Consent to Telehealth

You are receiving this Consent to Telehealth ("Consent") because you have chosen to access healthcare services through the Koves platform ("Koves Platform"). Medical services accessible through the Koves Platform are provided by independent licensed physicians, nurse practitioners, physician assistants, professional medical entities, or other appropriately licensed healthcare professionals (collectively, "Healthcare Providers").

Certain technology, clinical workflow, communications, administrative, or healthcare infrastructure used in connection with these services may be hosted, powered, facilitated, supported, or administered by third parties, including Bask Health, Inc., its affiliates, professional medical entities, and other service providers.

The identity and credentials of the Healthcare Provider responsible for your care will be made available to you through the applicable clinical workflow or communication channel.

Your Healthcare Provider exercises independent professional medical judgment and is solely responsible for determining whether telehealth is appropriate for you and whether any evaluation, diagnosis, treatment recommendation, prescription, laboratory testing, referral, follow-up, or other clinical service is medically appropriate.

By accepting this Consent, you acknowledge that:

• you have read and understand this Consent;
• you understand the nature, benefits, limitations, and potential risks of telehealth;
• you have had the opportunity to ask questions about telehealth before consenting, where applicable;
• you voluntarily consent to receive healthcare services using telehealth technologies;
• your telehealth encounter may be asynchronous, synchronous, or a combination of both, as permitted by law and determined appropriate by your Healthcare Provider;
• a Healthcare Provider may require a live video, telephone, in-person, laboratory, or other additional evaluation before making a clinical decision;
• telehealth does not guarantee that you will receive a diagnosis, prescription, medication, particular treatment, or other healthcare service; and
• you may withdraw your consent to telehealth as described below, subject to applicable law and the consequences of discontinuing telehealth services.

Telehealth is the delivery of healthcare services through electronic communications when you and your Healthcare Provider are not physically located in the same place.

Telehealth may include:

• online medical questionnaires;
• asynchronous clinical review;
• secure messaging;
• text-based communications;
• telephone communications;
• live video visits;
• photographs;
• audio or video files;
• electronic medical records;
• laboratory information;
• diagnostic information;
• electronic prescriptions;
• remote monitoring information where available; and
• other electronic communications or technologies permitted by applicable law.

Asynchronous telehealth, sometimes called "store-and-forward" telehealth, occurs when information is submitted and reviewed at different times rather than through a live interaction.

An asynchronous encounter may involve:

• completing an online medical questionnaire;
• submitting photographs or documents;
• providing medical history, medication, allergy, symptom, or other health information;
• sending and receiving secure messages;
• providing laboratory or diagnostic information; and
• a Healthcare Provider reviewing the information and responding at a later time.

"Asynchronous" means the patient and Healthcare Provider do not necessarily communicate at the same time.

Where permitted by applicable law and clinically appropriate, your encounter may be completed asynchronously. If applicable law, your Healthcare Provider, or your clinical circumstances require a synchronous interaction, you may be asked to participate in a live telephone, audio-video, or other real-time encounter.

Synchronous telehealth occurs when you and your Healthcare Provider communicate in real time using technologies such as live video, audio, or telephone.

Your Healthcare Provider may determine that a synchronous encounter is necessary based on:

• state law;
• professional licensing requirements;
• the nature of your condition;
• information submitted during your evaluation;
• a need for additional clarification;
• patient-safety considerations;
• prescribing requirements; or
• independent clinical judgment.

Potential benefits of telehealth may include:

• more convenient access to a licensed Healthcare Provider;
• reduced need to travel for certain healthcare services;
• the ability to communicate electronically with a Healthcare Provider;
• greater flexibility in obtaining certain evaluations or follow-up care;
• more efficient exchange of health information; and
• access to healthcare services that may otherwise be difficult to obtain locally.

These are potential benefits only. No particular benefit or outcome is guaranteed.

