Telehealth Consent

1. NATURE OF TELEHEALTH SERVICES

Telehealth involves the delivery of healthcare services using electronic communications, information technology, and other means between a healthcare provider and a patient who are not in the same physical location. 1.1 Asynchronous (Store-and-Forward) Care Most Kōvn Health services are delivered asynchronously, meaning: 1.2 Synchronous (Video Consultation) Care For certain clinical situations, a provider may require a live video consultation, including: You agree to participate in video consultations if requested by your provider. Failure to attend scheduled video visits may result in discontinuation of services.

• You complete a comprehensive medical intake questionnaire through our secure platform
• You may upload photos (for ED/libido) or provide additional medical information
• A licensed healthcare provider reviews your intake within 24-48 hours
• The provider makes a clinical determination and communicates the treatment plan via secure messaging
• Ongoing management occurs through secure portal messaging and periodic asynchronous reviews
• Initial evaluation for complex medical histories
• High-risk patients requiring real-time assessment
• Adverse event management or treatment complications
• State-specific telehealth requirements mandating synchronous care

2. BENEFITS OF TELEHEALTH

Telehealth offers several advantages:

• Improved access to healthcare without geographic barriers
• Convenience and reduced travel time
• Faster clinical response for time-sensitive conditions
• Greater flexibility in scheduling and communication
• Continuity of care through asynchronous monitoring
• Discreet access to sensitive health services (ED, weight, libido)

3. RISKS AND LIMITATIONS OF TELEHEALTH

You understand and acknowledge the following risks and limitations: 3.1 Clinical Limitations 3.2 Technology Risks 3.3 Service-Specific Risks Weight Management (GLP-1): Erectile Dysfunction: Peptide Therapy:.

• Inability to perform physical examinations, hands-on diagnostic procedures, or palpation
• Reliance on patient-reported symptoms, measurements, and medical history
• Limitations in diagnosing certain acute or complex conditions remotely
• Potential delays in care due to asynchronous communication (non-real-time reviews)
• Potential technology failures or service interruptions
• Internet connectivity issues affecting communication
• Very small risk of unauthorized access to health information despite encryption
• Side effects (nausea, vomiting, diarrhea, pancreatitis risk) may occur between provider check-ins
• Delayed detection of contraindications if medical history changes between visits
• Cardiovascular risk assessment relies on patient-reported history without in-person evaluation
• Drug interaction screening depends on accurate medication disclosure
• Limited clinical data on long-term safety due to off-label nature
• FDA regulatory changes may affect medication availability

4. LABORATORY MONITORING REQUIREMENTS

CRITICAL: For weight management (GLP-1) and future testosterone therapy services, continued treatment is CONTINGENT upon regular laboratory monitoring. 4.1 Baseline and Periodic Labs You acknowledge and agree that: 4.2 Consequences of Non-Compliance FAILURE TO PROVIDE REQUESTED LABORATORY RESULTS WILL RESULT IN IMMEDIATE SUSPENSION OF PRESCRIPTIONS UNTIL LABS ARE COMPLETED. This is a patient safety requirement and is non-negotiable. If you fail to complete required labs within 30 days of the request, your subscription will be automatically paused, and you will not receive prescription refills until labs are submitted and reviewed. This protects you from: undetected pancreatitis (GLP-1), renal impairment, hepatic dysfunction, and other potentially serious complications that require laboratory monitoring.

• Baseline laboratory tests may be required before initial prescribing (CMP, lipase, HbA1c)
• Periodic monitoring labs are required at 3-month, 6-month, and annual intervals
• Your provider will order specific tests based on your treatment plan and medical history
• You are responsible for completing ordered labs in a timely manner

5. PHARMACY SELECTION AND MEDICATION FULFILLMENT

5.1 Your Right to Choose YOU HAVE THE RIGHT TO SELECT ANY LICENSED PHARMACY OF YOUR CHOICE to fill your prescriptions. Kōvn Health does not require you to use any specific pharmacy. 5.2 Partner Pharmacy Recommendations Kōvn Health may recommend specific partner pharmacies for: These recommendations are for your convenience and potential cost savings. You are free to use any pharmacy licensed in your state. 5.3 340B Program Compatibility As Kōvn Health develops care coordination partnerships with federally qualified health centers (FQHCs) and Ryan White-funded programs, certain patients may become eligible for 340B drug pricing. Pharmacy selection flexibility ensures compliance with federal anti-steering regulations.

