Preamble. I, as Patient or Patient’s authorized legal representative, understand that eMed Population Health, Inc., and its affiliates (collectively, “eMed”) separately engage virtual care companies, which are independently owned by licensed physicians (“Virtual Care Partners”). eMed does not own these medical practices, employ or in any way supervise or control the Virtual Care Partners rendering care. Through its technology platform, eMed facilitates the provision of virtual care services but it is not itself, a source of healthcare, medical advice, or care (“Virtual Care” or “Virtual Care Services” or “Virtual Care Sessions”). All medical decisions are made solely by the Virtual Care Partners, who exercise independent clinical judgment. eMed does not review, direct, or influence medical treatment decisions. This Consent is effective and binding across all Virtual Care Sessions or services rendered by the Virtual Care Partners via eMed's technology platform.
Virtual Care or telemedicine (the terms will be used interchangeably throughout this Consent) involves the use of electronic communications, information technology, or other means to enable a healthcare provider and a patient at different locations to communicate and share individual patient health information for the purpose of rendering health care services. Virtual Care or telemedicine may be used for assessment, treatment, diagnosis, prescription, follow-up, and/or patient education. This Consent informs the patient (“Patient,” “you,” or “your”) concerning the treatment methods, risks, and limitations of using a Virtual Care platform.
Electronic Transmissions. The types of electronic transmissions that may occur using the Virtual Care platform include, but are not limited to:
• Completion, exchange, and review of relevant medical information (for example: health records; images; output data from medical devices; sound and video files; diagnostic and/or lab test results) between you and a healthcare provider via: asynchronous or synchronous communications; two- way interactive audio; and/or two-way interactive audio and video interaction;
• Treatment recommendations by a healthcare provider based upon such review and exchange of clinical information;
• Delivery of a consultation report with a diagnosis, treatment and/or prescriptions, as deemed medically relevant;
• Prescription refill reminders (if applicable); and/or
• Other electronic transmissions for the purpose of rendering health care services to you.
Recording. By participating in this Virtual Care Session, you acknowledge and consent to the recording of audio, video, and certain images for purposes including, but not limited to, quality review, operational improvement, training, and patient safety. All information collected during the session will be used, stored, and safeguarded in accordance with applicable privacy laws and regulations.
Benefits. Virtual Care provides an array of benefits to you, including (a) improved access to healthcare providers by allowing you to consult a provider from your home or office; and (b) improved efficiency for access to medical evaluation and management.
At-Home Blood Collection. As part of eMed’s GLP-1 Weight Management Program (the “Program”), eMed also engages companies that provide laboratory services, which utilize self-administered at-home blood collection devices to qualify and monitor patients in the Program. You hereby agree to use a self-administered at-home blood collection device as instructed by eMed.
GLP-1/GIP Medication:
Indication for Use. You are requesting treatment with an approved GIP/GLP-1 receptor agonist medication as part of your treatment plan for the management of weight or obesity. These medications work by mimicking the action of in cretin hormones, which help regulate blood sugar levels, promote feeling full, and reduce food intake.
Potential Benefits.
• Weight loss or weight management
• Improved blood glucose control
• Reduced cardiovascular risk
• Potential improvement in overall metabolic health
Potential Side Effects.
While these medications can be beneficial, they may also cause side effects. Although not common, these medications can result in emergency room visits, hospitalizations, or even death. Common and serious side effects include, but are not limited to:
Common Side Effects:
• Nausea
• Vomiting
• Diarrhea
• Constipation
• Decreased appetite
• Indigestion
Serious Side Effects:
• Pancreatitis (inflammation of the pancreas)
• Hypoglycemia (low blood sugar), especially when used with other diabetes medications
• Gallbladder disease (e.g., gallstones)
• Kidney problems
• Allergic reactions (e.g., rash, itching, swelling)
• Gastroparesis (paralysis of the bowels)
Risks and Considerations.
• Pancreatitis: There is a risk of developing pancreatitis. If you experience severe abdominal pain, nausea, or vomiting, you should contact your healthcare provider immediately.
• Thyroid Tumors: Animal studies have shown an increased risk of thyroid tumors with certain GLP-1 medications. Although this has not been confirmed in humans, please inform your healthcare provider if you have a history of thyroid cancer.
