VPC Consent, Terms of Use, and Privacy Notice

Amended 11/4/24

  1. Telemedicine/Telehealth Consent

I hereby request, consent, and authorize the independent healthcare providers including physicians, physician assistants, nurse practitioners or other licensed health care professionals in its care network (the “Practitioners”), to utilize telemedicine (or telehealth) through Virtual Psychiatric Care’s proprietary systems, methods and protocols to assess, diagnose, consult, treat and educate me and those I am authorized to represent (the “Services”).

I acknowledge and consent to see a Practitioner via telemedicine/telehealth. I understand that my eligibility to receive a visit via telemedicine is based on the Practitioner’s professional judgment that it is appropriate and that the quality of care will not be diminished by the use of telehealth. I understand that a telehealth visit is distinct from an in-person visit because I will not be in the same room as the healthcare Practitioner, and instead, I will communicate with the Practitioner through advanced communication technology using live video and audio feed.

I acknowledge that in order to protect my privacy, I need to choose a private location to place my telemedicine or telehealth call. I understand that in order to provide the best call environment, I should reduce background light from windows or light emanating from behind me. I understand that my camera should be placed on a secure, stable platform to avoid wobbling and shaking during the telemedicine session. To the extent possible, my camera should be placed at the same elevation as my eyes with my face clearly visible to the other person. I understand that I will be informed of the presence of any third party, including those that may be present to assist with the audio or video equipment, and that I have the right to: (1) omit specific details of medical history or physical examination that are sensitive to me during such third party presence, (2) ask non-medical personnel to leave the telehealth examination room, and/or (3) terminate the consultation at any time by notifying the Practitioner or disconnecting from the telehealth portal.

I understand the potential risks of receiving the Services via telehealth include: delays in medical evaluation due to technological equipment failure, a lack of access to all relevant information, or a security breach allowing unauthorized access to my confidential medical information. I understand that my Practitioner or I may terminate the telehealth visit at any time, including if the Practitioner or I feel that an in-person visit is necessary for any reason. I have had the Services and alternatives to telehealth for my

Services explained to me and I choose to and continue with a telemedicine visit.

I understand that any complaint may be filed with the Secretary of the Department of Health and Human Services.

I have read and understood the written information provided above. I agree that the information provided above adequately explains the Services, along with the risks and benefits to me of said Services. I have had the opportunity to ask questions about this information – if I had any questions, all of my questions have been answered in full. By electronically signing this form, I acknowledge and agree to all of the above, and certify that I have no questions and/or have had my questions answered in full.

By electronically signing this informed consent, I am agreeing to conduct transactions electronically, and intend for my electronic signature to be a binding electronic signature on myself and those I am authorized to represent.

I also agree that:

Further, I understand and acknowledge that I am digitally receiving a copy of this Agreement concurrently upon execution to print and/or retain a copy of this Agreement, and may also request a paper copy from VPC using the contact information below:

If you have any questions, please contact

support@virtualpsychiatriccare.com

  1.  Disclaimer: The use of telehealth or telemedicine through the VPC platform is not meant for emergencies or crisis intervention. If you are experiencing a medical or mental health emergency please dial 911 or visit the nearest hospital.
  2. Integrated Platform Terms of Use

The following “terms of use” describes the integrated online platform you will use to receive healthcare services. Virtual Psychiatric Care (“VPC”) and its subsidiaries (MiamiPsych Concierge, LLC), affiliates, representatives, and any third party (collectively, “VPC”) facilitate access and communication between you and healthcare providers using the integrated telehealth platform (Services). VPC is not a healthcare provider and does not render medical treatment or health services.

All Services received via the online telehealth platform are provided by independent healthcare providers ("Practitioners") and not VPC. Virtual Psychiatric Care (VPC) makes no warranties and shall not be held liable for any advice, services, course of treatment, or medications recommended by the Practitioners who use the VPC telehealth platform to communicate with you.

