Informed Consent for Telehealth Services

OUR SERVICES ARE NOT A REPLACEMENT FOR EMERGENCY MEDICAL SERVICES. IF YOU ARE EXPERIENCING A MEDICAL EMERGENCY, CALL 911 OR GO TO YOUR NEAREST EMERGENCY ROOM IMMEDIATELY. Do not use our platform to seek treatment for emergency or life-threatening conditions.

We may update, modify, or supplement the terms of this consent document at any time as required by changes in applicable law, regulation, business operations, or competitive considerations. Material changes will be communicated through our website. Your continued use of our Services following any changes constitutes your acceptance of the updated consent.

Telehealth involves the use of electronic communications, including but not limited to audio-video interfaces, videoconferencing, and secure messaging, to deliver healthcare services remotely. By using the services available through Prescriva, you consent to receiving healthcare services via telehealth from licensed healthcare providers within the OpenLoop Health provider network and its affiliated medical professional corporations.

Electronic systems used in the delivery of telehealth services incorporate network and software security protocols designed to protect the confidentiality of patient identification and health data, including measures to safeguard information integrity against intentional or unintentional corruption.

Prescriva is a management services organization (MSO) operated by Blue Oak Services LLC dba Prescriva, a California limited liability company. Prescriva does not practice medicine, employ clinicians or any healthcare providers, or make clinical decisions. All medical care is provided by independent, licensed healthcare providers through the OpenLoop Health provider network.

• The health assessment available on the Prescriva website is a preliminary screening tool. Completing an assessment does not create a doctor-patient relationship between you and Blue Oak Services LLC dba Prescriva.
• A doctor-patient relationship is established only between you and the licensed healthcare provider who evaluates and treats you through the Provider Network.
• OpenLoop Health has established exclusionary criteria to determine eligibility for treatment. The answers you provide during the assessment determine whether you are screened out of eligibility, and an OpenLoop Health clinician will consult with you after checkout to determine if you qualify for a prescription.
• Licensed clinicians within OpenLoop Health retain sole and independent discretion over all prescribing decisions. There is no guarantee that you will receive a prescription.

Expected benefits include:

• Improved access to healthcare providers, particularly for patients in underserved or remote areas
• More efficient health care management, including medical evaluation and ongoing treatment coordination
• Ability to receive care from the comfort of your home with reduced travel time
• Access to the expertise of distant specialists and maintaining connections with established providers

Potential risks and limitations include:

• In rare cases, information transmitted may not be sufficient (e.g., poor resolution of images or audio quality) to allow for appropriate medical decision-making by the licensed clinician or clinical staff
• Delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment or technology
• In very rare instances, security protocols could fail, causing a breach of privacy of personal medical information
• A lack of access to your complete medical records may result in adverse drug interactions, allergic reactions, or other clinical judgment errors
• The inability to perform a physical examination may limit the provider's ability to diagnose or treat certain conditions

In accordance with California Business & Professions Code §2290.5 and applicable state law, you understand and acknowledge the following:

• The laws that protect the privacy and confidentiality of medical information also apply to telehealth, and no information obtained through telehealth that identifies you will be disclosed to researchers or other entities without your consent
• You have the right to withhold or withdraw your consent to the use of telehealth at any time, without affecting your right to future care or treatment
• You have the right to inspect all information obtained and documented in the course of a telehealth interaction, and may receive copies of this information in accordance with applicable law
• A variety of alternative methods of health care may be available to you, and you may choose one or more of these at any time
• It is in your best interest to inform your provider of any other healthcare professionals involved in your care
• You may expect the anticipated benefits from the use of telehealth in your care, but no specific results can be guaranteed or assured
• You have the right to request an in-person consultation with a healthcare provider at any time
• You have the right to be informed of the identity and qualifications of the healthcare provider delivering services to you
• You have the right to receive a copy of this consent form

All healthcare providers delivering services through our platform are:

• Licensed to practice medicine in the state(s) where they provide care
• Credentialed through OpenLoop Health's established vetting and quality protocols
• Independently responsible for the medical services they provide

Prescriva does not credential, supervise, or direct the clinical judgment of healthcare providers. The decision to prescribe any medication is guided by the licensed provider's independent medical judgment, informed by the telehealth consultation and your medical history.

If a licensed provider determines that medication is appropriate for your treatment:

• All prescription medications are dispensed according to state and federal law
• Prescriptions require pharmacist approval in compliance with applicable Medical and State Pharmacy Board requirements
• Medications are fulfilled by state-licensed 503A compounding pharmacies
• Compounded medications are produced in FDA-regulated facilities but are not FDA-approved or FDA-evaluated for safety, efficacy, or quality
• We encourage you to speak with your provider about the specific risks and benefits that may come with the use of compounded medication
• Prescriva does not produce compounded medications, and you may receive medication that differs in appearance from what is portrayed on the website

Pharmacy Partnerships: We partner with multiple certified U.S. pharmacies to provide medications and services. Our team coordinates regularly with pharmacy partners regarding product availability, shipping timelines, and quality testing updates.