• Hypoglycemia: When taken with other diabetes medications, particularly insulin or sulfonylureas, there is a risk of low blood sugar. It is important that your provider knows if any of these medications are added to your regimen.
• Kidney Function: This medication may affect kidney function, particularly in patients with existing kidney disease. Regular monitoring of kidney function may be required.
Monitoring and Follow-up.
You will require regular follow-up visits to monitor your response to the medication and to assess any side effects, which may include weekly weigh-ins.
I acknowledge the potential benefits, risks, and side effects of GLP-1 or GIP/GLP-1 receptor agonist medications. I understand the importance of regular monitoring and follow-up appointments. I consent to the use of GLP-1 or GIP/GLP-1 receptor agonist medications as part of my treatment plan for
overweight or obesity.
Medication Responsibility. I acknowledge and agree that I may only use GLP-1 medication that is unexpired, properly stored, and obtained through the eMed GLP-1 Program during telehealth check-in sessions or at any other time. I further acknowledge that I am solely responsible for ensuring that any GLP-1 medication in my possession complies with these requirements. You are encouraged to check the medication’s expiration date, ensure it has been stored according to the manufacturer’s instructions (e.g., refrigeration required), and inspect the packaging for any signs of damage or tampering. eMed is not responsible for any adverse effects, outcomes, or complications resulting from the use of expired, improperly stored, or externally obtained medication. Always follow manufacturer’s instructions when administering GLP-1 medication.
Risks. As with any medical procedure, there are potential risks associated with the use of telemedicine. These risks may include, without limitation, the following:
• Technical problems: digital issues such as video quality, sound quality, or connectivity issues that may require an encounter to be rescheduled.
• Although measures are in place to prevent a breach of privacy, security protocols could fail, causing a breach of privacy of personal medical information.
• Provider's inability to conduct a hands-on physical examination of me and my condition.
• Risks related to the use of self-administered at-home blood collection devices:
- Improper use of blood lancets can increase the risk of inadvertent transmission of bloodborne pathogens, particularly in settings where multiple patients are tested.
- Minor bruising or residual marks may occur at the sample collection site.
- Fainting, as with any blood sampling procedure.
Patient Acknowledgments. I, as Patient or Patient’s authorized legal representative, further acknowledge and understand the following:
• If I am experiencing a medical emergency, I will be directed to dial 9-1-1 immediately and the provider is not able to connect me directly to any local emergency services.
• I have the right to withhold or withdraw my consent to the use of Virtual Care in the course of my care at any time without affecting my right to future care or treatment.
• If a minor is eligible for Virtual Care Services, I, as the minor’s parent or legal guardian, must provide explicit consent and be present during the Virtual Care Session.
• Federal and state law requires health care providers to protect the privacy and security of health information. I am entitled to all confidentiality protections under applicable federal and state laws. I understand all medical reports resulting from the Virtual Care visit are part of my medical record.
• I further understand that my healthcare information may be shared in the following circumstances:
- When a valid court order is issued for medical records.
- Reporting suspected abuse, neglect, or domestic violence.
- Preventing or reducing a serious threat to anyone's health or safety.
• I further understand that any provider's advice, recommendations, and/or decisions may be based on factors not within his/her control, including incomplete or inaccurate data provided by me. I understand that the provider only relies on information provided by me during our Virtual Care encounter and that I must provide information about my medical history, condition(s), and current or previous medical care that is complete and accurate to the best of my ability. I also understand that the provider may not have access to my full medical record or information.
• A healthcare provider will provide care consistent with the prevailing standards of medical practice but makes no assurances or guarantees as to the results of treatment. I understand that there is no guarantee that all treatment of all patients will be effective.
• The laws of the state in which I am located will apply to my receipt of Virtual Care services.
• I have the right to review and receive copies of my medical records, including all information obtained during a Virtual Care interaction, subject to our standard policies regarding request and receipt of medical records and applicable law.
• The Virtual Care Services are not a replacement for my primary care physician or annual office check-ups. Should I desire to seek in-office care through other providers, including my primary care physician, I can do so.
• Neither eMed nor the Virtual Care Partners are online pharmacies. The Virtual Care Partners do not prescribe drugs listed as controlled substances by the U.S. Drug Enforcement Agency. eMed does not control or supervise any prescription decision made by a Virtual Care Partner.
