Telehealth Informed Consent

Telehealth is the delivery of health care services using secure electronic communications, information technology, and store-and-forward transmission between a patient and a clinician who are not in the same physical location. Through Oxiline RX, care is delivered asynchronously where state law permits: a US-licensed clinician reviews the medical intake, answers, photos, and other information you submit — often not in real time — to evaluate you and, when clinically appropriate, to prescribe treatment and manage your care. Where the law of your state requires a real-time (synchronous) audio or video encounter before a prescription can be issued, or where your clinician determines one is necessary, that visit is scheduled for you and must be completed before any prescription is written. Telehealth through this program may include:

• electronic transmission of your medical history, health records, images, and other personal health information between you and your clinician;
• secure messaging with your clinician and care team through the patient portal, and audio or video interaction where the clinician deems it necessary or state law requires it; and
• electronic transmission of prescriptions to a licensed dispensing pharmacy.

Your care is provided by independent, US-licensed clinicians who practice through our clinical partner, MD Integrations. Your provider-patient relationship is with the clinician who treats you — not with Oxiline RX Corp., which is a technology platform and does not practice medicine. Your clinician exercises independent professional judgment in all clinical decisions. Telehealth through this program does not replace your relationship with your primary care provider, and we encourage you to maintain one and to keep them informed about treatment you receive through the program.

• Convenient access to US-licensed clinicians without travel or time away from work.
• Efficient evaluation, treatment, and follow-up, including ongoing dose titration and side-effect support through secure messaging.
• Access to your care team and records through the patient portal.

As with any health care service, telehealth carries potential risks. These include, but are not limited to:

• the information you transmit (including photos or reported measurements) may be insufficient for your clinician to make a fully informed decision — for example, because a physical examination is not performed — which is one reason accurate and complete answers are essential;
• delays in evaluation or treatment could occur due to failures or limitations of electronic equipment or connectivity;
• in rare instances, security protocols could fail, causing a breach of privacy of personal health information despite reasonable safeguards; and
• your clinician may determine that telehealth is not appropriate for your situation and that an in-person evaluation is needed.

All medications carry potential side effects and risks, which your clinician will review with you. If you experience severe or concerning side effects, contact your clinician promptly — and call 911 for anything that may be an emergency.

A clinician must review your intake before any prescription is issued. The clinician exercises independent medical judgment and may determine that treatment is not appropriate or safe for you, in which case treatment will be declined; the clinician may also recommend a different medication, dose, or plan than the one you selected. Completing intake or saving a payment method does not guarantee a prescription. You agree to provide accurate, current, and complete information about your health, medications, and history — your safety depends on it — and to keep your clinician informed of changes in your health during treatment.

If your clinician prescribes treatment, you understand and acknowledge that:

• Compounded medications (such as compounded semaglutide and compounded tirzepatide) are not FDA-approved. They are prepared by state-licensed compounding pharmacies and have not been evaluated by the FDA for safety, effectiveness, or quality in the way commercially manufactured, FDA-approved drugs are.
• you will follow your clinician’s and the pharmacy’s instructions for storage, preparation, dosing, and administration, and will not use medication other than as directed;
• medication prescribed to you is for your use only and must not be shared with or sold to anyone else; and
• no particular outcome is guaranteed — individual results vary.

Telehealth is voluntary. Reasonable alternatives are available to you, including in-person evaluation and treatment with a local clinician, other weight-management approaches (lifestyle programs, other medications, or bariatric procedures where appropriate), or no treatment at all. You may choose in-person care instead of telehealth at any time, and your clinician can help coordinate a transition of care.

The program is not for emergencies and is not monitored in real time. For a medical emergency, call 911 or go to the nearest emergency room immediately. The care team responds to messages during regular operating hours; do not use the patient portal to seek urgent or emergency help.

Your clinical information, records, and messages with your care team are maintained by our clinical partner in a HIPAA-compliant environment, as described in our HIPAA Notice of Privacy Practices and Privacy Policy. Reasonable security measures are used to protect the confidentiality of your telehealth care, though no electronic transmission can be guaranteed to be perfectly secure. The laws that protect the confidentiality of medical information apply to telehealth.

• You may withhold or withdraw this consent at any time by contacting support@oxilinerx.com, without affecting your right to future care or treatment. Withdrawal does not affect care already provided, and your clinician may recommend how to safely discontinue any active treatment.
• You may ask your clinician questions about your evaluation, diagnosis, treatment options, risks, and prognosis at any time, and you have the right to have them answered before consenting to treatment.
• You may request a copy of your medical records as described in the HIPAA Notice.
• You may request information about the identity, licensure, and credentials of the clinicians who treat you, and you may direct complaints about your clinical care to the medical licensing board of the state where you are located.

By continuing, you acknowledge and agree that:

• you have read and understand this Telehealth Informed Consent, you have had the opportunity to ask questions, and all questions have been answered to your satisfaction;
• you understand the nature of telehealth and its potential benefits, risks, and alternatives as described above;
• you voluntarily consent to receive evaluation and treatment via telehealth from US-licensed clinicians through the Oxiline RX program;
• you are at least 18 years old, are located in the state you identified, and are requesting care for yourself; and
• this consent will remain in effect for the duration of your care through the program unless you withdraw it.