Telehealth involves risks and limitations that may differ from an in-person examination. These may include, without limitation:

• a Healthcare Provider may not be able to perform a complete physical examination;
• certain signs, symptoms, measurements, or conditions may be more difficult to evaluate remotely;
• important medical information may be unavailable, incomplete, inaccurate, misunderstood, or omitted;
• a remote evaluation may not identify a condition that could have been detected during an in-person examination;
• technical problems may interrupt, delay, or prevent an encounter;
• poor internet connectivity, hardware problems, software errors, power failures, or other service interruptions may affect communications;
• electronic communications may be delayed;
• images, audio, video, or other information may be incomplete or of insufficient quality;
• unauthorized access, cybersecurity incidents, or failures of security safeguards could result in loss of privacy or confidentiality;
• electronic communications may be misdirected, intercepted, delayed, corrupted, or accessed by unauthorized persons despite reasonable safeguards;
• a Healthcare Provider may determine that telehealth is not sufficient for your evaluation or treatment;
• you may be required to obtain laboratory testing, diagnostic testing, an in-person examination, emergency care, specialist care, or other services outside the Platform;
• differences in state law may affect the availability or method of telehealth services; and
• there may be other risks that are not currently known or reasonably foreseeable.

Your Healthcare Provider may not have access to your complete medical record, including records maintained by other physicians, health systems, pharmacies, laboratories, hospitals, or other organizations.

You are responsible for providing complete, truthful, current, and accurate information requested in connection with your care, including information concerning:

• your medical history;
• current and previous diagnoses;
• allergies;
• prescription medications;
• over-the-counter medications;
• supplements;
• substance use where relevant;
• previous adverse reactions;
• pregnancy status where applicable;
• family history;
• laboratory results;
• symptoms;
• prior treatment;
• other healthcare providers involved in your care; and
• other information reasonably requested by your Healthcare Provider.

Failure to provide accurate and complete information may impair your Healthcare Provider's ability to safely evaluate or treat you and may increase the risk of adverse events, medication interactions, inappropriate treatment, delayed diagnosis, or other negative outcomes.

PARTICIPATING IN A TELEHEALTH ENCOUNTER DOES NOT GUARANTEE THAT YOU WILL RECEIVE A DIAGNOSIS, TREATMENT, PRESCRIPTION, PARTICULAR MEDICATION, PARTICULAR DOSAGE, LABORATORY ORDER, OR ANY OTHER HEALTHCARE SERVICE.

Your Healthcare Provider may:

• determine that treatment is not appropriate;
• decline to prescribe medication;
• recommend a treatment different from the treatment you requested;
• require additional information;
• require laboratory or diagnostic testing;
• require a synchronous telehealth encounter;
• require an in-person examination;
• refer you to another healthcare professional;
• recommend urgent or emergency evaluation;
• modify an existing treatment plan; or
• discontinue treatment.

These decisions are made solely through the independent professional judgment of the applicable Healthcare Provider.

A provider-patient relationship, if established, exists between you and the applicable Healthcare Provider or professional medical entity providing your medical care.

Use of the Koves Platform does not create a physician-patient relationship between you and Koves LLC.

The requirements for establishing a provider-patient relationship vary by state. Your Healthcare Provider is responsible for complying with applicable state-specific requirements before providing medical care.

You agree to provide your true and accurate physical location at the time healthcare services are provided.

Healthcare Providers generally must be appropriately licensed or otherwise legally authorized to provide medical services in the jurisdiction where the patient is physically located.

You must not misrepresent, obscure, falsify, spoof, or otherwise conceal your physical location for purposes of obtaining healthcare services.

If you travel or relocate, you should update your location before receiving additional clinical services because your Healthcare Provider may not be authorized to treat you in your new location.

You may be required to verify your identity, age, physical location, or other information before receiving healthcare services.

Verification may include:

• government-issued identification;
• photographs;
• identity-verification technology;
• account authentication;
• contact-information verification;
• billing information;
• location verification; or
• other reasonable methods permitted by law.

You agree to provide accurate information and not impersonate another person or permit another person to use your identity to obtain healthcare services.

Information generated or exchanged in connection with healthcare services may constitute protected health information or other confidential medical information.

Healthcare Providers and professional medical entities may provide you with a separate Notice of Privacy Practices explaining how they may use and disclose your medical information and describing your rights regarding that information.

Koves privacy practices are described separately in the Koves Privacy Policy.

