Effective date: July 13, 2024

BY CLICKING “I AGREE,” CHECKING A RELATED BOX TO SIGNIFY YOUR ACCEPTANCE, USING ANY OTHER ACCEPTANCE PROTOCOL PRESENTED THROUGH THE SERVICE OR OTHERWISE AFFIRMATIVELY ACCEPTING THIS CONSENT, YOU ACKNOWLEDGE THAT YOU HAVE READ, ACCEPTED, AND AGREED TO BE BOUND BY THIS CONSENT. IF YOU DO NOT AGREE TO THIS CONSENT, DO NOT CREATE AN ACCOUNT OR USE THE SERVICE. YOU HEREBY GRANT AGENCY AUTHORITY TO ANY PARTY WHO CLICKS ON THE “I AGREE” BUTTON OR OTHERWISE INDICATES ACCEPTANCE OF THIS CONSENT ON YOUR BEHALF.

IF YOU ARE EXPERIENCING A LIFE-THREATENING SITUATION, SUCH AS CONTEMPLATING SUICIDE, CALL 911 OR THE 988 SUICIDE & CRISIS LIFELINE 988.

PURPOSE

The purpose of this consent form (“Consent”) is to provide you with information about Telehealth and to obtain your informed consent to the use of Telehealth in the delivery of healthcare services to you by physicians, physician assistants, nurse practitioners (“Providers”) using the online platforms owned and operated by Sage Meds, LLC DBA Happy Care Meds (the “Service”). In this Consent, the terms “you” and “yours” refer to the person using the Service.

USE OF TELEHEALTH

Telehealth involves delivering healthcare services using electronic communications, information technology, or other means between a healthcare provider and a patient not in the exact physical location. Telehealth may be used for diagnosis, treatment, follow-up, and/or patient education and may include, but is not limited to, one or more of the following: electronic transmission of medical records, photo images, personal health information, or other data between a patient and a provider; interactions between a patient and provider via audio, video, and/or data communications (such as messaging or email communications); use of output data from medical devices, sound and video files. Alternative care methods, such as in-person services, may be available to you, and you may choose an alternative at any time. Always discuss alternative options with your Provider.

ANTICIPATED BENEFITS

The use of Telehealth may have the following possible benefits: making it easier and more efficient for you to access medical care or other services and treatment for the conditions treated by your Provider(s); allowing you to obtain medical care or other services and treatment by Provider(s) at times that are convenient for you; and enabling you to interact with Provider(s) without the necessity of an in-office appointment.

POTENTIAL RISKS

While Telehealth in care delivery can provide potential benefits for you, there are also potential risks associated with using telehealth and other technology. These risks include, but may not be limited to, the following: the quality, accuracy, or effectiveness of the services you receive from your Provider could be limited; technology, including the Service, may contain bugs or other errors, including ones which may limit functionality, produce erroneous results, render part or all of such technology, including the Service, unavailable or inoperable, produce incorrect records, transmissions, data or content, or cause records, transmissions, data or content to be corrupted or lost; failures of technology may also impact your Provider(s) ability to correctly diagnose or treat your condition; the inability of your Provider(s) to conduct specific tests or assess vital signs in-person may in some cases prevent the Provider(s) from providing a diagnosis or treatment or from identifying the need for emergency medical care or treatment for you; your Provider(s) may not be able to provide treatment for your particular condition and you may be required to seek alternative healthcare or emergency care services; mental health services may result in feeling worse as therapy progresses; delays in medical evaluation/treatment could occur due to the unavailability of your Provider(s) or deficiencies or failures of the technology or electronic equipment used; the electronic systems or other security protocols or safeguards used could fail, causing a breach of privacy of your medical or other information; data stored and communicated electronically, for example, through email communications, may be more susceptible to unintended disclosure of protected health information to third parties; given regulatory requirements in certain jurisdictions, your Provider(s) diagnosis and/or treatment options, especially pertaining to certain prescriptions, may be limited; a lack of access to all of your medical records may result in adverse drug interactions or allergic reactions or other judgment errors.

LIFE-THREATENING AND OTHER EMERGENCY SITUATIONS; FOLLOW-UP CARE

If you are experiencing a life-threatening situation, such as contemplating suicide, call 911 or the 988 Suicide and Crisis Lifeline at 988.