The Practitioners require consent and authorization for use of telemedicine (or telehealth) through VPC’s proprietary systems, methods, and protocols to access, diagnose, consult, treat and educate you and those you are authorized to represent (the “Services”). I understand the use of this telehealth platform is not intended for emergency services or treatment.

  1. Communication: Communication/Chats: The VPC platform allows the ability for you to send Chat messages to your Practitioner. Chat messaging and video calls are encrypted and HIPAA compliant. I understand Chat messages may include non-urgent questions or concerns about your treatment. I understand chat messages are not regularly monitored and shall not be used for urgent or emergency issues.

 IF YOU ARE EXPERIENCING A MEDICAL OR MENTAL HEALTH EMERGENCY, OR EXPERIENCING SERIOUS MEDICATION SIDE EFFECTS YOU WILL CALL 911 OR CONTACT YOUR NEAREST EMERGENCY MEDICAL PROVIDER.

I understand that any information contained in its Chats or in any other VPC resource should not take the place of medical intervention, diagnosis, treatment and/or advice rendered by your Practitioner during a regularly scheduled telemedicine visit.

By communicating through the use of VPC Chats, I agree to indemnify and hold harmless VPC, Practitioners, its agents and assigns with respect to any claim based upon transmission of your message(s).

I understand that I may also contact your Practitioner by calling 888-947-3888 OR send an email to support@virtualpsychiatriccare.com for assistance.

  1. Cancellation / Refund Policy: I understand that I must reschedule or cancel my appointment outside the cancellation period to avoid a cancellation fee. I understand appointment cancellations made within 24 hours prior to appointment time will incur a cancellation fee equal to  50% of visit cost. “No Show” missed visits will be charged the full visit fee. This Cancellation policy applies only to visits that are paid “out-of-pocket” and not through the use of my health insurance plan.

**Use of “Walk-In” visit feature: I understand the cancellation charge does not apply to me if I choose to use the “Walk-In” visit feature of the platform and am unable to be seen by a provider. In this case all funds are automatically returned to my card upon exiting the platform. Also, by electronically agreeing to this consent I acknowledge there are absolutely no refunds for telehealth visits that have already started, regardless of length of visit, the treatment plan set forth, or whether medications are

prescribed, or for any other reason not listed, unless the Practitioner chooses to end visit for any reason without completing the evaluation.

  1. Medication Refills: Please ensure that you are adhering to your scheduled follow-up appointments to avoid gaps in care and for appropriate medication management. Medication refill requests will not be provided without a follow-up appointment or as agreed between you and your Practitioner. You, the patient, are responsible for scheduling your follow-up visit.

  1. Consent to Obtain Patient Medication History

Patient medication history is a list of prescriptions that your healthcare providers have prescribed for you. A variety of sources, including pharmacies and health insurers, contribute to the collection of this history.

The collected information is stored in the practice electronic medical record system and becomes part of your personal medical record. Medication history is very important in helping providers treat your symptoms and/or illness properly and avoid potentially dangerous drug interactions.

It is very important that you and your provider discuss all your medications in order to ensure that your recorded medication history is 100% accurate. Some pharmacies do not make prescription history information available, and your medication history might not include drugs purchased without using your health insurance.

Also, over-the-counter drugs, supplements, or herbal remedies that you take on your own may not be included.

I give permission to allow my chosen Practitioner to obtain my medication history from my pharmacy, my health plans, electronically via prescription monitoring programs, and my other healthcare providers.

By electronically signing this consent form you are giving your healthcare provider permission to collect and share your pharmacy and your health insurer information about your prescriptions that have been filled at any pharmacy or covered by any health insurance plan. This includes prescription medicines to treat AIDS/HIV and medicines used to treat mental health issues such as depression. Your information will be collected and shared in compliance with applicable privacy laws and regulations, and appropriate safeguards will be in place to protect your information.

