Telehealth enables a healthcare provider and a patient, each at different locations, to communicate and share individual patient health information securely. This “Telehealth Informed Consent” document informs patients (“you” or “your”) about treatment methods, risks, and limitations associated with the use of BriskMD’s telehealth platform.

Services Provided

Telehealth services provided by BriskMD’s engaged providers (your “Provider”) may include consultations, diagnoses, treatment recommendations, prescriptions, and/or referrals for in-person care, as clinically appropriate.

BriskMD itself performs administrative, payment, and other supportive activities for our Providers but does not directly provide medical services.

Electronic Transmissions

Using BriskMD’s telehealth platform may involve electronic transmissions that include but are not limited to:

• Appointment scheduling
• Completion, exchange, and review of medical intake forms and other clinically relevant information (e.g., health records, diagnostic tests)
• Asynchronous communications, two-way interactive audio with store-and-forward communications, and/or two-way interactive video
• Treatment recommendations based on your clinical information
• Prescription refills (if applicable)
• Other transmissions for the purpose of clinical care

Expected Benefits

• Improved access to care: Consult with your Provider from your preferred location.
• Convenient follow-up care: For non-emergent follow-up, contact your Provider via the BriskMD app or our “Contact Us” form.
• Efficient evaluation and management: Care coordinators are available Monday through Friday, from 9:00 am to 5:00 pm Central Time, excluding federal holidays.

Service Limitations

The key difference between telehealth and in-person care is the lack of physical contact. Some clinical needs may not be suitable for telehealth; your Provider will assess this.

NOTE: BRISKMD PROVIDERS DO NOT HANDLE MEDICAL EMERGENCIES. FOR EMERGENCIES, CALL 9-1-1 OR GO TO THE NEAREST EMERGENCY ROOM. AFTER RECEIVING EMERGENCY CARE, FOLLOW UP WITH YOUR PRIMARY CARE PROVIDER.

BriskMD providers are intended to supplement, not replace, your local primary care provider.

Security Measures

BriskMD uses security protocols to protect patient data. Services are delivered over a secure connection in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Possible Risks

• Technological failures may delay treatment.
• Communication failure due to technical issues may require a rescheduled consultation.
• In rare cases, security protocols could fail, risking a privacy breach.

Patient Acknowledgments

By using BriskMD’s telehealth services, you acknowledge and understand the following:

1. You may select a provider or opt for the next available provider, with access to credentials.
2. In case of a medical emergency, dial 9-1-1 as Providers cannot connect to emergency services.
3. You may seek in-person services if preferred.
4. You may withhold or withdraw telehealth consent without affecting future care.
5. All federal and state confidentiality protections apply, and medical records from telehealth visits are part of your medical record.
6. BriskMD takes measures to protect health information but may involve out-of-state providers.
7. BriskMD will not release patient-identifiable information to educational entities without consent unless permitted by law.
8. Technical failures beyond BriskMD’s control are possible.
9. Tests may be conducted at external facilities, as needed.
10. You will be informed of others present during your telehealth session.
11. You can request copies of your medical records by contacting BriskMD.
12. BriskMD Providers exercise discretion in issuing prescriptions, which you may fill at a pharmacy of choice.
13. Providers reserve the right to deny care if deemed inappropriate.