Certain clinical technology or services may also be subject to privacy notices provided by Bask Health, professional medical entities, pharmacies, laboratories, or other service providers.

Telehealth technologies involve inherent privacy and security risks. While appropriate safeguards may be used to protect medical information, no method of electronic transmission or storage can be guaranteed to be completely secure.

You are responsible for taking reasonable steps to protect your privacy during telehealth encounters.

When possible, you should:

• participate from a private location;
• use a device you trust;
• use a secure internet connection;
• avoid public or unsecured Wi-Fi for sensitive communications where practical;
• protect your account credentials;
• prevent unauthorized individuals from viewing your screen or communications;
• tell your Healthcare Provider if another person is present during a live encounter; and
• notify the appropriate support channel if you suspect unauthorized access to your account.

Telehealth may involve communication through secure messaging, email, SMS, MMS, telephone calls, video calls, account notifications, or other electronic methods.

You acknowledge that ordinary email and SMS may not provide the same level of confidentiality or security as dedicated secure healthcare communication systems.

You should not use ordinary email, SMS, or non-emergency messaging channels for a medical emergency.

By providing contact information and accepting this Consent, you consent, to the extent permitted by applicable law, to receive communications reasonably related to your requested healthcare services, account, clinical workflow, appointment, consultation, prescription, laboratory order, pharmacy fulfillment, shipping, or follow-up.

Such communications may be sent by or on behalf of:

• your Healthcare Provider;
• the applicable professional medical entity;
• Koves;
• Bask Health or another technology provider;
• a pharmacy;
• a laboratory;
• a fulfillment or shipping provider; or
• another organization involved in providing services you requested.

Message and data rates may apply. Message frequency may vary.

To the extent required by law, separate consent will be obtained for promotional or marketing text messages, autodialed calls, prerecorded calls, or other communications requiring specific consent. Consent to marketing communications is not a condition of purchasing healthcare services where prohibited by law.

Information submitted in connection with your medical evaluation, messages with your Healthcare Provider, clinical decisions, prescriptions, and other healthcare-related information may become part of your medical record.

Medical records may be maintained by the applicable Healthcare Provider, professional medical entity, technology provider, or another legally responsible organization.

Your rights to inspect, obtain, amend, restrict, or otherwise exercise rights regarding your medical records are governed by applicable law and the privacy notices of the organization maintaining those records.

A telehealth encounter will not be intentionally audio- or video-recorded by a Healthcare Provider or participating organization unless recording is permitted by applicable law and any consent required by law has been obtained.

You should not record a telehealth encounter unless you have confirmed that doing so is permitted by applicable law and obtained any consent required from other participants.

If your Healthcare Provider determines that a prescription is medically appropriate, the prescription may be transmitted electronically to an appropriately licensed pharmacy.

A pharmacy is responsible for its own professional pharmacy services, including prescription verification, preparation, compounding where applicable, pharmacist review, labeling, dispensing, counseling, and fulfillment.

Koves does not prescribe, manufacture, compound, or dispense medication.

Your Healthcare Provider may determine that laboratory testing, diagnostic testing, medical records, photographs, vital signs, or other information is necessary before or during treatment.

Failure to complete requested testing or provide requested information may result in delay, modification, suspension, or discontinuation of treatment.

Laboratory or diagnostic services may be provided by independent organizations and may be subject to separate charges, terms, and privacy practices.

Telehealth is not appropriate for every condition or patient.

Your Healthcare Provider may recommend:

• an in-person physical examination;
• primary care follow-up;
• urgent care;
• emergency care;
• specialist consultation;
• laboratory testing;
• diagnostic testing;
• imaging;
• hospital evaluation; or
• another form of care.

You remain free to seek in-person medical care or a second opinion at any time.

TELEHEALTH SERVICES ACCESSED THROUGH KOVES ARE NOT DESIGNED FOR MEDICAL OR PSYCHIATRIC EMERGENCIES AND ARE NOT MONITORED CONTINUOUSLY FOR EMERGENCY CONDITIONS.

If you are experiencing symptoms that may represent an emergency, including a potentially life-threatening medical condition, you should call 911 or seek immediate emergency medical attention rather than waiting for a response through the Platform.