  1. Privacy Policy

  1. INTRODUCTION

Virtual Psychiatric Care, a subsidiary of MiamiPsych Concierge, LLC, (“VPC”, “Company”, “us”, and “we”) is committed to protecting your privacy. We have prepared this Privacy Policy to describe to you our practices regarding the Personal Information (as defined below) we collect from users of both our website, located at www.VirtualPsychiatricCare.com, and the VPC telemedicine application powered by VSee (collectively the “VPC Platform”) as described and defined in the VPC Terms of Use (“VPC TOS”). Capitalized terms not defined herein are defined in the VPC TOS. Our Privacy Policy also serves as a notice to describe how personal information and health information (PHI) about you may be used, how it may be disclosed, and how you can obtain access to this information. The law (45 CFR Part 160 and Part 164, Subparts A and E) requires that your PHI be kept private. We must give you such notice about our privacy practices and follow the terms of this notice while it is in effect. Your use of our website or VPC Platform indicates your acceptance of the terms of this notice and our Privacy Policy. VPC is engaged in the business of providing internet healthcare resources to connect our Users with Independent Professional providers in real-time, via live streaming video, telephone, messaging, social media, and/or secure e-mail and to provide VPC Collection Services between our Users and Independent Professionals (collectively “Platform Services”).

  1. INFORMATION THAT MAY BE COLLECTED BY VPC

In order to use the Platform Services, you as a User are required to enter an email address and create a password, which we refer to here as your VPC ID or credentials. After you create your VPC ID, you will use these same credentials to log into and utilize the Platform Services. This log-in process will allow you to manage your account, it will allow you to search for a provider, make appointments, attend appointments, and utilize and enjoy all Platform Services. The first time you log in to VPC’s platform to utilize the Platform Services, you will be asked to create an account also known as your profile.

To create an account, you must provide personal information such as name,

address, telephone number, date of birth, e-mail address, gender, and other pertinent data that will be available for you to share with the Independent Professionals who are also registered on the VPC Platform. VPC will use the email address you provide when you create your account to send you an email requesting that you validate your account. Your email address may also be used by VPC to provide appointment reminders, changes in appointments, messages from our Independent Professionals, and other relevant communications in connection with Platform Services. VPC will also use your e-mail address as the primary means to reset your username and password. Your email address will not be shared with any other third parties and will not be used for advertising or sales purposes. VPC creates as appropriate, a textual, audio, and visual record of all Platform Services in which you participate. Some examples include the creation of video and/or audio files associated with all Practitioner sessions, electronic medical records that may be uploaded or created as a result of treatment by you or an Independent Professional, data received from medical wearable technologies, etc.

Mobile SMS Privacy Policy:

As a current or prospective customer you understand that you can text us STOP at any time to opt out of receiving SMS text messages from us. You can text us HELP at any time to receive help.Your mobile information will not be shared with any third parties/affiliates for marketing/promotional purposes. All policies are followed as per CTIA guidelines 5.2.1. At any time if you want your information to be removed, you can contact us via our email address or regular mail.

For certain Platform Services that require a fee, we will collect credit card or billing/payment account information which we maintain in encrypted form on secure servers. In order to participate in Platform Services, you will need to provide, and/or upload to the VPC Platform, Personal Health Information (“PHI”). Here are examples of the types of Personal Health Information we gather:-Information You Give Us – Examples of the types of information you may provide us include mental health history, lab results, medications, medical health history, and other health or PHI, such as prescription

information.-Information Accessed through Third-Party Data Platform Services – When you use VPC Platform Services, we may access health-related information about you that is stored with third party-data Platform Services such as VSee, and such information will subsequently be available to

us.-Third-Party Information – Health-related information about you received from third parties (such as therapists, doctors, or family members) as well as personally identifiable and other health-related information you provide specifically related to family members who may be utilizing the Platform Services under your account. Demographic information, such as age, education, gender, social security number, and zip code.