If the situation is an emergency, call 911. In some situations, Telehealth is not an appropriate method of care. If you require immediate or urgent care, you must seek care at an emergency room facility or other provider equipped to deliver urgent or emergent care. Just so you know, providers may respond slowly to communications you submit through the Service. If you are not experiencing an emergency or do not require immediate or urgent care, you can communicate with Providers through the secure message service in the Service.

DATA PRIVACY AND PROTECTION

The electronic systems used in the Service will incorporate network and software security protocols to protect the privacy and security of your information. They will include measures to safeguard data against intentional or unintentional corruption. Personal information that identifies you or contains protected health information will not be disclosed to any third party without your consent except as authorized by law for consultation, treatment, payment/billing, specific administrative purposes, and as required by law to disclose to other persons and agencies certain information obtained during the provision of mental health services (e.g., danger to self or others; mandatory reporting of child, elder, or vulnerable adult abuse) or as otherwise outlined in your Provider’s Notice of Privacy Practices. Use of the Service may include email communications to and from you that may consist of your protected health information. You understand that Happy Care Meds cannot guarantee the security or privacy of the services you use to receive communications, including, for example, your email service provider.

YOUR ACKNOWLEDGMENTS

By clicking “I Agree”, checking a related box to signify your acceptance, using any other acceptance protocol presented through the Service, or otherwise affirmatively accepting this consent, you are agreeing and providing your consent concerning the following:

Telehealth will provide healthcare services to you by Providers via the Service. In some cases, your treating Provider may be a nurse practitioner or physician assistant and not a physician, and you agree to be treated by non-physician providers, if applicable, by using the Service. Your treating Provider for therapy services will be a mental health professional, such as a licensed counselor. Specific technology, including the Service, may be used while still in the beta testing and development phase and before such technology is a final and finished product. Technology used to deliver care, including the Service, may contain bugs or other errors, including ones which may limit functionality, produce erroneous results, render part or all of such technology unavailable or inoperable, produce incorrect records, transmissions, data or content, or cause records, transmissions, data or content to be corrupted or lost, any or all of which could limit or otherwise impact the quality, accuracy and/or effectiveness of the medical care or other services that you receive from your Provider(s). Certain diagnostic testing services, including laboratory products and services offered through the Service, may contain defects, including ones that may limit functionality or produce erroneous results, any or all of which could restrict or otherwise impact the quality, accuracy, and/or effectiveness of the medical care or other services that you receive from your Provider(s). The delivery of healthcare services via Telehealth is an evolving field, and the use of Telehealth or other technology in your medical care and treatment from Provider(s) may include uses of technology different from those described in this Consent or not explicitly described in this Consent. No potential benefits from using Telehealth or other technology or specific results can be guaranteed, including any laboratory testing results or related diagnosis or treatment by your Provider(s). Your condition may not be cured or improved, and in some cases, may get worse. There are limitations in providing medical care or other services and treatment via Telehealth and technology, including the Service, and you may not be able to receive diagnosis and/or treatment through Telehealth for every condition for which you seek diagnosis and/or treatment. There are potential risks to the use of Telehealth and other technology, including but not limited to the risks described in this Consent. You have the opportunity to discuss the use of Telehealth, including the Service, with your Provider(s), including the benefits and risks of such use and the alternatives to the use of Telehealth. You understand that there will be no recording of any online treatment sessions by your Provider(s) or you. Your Provider(s) will assess your medical condition and, in their sole discretion, may determine it is medically appropriate to diagnose and/or treat your condition via telehealth and whether you maintain sufficient knowledge and skills in the use of technology applicable to diagnosing and/or treating your condition via telehealth. By continuing to use the Service, you concur with your Provider’s medical assessment and agree to receive a diagnosis and/or treatment via telehealth technology. You have the right to withdraw your consent to the use of telehealth in the course of your care without prejudice to any future care or treatment and without risking the loss or withdrawal of any health benefits to which you are entitled. Still, you understand that the Providers who utilize the Service do not offer in-person treatment. Any withdrawal of your consent will be effective upon receipt of written notice to your Providers, except that such withdrawal will not affect any action taken by Happy Care Meds or your Provider(s) in reliance on this Consent before it receives your written notice of withdrawal.

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