DRAFT — placeholder written by the engineering team. Must be reviewed by counsel and the treating physician before real patients.

Informed Consent to Telemedicine

Please read this carefully. By accepting, you agree to receive care by video from a licensed physician through Varm Health.

What telemedicine is

Telemedicine means you and the physician are in different places and talk over a secure, live video connection. The physician may ask you questions, look at you on camera, review the information you entered, and decide on a plan.

What to expect at the start of each visit

The law requires us to verify who you are and where you are. At the start of each visit the physician will:

• ask to see your photo ID on camera (or confirm your identity another way);
• ask which town and state you are in;
• tell you their name, license type and how to contact the clinic;
• ask for your spoken consent to a telemedicine visit.

Benefits and limits

Telemedicine can make care faster and easier to get. It also has limits: the physician cannot examine you with their hands or run tests. Some conditions cannot be safely handled by video; if so, the physician will tell you where to go instead (for example urgent care or an emergency room). Technology can fail; if the connection drops we will try to reconnect, and you can always call us at (800) 555-0100.

Emergencies

Telemedicine is not for emergencies. If you have an emergency, call 911 or go to the nearest emergency room.

Prescriptions

If a prescription is appropriate it will be called in to the pharmacy you choose. We do not prescribe controlled substances.

Recording and privacy

We do not record video visits. Your information is protected as described in our Notice of Privacy Practices. Please take your visit from a private place.

Your choices

Taking part is voluntary. You may stop a visit at any time. You may ask for your records at any time.

Consent

By accepting, you confirm that you have read and understood this document, had a chance to ask questions, and agree to receive care by telemedicine from Varm Health.