All prescription medications are dispensed according to state and federal law with the approval of the pharmacist in charge and in compliance with all laws applicable from the relevant Medical Boards and State Boards of Pharmacy.

• Medication is considered dispensed and the order completed when it is signed out for shipping by the pharmacy, not when it arrives at your address
• By providing your shipping address during intake or at any subsequent time, you authorize the shipment of prescribed medications to that address
• You acknowledge and agree that Blue Oak Services LLC dba Prescriva shall not be held liable for any delays or errors that occur during the shipping process once medication has been released to a third-party carrier

The Health Insurance Portability and Accountability Act (HIPAA) provides safeguards to protect your privacy. We have adopted the following policies regarding your Protected Health Information (PHI):

• Your health information will be kept confidential except as necessary to provide services or to ensure that all administrative matters related to your care are handled appropriately, including the sharing of information with other healthcare providers, laboratories, and health insurance payers as necessary and appropriate for your care
• We utilize vendors and technology partners in the conduct of our business who may have access to PHI, and who are required to abide by the confidentiality rules of HIPAA through Business Associate Agreements
• You understand and agree to inspections and reviews of documents which may include PHI by government agencies or insurance payers in the normal performance of their duties
• Your confidential information will not be used for purposes of marketing or advertising products, goods, or services without your explicit consent
• We will provide you with access to your records in accordance with state and federal laws
• You have the right to request restrictions in the use of your PHI and to request changes in certain policies used concerning your PHI; however, we are not obligated to alter internal policies to conform to your request

For full details on how your data is collected, used, and shared, please review our Privacy Policy and Notice of Privacy Practices.

Your health information is protected under HIPAA and applicable state privacy laws, including the California Consumer Privacy Act (CCPA). We implement administrative, technical, and physical safeguards to protect your information.

Communications via telehealth are conducted through secure, encrypted channels. However, as with any electronic communication, there is some risk that information could be intercepted or accessed by unauthorized parties despite our security measures.

We may contact you by telephone, email, text message, or other electronic means to provide appointment reminders, service updates, or information about changes to our policies or procedures that may be relevant to your care.

By using our Services, you understand and accept the following financial terms:

• You authorize Blue Oak Services LLC dba Prescriva to charge the payment method you provide for services rendered, including any outstanding balances
• You authorize the release of any medical records or other information necessary to process your consultation and orders
• Subscription-based programs are auto-renewing. You consent to be automatically charged for any active program unless you explicitly request cancellation before your next payment is processed
• Fee schedules and receipts for all professional services are available upon request

For details on cancellation and refund eligibility, please review our Cancellation & Refund Policy.

You acknowledge that health assessments and consultations conducted through our platform rely on information that you provide. Providing accurate, complete, and truthful health information is essential for your safety and the effectiveness of your care. You understand that inaccurate or incomplete information may result in inappropriate treatment recommendations and may pose a risk to your health.

Individual results from treatment vary based on multiple factors, including but not limited to starting health conditions, medication adherence, lifestyle factors, and clinical recommendations. All claims and results referenced on this website represent self-reported data from patients on a treatment plan that includes compounded medications and consultations with medical professionals. No specific outcome is guaranteed. Patients typically experience gradual results when combined with a healthy diet and exercise modifications, as recommended by their provider.

References to brand-name medications on this website (such as Ozempic®, Wegovy®, Mounjaro®, and Zepbound®) are for informational purposes only and are the registered trademarks of their respective owners. Prescriva is not affiliated with, endorsed by, or sponsored by the manufacturers of these brand-name medications. The compounded medications available through our platform are not the same as these brand-name products.

Certain materials on this website, including educational content and informational resources, may be generated or enhanced using artificial intelligence technologies. AI-generated content is provided for informational purposes only, does not constitute medical advice, and carries no warranty regarding its accuracy or completeness. All clinical decisions are made by licensed healthcare providers, not by AI systems.

By using the Prescriva platform and initiating a health assessment or telehealth consultation, you acknowledge that:

• You have read and understand the information provided above regarding telehealth services, HIPAA protections, financial terms, and medication compounding
• All of your questions have been answered to your satisfaction
• You voluntarily give your informed consent for the use of telehealth in the course of your diagnosis and treatment
• You voluntarily consent to receive healthcare services via telehealth from providers within the OpenLoop Health network
• You have been offered a copy of this consent form for your personal records

Your continued use of the Services constitutes your understanding and acceptance of all terms set forth in this document and any subsequent changes.

If you have questions about telehealth services or this consent form, please contact us at help@prescriva.com.