Licensure in Medicine; complaints about a D.O. clinician with the Maine Board of Osteopathic Licensure.
• 10.10 New Hampshire: New Hampshire residents have the right to receive copies of their telehealth encounter records and to share those records with their primary care or treating provider.
• 10.11 Ohio: Ohio residents have the right to share copies of their telehealth encounter records with their primary care physician.
• 10.12 Oklahoma: Complaints about an Oklahoma-licensed M.D. may be filed with the Oklahoma State Board of Medical Licensure and Supervision; complaints about a D.O. with the Oklahoma State Board of Osteopathic Examiners.
• 10.13 Rhode Island: Complaints about a Rhode Island-licensed clinician may be filed with the Rhode Island Department of Health.
• 10.14 South Carolina: South Carolina residents have the right to control the distribution of their medical records.
• 10.15 Texas: Under Texas law, with your consent, a copy of your medical records from the telehealth encounter may be transmitted to your primary care physician within seventy-two (72) hours of the encounter. Complaints against physicians and other licensees of the Texas Medical Board may be reported to: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018. Telephone: 1-800-201-9353. Website: www.tmb.texas.gov.
• 10.16 Vermont: Vermont residents have the right to receive a real-time consultation with the distant-site provider, either at the time of the initial consult or within a reasonable time thereafter (Vt. Stat. Ann. § 9361). Complaints about a Vermont-licensed clinician may be filed with the Vermont Board of Medical Practice or the Vermont Board of Osteopathic Examiners.

By checking the acceptance box at enrollment and proceeding to a consultation, you acknowledge that you have read this Telehealth Informed Consent, that you have had the opportunity to ask questions, and that you voluntarily consent to receive care via telehealth on the terms described above. A copy of this Consent is available at pepd.com and upon request to support@pepd.com.