  1. HOW INFORMATION ABOUT YOU MAY BE USED BY VSEE

Virtual Psychiatric Care may gather PHI primarily to share with VPC Independent Professionals for the purposes of diagnosis, treatment, and health care operations. However, in limited circumstances, Virtual Psychiatric Care may use de-identified, non-personal information for statistical analysis, improvement of the Platform Services, and customization of web design and content layout.

  1. Uses and Disclosures of PHI

The law requires that your PHI, including mental health records, be kept private as per federal regulations governing Confidentiality of Alcohol and Drug Abuse Patient Records, 42 C.F.R. Part 2, and the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), 45 C.F.R. Pts. 160 & 164 and cannot be disclosed without written consent unless otherwise provided for in the regulations.

Virtual Psychiatric Care may use or disclose your PHI to facilitate your treatment via Platform Services that is being provided by a Virtual Psychiatric Care registered Independent Professional. For Payment: Virtual Psychiatric Care may use and disclose your PHI with others who help pay for your care such as health insurers or health plans in connection with the processing and payments of claims and other charges. For Health Care Operations: Virtual Psychiatric Care may use and disclose your PHI for its health care operations. These uses and disclosures help us run our programs and make sure Virtual Psychiatric Care’s patients receive quality care. For example, Virtual Psychiatric Care may use PHI to review the treatment and provision of Platform Services. Virtual Psychiatric Care may use PHI to measure the performance of the Independent Professionals who are working with you or providing you treatment. Virtual Psychiatric Care may share PHI with third parties who Virtual Psychiatric Care engages to provide various Platform Services. If any such third party requires access to your PHI in order to perform the agreed-upon Platform Services, Virtual Psychiatric Care will require that third party be bound to the terms outlined in this Privacy Policy.

Business Associates: Virtual Psychiatric Care may contract with outside businesses to provide some Platform Services. For example, Virtual Psychiatric Care may use the Platform Services of transcription, laboratories,

or collection agencies. Each contracted party must enter into a Business Associate agreement with Virtual Psychiatric Care, which requires said third party businesses to protect PHI that is shared with them in accordance with the restrictions outlined in this Privacy Notice. Furthermore, PHI will only be provided to third party businesses for the limited scope of performing required Platform Services to help facilitate treatment, payment, and health care operations to you. For Appointment Reminders. Virtual Psychiatric Care may contact you to remind you about your appointments. Treatment Alternatives. Virtual Psychiatric Care may use and disclose PHI to tell you about different types of treatment available to you. Virtual Psychiatric Care may use and share PHI to tell you about other benefits and Platform Services related to your health. Research. In support of telemedicine initiatives, Virtual Psychiatric Care may use and disclose your PHI for research. Virtual Psychiatric Care will only use and disclose information for research if Virtual Psychiatric Care receives your written consent, or if a review committee that meets Federal standards says Virtual Psychiatric Care does not need your consent. Genetic Information. Virtual Psychiatric Care does not use genetic information for underwriting and related purposes. Fundraising Activities. Virtual Psychiatric Care will not disclose your individual PHI for fundraising activities without your written authorization. As Required By Law. Virtual Psychiatric Care may use and disclose your PHI when required to do so by federal, state or local law (see below). Testimonials. We display personal testimonials of satisfied customers on our site in addition to other endorsements. With your written consent, we may post your testimonial along with your name.

In the event of a data breach affecting your PHI, VPC will notify you promptly, no later than 60 days following the discovery of the breach. We will provide notification via email or postal mail, depending on your preferences, and will include details about the breach, the types of information involved, steps you should take to protect yourself, and what we are doing to investigate and mitigate the situation. We will also notify relevant authorities as required by law.

  1. How Virtual Psychiatric Care Independent Professional Healthcare Providers May Use and Disclose PHI – Special Situations

Your record will not be disclosed unless you direct your provider to do so or unless the law compels your provider to do so. Information communicated is protected by professional ethics and state and federal law required by the Health Insurance Portability & Accountability Act (HIPAA). Your medical records will not be disclosed unless you provide specific written consent.

