Telehealth Informed Consent

This Informed Consent for Telehealth Services ("Consent") provides you with important information regarding the use of telehealth technology for your medical consultations and treatment through INA, operated by Adsail LLC. Please read this document carefully before proceeding with any telehealth services. By using our telehealth services, you acknowledge that you have read, understood, and voluntarily agree to the terms described below.

Nature of Telehealth Services

Telehealth involves the delivery of healthcare services using electronic communications, information technology, and other electronic means when you and your healthcare provider are not in the same physical location. Through INA, you will interact with independent, licensed healthcare providers from the OpenLoop physician network via our Bask Health platform, which may include:

• Asynchronous consultations, in which you submit health information through intake questionnaires and your provider reviews and responds to your case at a later time
• Synchronous (real-time) consultations via secure video or audio communication, when clinically indicated
• Secure messaging between you and your healthcare provider for follow-up questions, treatment adjustments, and ongoing care management
• Electronic prescribing of medications, including FDA-approved and compounded formulations

Telehealth is not intended to replace in-person medical evaluations when a physical examination is necessary for proper diagnosis or treatment. Your healthcare provider may determine that your condition requires an in-person visit and will advise you accordingly.

Expected Benefits

Telehealth services offer several potential benefits, including:

• Increased access to healthcare, particularly for individuals in areas with limited provider availability or those with mobility limitations
• Convenience of receiving medical consultations and treatment from the comfort and privacy of your home
• Reduced travel time and associated costs compared to traditional in-person visits
• Timely access to licensed healthcare providers and expedited treatment initiation
• Ongoing monitoring and care management with the ability to communicate with your provider between scheduled consultations

Potential Risks and Limitations

As with any form of medical care, telehealth services involve certain risks and limitations that you should understand:

• Limitations of remote evaluation:Your healthcare provider will not be able to perform a physical examination. The inability to conduct a hands-on evaluation may, in some cases, limit the provider's ability to diagnose your condition or identify certain findings that might be apparent during an in-person visit.
• Technology failures: Telehealth services depend on electronic systems and internet connectivity. Technical difficulties, interruptions in service, or equipment failures may delay or prevent the delivery of care.
• Security risks: Although we implement robust security measures to protect your health information, electronic communications carry an inherent risk of interception or unauthorized access. While unlikely, breaches in data security could result in unauthorized disclosure of your personal health information.
• Delayed treatment: In some cases, the information transmitted via telehealth may be insufficient for your provider to make a clinical decision, which may result in a delay in treatment or the need for an in-person evaluation.
• Medication risks: All medications, including those prescribed through telehealth, carry risks of side effects and adverse reactions. Your provider will discuss relevant risks associated with any prescribed medications.

Patient Rights

As a patient using our telehealth services, you have the following rights:

• You have the right to withdraw your consent and discontinue telehealth services at any time without affecting your right to seek future care
• You have the right to ask questions about your diagnosis, treatment plan, and any aspect of your care at any time
• You have the right to know the identity and qualifications of the healthcare provider delivering your care
• You have the right to expect that your health information will be treated with the same confidentiality as in-person consultations, in accordance with HIPAA and applicable state laws
• You have the right to request copies of your medical records maintained by INA
• You have the right to refuse any proposed treatment or medication without penalty or loss of benefits to which you are otherwise entitled
• You have the right to be informed of all potential costs associated with your telehealth consultation and treatment before services are rendered

Consent to Treatment

By proceeding with telehealth services through INA, you voluntarily consent to the following:

• You consent to receive healthcare services via telehealth technology, including asynchronous and synchronous consultations as described above
• You understand that a licensed healthcare provider will review your health information and, if clinically appropriate, may prescribe medications as part of your treatment plan
• You affirm that all information you provide in your health intake questionnaire and during consultations is truthful, accurate, and complete to the best of your knowledge
• You understand that providing inaccurate or incomplete information may result in inappropriate treatment recommendations and could pose serious risks to your health
• You agree to follow the treatment instructions provided by your healthcare provider and to promptly report any adverse reactions, side effects, or changes in your condition
• You understand that a prescription is not guaranteed and that the healthcare provider may determine that telehealth treatment is not appropriate for your condition

Technology Requirements

To use our telehealth services, you will need the following:

• A device with internet access (computer, tablet, or smartphone) and a modern web browser
• A stable internet connection sufficient for secure data transmission and, if applicable, video or audio consultations
• A valid email address for account registration, communications, and notifications about your care
• For video consultations, a device equipped with a camera and microphone

You are responsible for ensuring that your technology and environment meet these requirements. You should conduct telehealth consultations from a private, quiet location where you feel comfortable discussing your health information. INA is not responsible for technology failures on your end, including but not limited to internet outages, hardware malfunctions, or software incompatibilities.

Emergency Situations

INA telehealth services are not designed or intended for emergency medical situations. If you are experiencing a medical emergency, including but not limited to chest pain, difficulty breathing, severe allergic reactions, signs of a stroke, suicidal ideation, or any other condition that you believe poses an immediate threat to your life or health, you should:

• Call 911 or your local emergency services immediately
• Go to the nearest hospital emergency department
• Do not rely on INA or any telehealth platform for emergency care

By using our services, you acknowledge that you understand the limitations of telehealth in emergency situations and agree not to use INA as a substitute for emergency medical services.

Contact Us

If you have questions about this Telehealth Informed Consent or wish to discuss any aspect of our telehealth services, please contact us: