Telehealth Informed Consent

1. What telehealth is

Telehealth is the delivery of healthcare using communications technology rather than an in-person visit. Your clinician may evaluate you through written questionnaires, secure messaging, photographs you provide, laboratory results, and where appropriate a telephone or video consultation.

Most care at Prova is asynchronous. You provide information and your results, a licensed clinician reviews them on their own time, and responds. You will not always speak to your clinician in real time, though you may request to.

2. How care at Prova works

• You complete an intake describing your health, history, medications and goals.
• You have blood drawn, at home or at a partner site, and a certified laboratory runs your panel.
• A licensed clinician reviews your intake and your results together.
• The clinician decides whether treatment is appropriate, and if so prescribes it and sets the date of the draw that will show whether it worked.
• You are re-tested on that schedule, and your clinician reviews each set of results.

Your clinician is licensed in the state where you are located when you receive care. This is why we ask which state you live in, and why you must tell us if you move.

3. Benefits

Telehealth can give you access to clinicians without travel or waiting rooms, at times that suit you, and often at lower cost. Combined with regular testing it allows your care to be reviewed far more frequently than an annual physical would allow.

4. Limitations you should understand

• Your clinician cannot physically examine you. They cannot palpate, listen to your chest, or observe you in person, and some conditions can only be found that way.
• Your clinician relies on the accuracy and completeness of what you tell them. If something is omitted or wrong, the assessment may be wrong.
• A blood panel, however broad, does not detect everything. Many conditions do not show up in blood at all.
• Telehealth is not appropriate for every condition. Your clinician may determine that you need to be seen in person, and will tell you so.
• Prova does not provide emergency, urgent, surgical, obstetric or inpatient care, and does not manage acute illness.

5. Risks

As with any medical care, there are risks. By consenting you accept these:

• The information available to your clinician may be insufficient for a sound decision, which can lead to a missed or delayed diagnosis, or to treatment that is not right for you.
• Delays may occur in evaluation, in results, or in treatment, because of technical problems, laboratory turnaround, or shipping.
• Technology can fail. A connection may drop, a message may not send, or a file may not transmit.
• Despite encryption and safeguards, electronic transmission and storage of health information carries a risk of interception or unauthorised access.
• Laboratory results can be inaccurate, and false positives and false negatives occur.
• Any medication can cause side effects, including rare and serious ones, and can interact with other medications you take.
• In rare cases an adverse reaction could occur when no clinician is physically present to help you.

6. This is not for emergencies

Signs that need emergency care include chest pain, difficulty breathing, heavy or uncontrolled bleeding, fainting, sudden weakness or difficulty speaking, a severe allergic reaction, and thoughts of harming yourself. If you are in crisis, you can also call or text 988 to reach the suicide and crisis lifeline.

7. Prescriptions

No prescription is guaranteed. Paying for a membership does not entitle you to one. Your clinician exercises independent professional judgement and may decline to prescribe, prescribe something different from what you expected, ask for more information or further testing, or refer you for in-person care.

Prova does not prescribe controlled substances. Thyroid medication, antidepressants and hormonal contraception remain with your existing prescriber; we will measure what they are doing and, if you ask, send those results to them.

8. Compounded medications

Some medications prescribed through Prova are compounded by a licensed pharmacy specifically for you. Compounded medications are not approved by the FDA, and the FDA does not review them for safety, effectiveness or manufacturing quality before they are dispensed. A compounded formulation may differ from a commercial product in strength, form or absorption.

Your clinician will prescribe one only where they judge it clinically appropriate. By consenting you acknowledge you understand this, and you may ask your clinician about alternatives at any time.

9. Consent to blood draws and testing

You consent to having blood drawn by a trained phlebotomist and analysed by a certified laboratory, and to those results being provided to your clinician and to you.

A blood draw is a common procedure with minor risks, including discomfort, bruising, bleeding, lightheadedness or fainting, and, rarely, infection or a hematoma at the site.

Testing may reveal findings you were not expecting, including serious ones, and some findings will require follow-up outside Prova. Your clinician will tell you what a result means and what should happen next.

10. Your responsibilities

• Give complete and truthful information, especially about medications, allergies, existing conditions, and whether you are pregnant, trying to conceive or breastfeeding.
• Report side effects and changes in your health promptly.
• Attend your scheduled draws, since monitoring is what makes treatment safe.
• Tell your other healthcare providers what you are taking.
• Keep your contact details current so we can reach you about a result that needs attention.

11. Records and privacy

Your consultation, results and treatment are documented in a medical record held by the medical group and protected under HIPAA and state law. You may request a copy at any time. The medical group's notice of privacy practices, and the Prova privacy policy, describe how this information is handled, including how de-identified information is used for research and product development.

We do not record video consultations without telling you and obtaining your agreement first.

12. Alternatives to telehealth

You are free to seek in-person care instead, and in some situations that is the better choice. You can see your primary care provider, a specialist, an urgent care clinic or an emergency department. Choosing Prova does not prevent you from doing any of these, and we encourage you to keep a primary care provider.

13. Your right to withdraw consent

You may withdraw this consent at any time, for any reason, by emailing support@prova.com or through your account settings. Withdrawing it stops future telehealth care through Prova. It does not affect care already provided, does not delete your medical record, which we must retain by law, and does not affect your right to obtain a copy of it.

14. State requirements

Some states impose additional requirements on telehealth consent, on what must be disclosed before care, and on which services may be delivered remotely. Where your state requires more than this document provides, those requirements apply and you will be asked to acknowledge them separately before care begins.

You have the right to know the name, licence type and licence number of the clinician treating you, and to request that information at any time.

15. Acknowledgment

By accepting this consent you confirm that:

• You have read and understood it, and have had the chance to ask questions.
• You understand the benefits, the limitations and the risks of care delivered by telehealth.
• You understand that no prescription is guaranteed and that clinical decisions rest with your clinician.
• You understand that compounded medications are not FDA approved.
• You understand this is not an emergency service.
• You are at least 18 and are consenting for yourself.
• You consent to evaluation and treatment by telehealth, and to blood draws and laboratory testing.

A record of your acceptance, including the date and time and the version you accepted, is kept in your medical record.