• Cost-efficiency and subscription pricing models
• Compounding availability (GLP-1, peptides)
• Cold-chain logistics for injectable medications
• Coordinated prescription management and auto-refills

6. YOUR RIGHTS AS A TELEHEALTH PATIENT

You have the right to:

• Withdraw consent for telehealth services at any time without affecting your right to future care
• Request an in-person visit or referral to local providers if telehealth is not appropriate
• Receive the same standard of care as in-person medical services
• Privacy and confidentiality in all telehealth encounters under HIPAA
• Access your medical records and request amendments
• File complaints with your state medical board or Kōvn Health's Medical Director

7. EMERGENCY MEDICAL SITUATIONS

Kōvn HEALTH TELEHEALTH SERVICES ARE NOT INTENDED FOR EMERGENCY MEDICAL SITUATIONS. If you believe you are experiencing a medical emergency, including but not limited to: YOU MUST:.

• Severe allergic reaction (anaphylaxis)
• Chest pain or suspected heart attack
• Severe abdominal pain (potential pancreatitis from GLP-1)
• Priapism (erection lasting >4 hours from ED medications)
• Difficulty breathing or throat swelling
• Symptoms of stroke (facial drooping, arm weakness, speech difficulty)
• CALL 911 IMMEDIATELY, or
• Go to the nearest emergency department
• DO NOT use Kōvn Health messaging or wait for provider response

8. TELEHEALTH PROVIDER-PATIENT RELATIONSHIP

Telehealth services through Kōvn Health establish a valid provider-patient relationship subject to the same ethical and legal standards as in-person care. Your assigned provider will:

• Conduct a thorough medical evaluation based on your intake
• Apply the same standard of care as in-person medicine
• Determine if your condition is appropriate for telehealth treatment
• Refer you for in-person evaluation if clinically necessary
• Maintain your medical records in compliance with state and federal law

9. STATE-SPECIFIC TELEHEALTH REQUIREMENTS

9.1 Florida Patients (Florida Statute 456.47) Florida law requires explicit informed consent for telehealth services. By proceeding, you acknowledge: 9.2 Tennessee Patients (Tennessee Code 63-1-155) Tennessee law permits telehealth for established and new patient-provider relationships. Asynchronous (store-and-forward) telehealth is explicitly authorized under Tennessee regulations. 9.3 Future State Expansion As Kōvn Health expands to additional states, state-specific telehealth requirements will be incorporated into this consent, and you will be notified of material changes.

• You understand the nature of telehealth services
• You consent to telehealth delivery of care
• You have the right to refuse telehealth and request in-person care
• Your provider is licensed in Florida and practicing under Florida medical standards

10. CONFIDENTIALITY AND SESSION RECORDING

All telehealth sessions, communications, and medical information are protected under HIPAA and state privacy laws. Information is maintained in a HIPAA-compliant electronic health record system. 10.1 No Recording by Kōvn Health Kōvn Health does NOT record video consultations or voice calls unless you provide explicit written authorization. If recording is necessary for quality assurance or training purposes, you will be notified in advance and must consent separately. 10.2 Patient Recording Some states require two-party consent for recording. Before recording any telehealth session, you must obtain provider consent and comply with applicable state recording laws.

11. ACKNOWLEDGMENT AND CONSENT

By clicking 'I Agree' or proceeding with your clinical intake, you acknowledge that: A copy of this consent will be available in your patient portal for your records.

• You have read and understand this Telehealth Informed Consent
• You have had the opportunity to ask questions and receive answers
• You voluntarily consent to receive telehealth services
• You understand the benefits, risks, and limitations of telehealth
• You agree to comply with laboratory monitoring requirements
• You understand this is not emergency medical care
• You have the right to withdraw consent at any time by contacting support