Depending on the circumstances, your Healthcare Provider may instruct you to seek urgent or emergency in-person evaluation.

You may withdraw your consent to receive healthcare through telehealth at any time, subject to applicable law.

Withdrawal of consent will not affect the legality of telehealth services already provided before withdrawal and will not require deletion of medical records that must or may be retained under applicable law.

Withdrawing consent to telehealth may prevent you from continuing to receive some or all healthcare services through the Platform. Your Healthcare Provider may discuss alternative methods of care where appropriate.

To request withdrawal of telehealth consent, use the applicable clinical communication channel or contact hello@koves.co for administrative assistance in identifying the appropriate channel.

You may refuse telehealth or request to stop a telehealth interaction at any time, subject to applicable law.

You may also ask questions about the telehealth process, request clarification, or ask whether another method of care is available.

Refusing telehealth may mean that the applicable healthcare service cannot be provided through the Platform.

Telehealth laws and informed-consent requirements vary by jurisdiction.

Additional disclosures, acknowledgements, consents, live-video requirements, identity-verification steps, prescribing requirements, or other procedures may apply depending on your physical location and the healthcare service requested.

Where a state or other jurisdiction requires additional telehealth consent language or a different method of obtaining consent, the applicable Healthcare Provider or professional medical entity may provide you with additional disclosures or consent forms.

This Consent is intended to supplement, and not replace, any state-specific consent required by applicable law.

Unless a shorter period is required by applicable law or a separate consent states otherwise, this Consent remains effective while you receive telehealth services through the applicable Healthcare Provider or professional medical entity until you withdraw consent or the relevant treatment relationship ends.

You may be asked to review or re-accept this Consent if the telehealth services, applicable law, clinical organization, or material terms change.

You agree that your electronic acceptance of this Consent may serve as your electronic signature to the extent permitted by applicable law.

Your acceptance may be recorded together with information such as:

• your name;
• date and time of acceptance;
• account identifier;
• version of the Consent accepted;
• IP address or device information where permitted;
• electronic signature information; and
• other information reasonably necessary to document consent.

A copy of this Consent may be made available electronically. You may request a copy of consent documentation through the applicable clinical or administrative channel.

By accepting this Consent, you acknowledge and agree that:

• you understand what telehealth is;
• you understand the distinction between asynchronous and synchronous telehealth;
• you understand the potential benefits, risks, and limitations of telehealth;
• you understand that technical failures or privacy and security incidents may occur despite reasonable safeguards;
• you understand that telehealth may not be sufficient for every medical condition;
• you agree to provide accurate and complete information;
• you agree to accurately identify your physical location;
• you understand that your Healthcare Provider may require additional testing, live communication, or in-person care;
• you understand that no diagnosis, prescription, treatment, or result is guaranteed;
• you understand that Koves is not your medical provider;
• you understand that medical decisions are made independently by your Healthcare Provider;
• you understand that additional provider or state-specific privacy notices and consents may apply;
• you understand your right to withdraw consent to telehealth as permitted by law; and
• you voluntarily consent to receive healthcare services using telehealth.

Questions concerning your diagnosis, prescription, medication, symptoms, treatment plan, medical records, side effects, or other clinical matters should be directed to your licensed Healthcare Provider through the appropriate clinical communication channel.

For administrative questions concerning the Koves Platform, contact:

Koves LLC
Email: hello@koves.co
Website: Koves.co

Questions concerning provider privacy practices or medical records may need to be directed to the applicable Healthcare Provider or professional medical entity identified during your clinical encounter.

BY CLICKING "I AGREE," CHECKING AN ACCEPTANCE BOX, PROVIDING AN ELECTRONIC SIGNATURE, OR OTHERWISE AFFIRMATIVELY ACCEPTING THIS CONSENT, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THIS CONSENT TO TELEHEALTH AND VOLUNTARILY CONSENT TO RECEIVE HEALTHCARE SERVICES THROUGH TELEHEALTH.

IF YOU BELIEVE YOU ARE EXPERIENCING A MEDICAL OR PSYCHIATRIC EMERGENCY, CALL 911 OR SEEK IMMEDIATE EMERGENCY MEDICAL ATTENTION.