• I further agree that any prescription obtained through the eMed platform prescribed by a Virtual Care Partner will be used only for its intended use. Neither eMed nor the Virtual Care Partners guarantee that a specific medication will be prescribed if requested.
• I hereby release and hold harmless eMed and the Virtual Care Providers from any loss of data or information due to technical failures associated with the Virtual Care/telemedicine service.
• I understand that I will be given information about test(s) and treatments(s), as applicable, including the benefits, risks, possible problems or complications, and alternate choices for my medical care through the Virtual Care/telemedicine visit.
• I understand that the Program does not guarantee a specific result or amount of weight loss. Weight loss results vary depending on the individual. Results may vary based on each patient’s physical health, diet and exercise, and adherence to the Program.
• I understand that under the Program, no prescriptions or treatments will be given unless a clinical need exists based on an examination, any necessary testing or lab work, a medical consultation, and current medical history analyzed by the Virtual Care Partners.
• I understand that failure to comply with the terms of this Consent may result in the termination of my ability to use the Virtual Care Services.
Additional Acknowledgment of Risks and Release from Liability. YOU UNDERSTAND THAT THERE ARE POTENTIAL RISKS, WHETHER KNOWN OR UNKNOWN, ASSOCIATED WITH THE USE OF VIRTUAL CARE SERVICES AND THE USE OF SELF-ADMINISTERED AT-HOME BLOOD COLLECTION DEVICES. YOU FULLY AND FOREVER RELEASE AND DISCHARGE EMED POPULATION HEALTH, INC., ITS SUBSIDIARIES, BUSINESS PARTNERS, AFFILIATES, AND ANY THIRD-PARTY PROFESSIONALS FROM LOSSES, DAMAGES, CLAIMS (INCLUDING NEGLIGENCE CLAIMS), DEMANDS, LAWSUITS, EXPENSES, AND ANY OTHER LIABILITY OF ANY KIND, DIRECTLY OR INDIRECTLY ARISING OUT OF, CONCERNING, OR RELATING TO THE USE OF VIRTUAL CARE SERVICES OR THE USE OF THE AT-HOME BLOOD COLLECTION DEVICE EVEN IF IT IS DUE TO THE NEGLIGENCE, OMISSION, OR OTHER FAULT OF THE RELEASED PARTIES.
Biometric consent. eMed utilizes Onfido Inc. and its affiliates (“Entrust”) to verify users’ identities. This verification process requires users to submit biometric data, including facial scans and audio recordings, for identity verification purposes. By agreeing to this informed consent, you must also consent to the processing of biometric data as outlined below and in eMed’s Biometric Data Policy.
Consent to process biometric data and sensitive data: To utilize eMed’s Virtual Care Services, you must grant Entrust, the service providers listed below (providers), and eMed, consent to collect, capture, obtain, possess, store, use, process, disclose and re-disclose (Process) your Biometric Data (defined below) and other personal data, including sensitive personal data (Personal Data), for the purpose described below.
By agreeing to this Informed Consent for Virtual Care within the app, you confirm that you have: (1) read, understand, and accept the Facial Scan & Voice Recording Policy (Policy) and Terms of Service, (2) grant consent to Entrust, eMed, and providers to Process your Biometric Data and other Personal Data for the purposes described in the Policy and summarized below. If you do not agree, do not check the box indicating that you consent to this Informed Consent for Virtual Care and do not continue with the enrollment process. Without your consent, Entrust will not be able to complete the verification process and you will be unable to use eMed’s Virtual Care Services.
Personal Data: If you consent, Entrust and providers will Process your Personal Data, including:
• Images: images/videos (including audio recordings) of you captured via your device camera or otherwise uploaded.
• ID Doc: images (front and back) of your ID including the photo on your ID, ID number and other data extracted from your ID (e.g., name, DOB, gender, and data from your ID's machine-readable zone).
• Biometric Data: We may extract "scans of face geometry" and/or "voiceprints", from your Images and/or ID Docs, which may be considered biometric identifiers or biometric information.
• Device Data: location data, IP address, and other device data.
Purpose: Entrust and providers Process your personal data on eMed’s behalf, as part of the Entrust Identity Verification Services. eMed and Entrust and providers may use Biometric Data from your ID Doc and Images and other personal data to: (i) verify your identity or authenticate you and your use of eMed’s services, including to compare Biometric Data from your Images and ID Doc; (ii) detect and prevent fraud, (iii) evaluate the authenticity of Images and ID Docs, including to look for signs of tampering, and detect whether they contain a genuine human or physical document, and (iv) improve and develop the Entrust Identity Verification Services, where permitted by applicable law.
Retention: Biometric Data is retained by Entrust only until the initial purpose for which it was collected has been satisfied and will be securely deleted within three-hundred and sixty five (365) days (or a shorter period set by the eMed) after you submit your Images and ID Doc. Images and ID Docs may be stored by Entrust for up to three (3) years after you submit them. After the applicable retention period, Entrust
permanently destroys the data, unless otherwise required by law or legal process. (Please note that if an Entrust Identity Verification Service involves providing the eMed with access to your Biometric Data, you should read the eMed’s own privacy related policy to understand how long the eMed may retain that information).
Disclosures: Biometric Data and other personal data may be disclosed: (1) to our providers, namely Microsoft Ireland Operations Limited (whose technology is used to convert your voice recording into written text (Speech to Text)) and Amazon Web Services (who provides another Speech to Text service as well as cloud storage), who Process this data on our behalf; (2) to eMed, to complete any financial transaction as requested and authorized by you; (3) as required by state or federal law or municap ordinance; (4) as required pursuant to a warrant or subpoena; and (5) as expressly consented to by you or your authorized representative.
Withdrawal of Consent: If you consent now but would like to later withdraw your consent, please contact eMed as set forth in eMed’s Privacy Policy.
Consent to Email, Cellular Telephone, or Text Usage for Healthcare Communications. If at any time I provide an email address or cellphone number at which I may be contacted, I consent to receiving unsecure instructions and other healthcare communications at the email or text address I have provided or eMed or the Virtual Care Partners have obtained, at any text number forwarded, or transferred from that number. These instructions may include, but not be limited to, follow-up instructions, educational information, and prescription information.
Note: You may opt out of these communications at any time. eMed does not charge for this service, but standard text messaging rates or cellular telephone minutes may apply as provided in your wireless plan (contact your carrier for pricing plans and details).
Telehealth Consent for Pharmaceutical Benefits. By participating in this Program and unless otherwise directed by your employer, you understand and agree that any medication prescribed as part of this Program will only be available through your employer’s designated pharmaceutical benefits manager (PBM) network of affiliated pharmacies. You further acknowledge that prescriptions may not be filled or obtained outside of this PBM network. This requirement is in place to ensure continuity of care, adherence to program guidelines, and alignment with your employer’s pharmaceutical benefits structure.
Patient Consent to the Use of Telemedicine, and Laboratory and Wellness Services. I have read and understand the information provided above and understand the risks and benefits of telemedicine services and related laboratory and wellness services. I have the legal capacity and authority to provide this consent for myself and/or the minor for which I am consenting under applicable federal and state laws, including laws related to the age of
majority and/or parental/guardian consent. By accepting these terms, I hereby give informed consent to Virtual Care as an acceptable form of delivering healthcare services to me, my child or a child for whom I have legal responsibility and that this consent will cover any and all of my sessions using Virtual Care and related laboratory and wellness services.
Duration. This consent will remain fully effective until it is revoked.
Truthfulness Consent. Please attest to the following confirming that all information you have provided to us is true and complete.
I verify that I am the Patient or Patient’s legal representative and that I have answered the questions asked in this intake form. I confirm that I have reviewed and understood all the questions asked of me. I attest that the answers and information I have provided in this questionnaire are true and complete to the best of my knowledge. I understand that it is critical to my health to share complete health information. I will not hold eMed or the Virtual Care Partners responsible for any oversights or omissions, whether intentional or not, in the information that I provided.
AGREE. By checking this box, I acknowledge that I have read and understand this Informed Consent for Virtual Care, including the biometric data practices and disclosures involving Onfido, Inc. outlined herein. I agree that checking this box constitutes my electronic signature and legal authorization, confirming my consent to the terms of this document.
Last Updated: September 2, 2025