There are exceptions to this confidentiality, where disclosure is mandatory. These include the following:

  1. HOW PHI DATA SECURITY IS HANDLED AT VSEE

The importance of security for all personal information including, but not limited to, PHI associated with you is of utmost concern to us. At VPC, utilizing VSee encrypted technology, we exercise state of the art care in providing secure transmission of your information from your PC or mobile device to VSee servers. PHI collected by the VPC platform is stored in secure operation environments that are not available or accessible to the public. Only those employees who need access to your information in order to do their jobs are allowed access, each having signed confidentiality agreements. Any employee who violates our privacy or security policies is subject to disciplinary action, including possible termination and civil and/or criminal prosecution.

VPC is not only HIPAA compliant but additionally utilizes the latest technologies to ensure the utmost security. VPC, through the use of VSee technology, uses several layers of firewall security and different degrees of encryption for each customer’s sensitive PHI to ensure the highest level of security which meets or exceeds the requirements promulgated under HIPAA (defined below). VPC is the sole owner of the information collected on its site. VPC will not sell, share, or lease this information to others. VPC does not sell any customer lists, e-mail addresses, cookies, or other data without your written authorization.

  1. Cookies and Tracking Technologies

Cookies are text information files that your web browser places on your computer when you visit a website. Cookies assist in providing non-personal information from you as an online visitor. It can be used in the customization of your preferences when visiting our website. Most browsers accept cookies automatically but can be configured not to accept them or to indicate when a cookie is being sent. VPC uses Google Analytics, a third-party tracking service, which uses cookies to track non-personal identifiable information about our visitors to our main site in the aggregate to capture usage and volume statistics. VPC has no access to or control over these cookies.

VPC works with other companies, including Google, who use tracking technologies to serve ads on our behalf across the Internet. These companies use first-party cookies (such as the Google Analytics cookies) and third-party cookies (such as the Adwords cookie) to collect information about your

interaction on our website, including advertising and remarketing. If you would like to opt-out of receiving ads tailored by 3rd party tracking technologies associated with our website, please click here. Note that if you opt-out from these third-party tracking technologies, you may still see our ads at other websites, but the ads will not be tailored using third-party tracking technologies associated with our website.

  1. Secure interaction

When you interact with the VPC Platform, all of your PHI including, but not limited to, your credit card number and delivery address, is transmitted through the Internet using Secure Socket Layers (SSL) technology. SSL technology causes your browser to encrypt your entered information before transmitting it to our secure server. SSL technology, an industry-standard, is designed to prevent someone other than operators of our web site from capturing and viewing your personal information. VPC also takes the following measures to protect your PHI online: Passwords. To provide you with an increased level of security, online access to your PHI is protected with a password you select. We strongly recommend that you do not disclose your password to anyone. VPC will never ask you for your password in any unsolicited communication (including unsolicited correspondence such as letters, phone calls, or e-mail messages). No data transmission over the Internet can be guaranteed to be 100% secure. While we strive to protect your PHI from unauthorized access, use, or disclosure, VPC cannot ensure or warrant the security of any information you transmit to us on our website.

  1. Your Rights Regarding Your PHI

You have the following rights regarding PHI that VPC maintains about you: Right To Inspect and To Receive Copies. You have the right to view and receive copies of the PHI used to make decisions about your care, provided you submit your request in writing. Usually, this includes medical and billing records. It does not include some records such as psychotherapy notes. VPC may deny your request to view and/or copy your PHI in limited circumstances. If your request is denied, VPC will inform you of the reason for the denial and you have the right to request a review of the denial. VPC may charge a fee for the costs of processing your request. Right To Amend. If you think that

personal information VPC has about you is wrong or incomplete, you have the right to ask for an amendment to your record. To request the deletion of any personal information or ask for a change to your record, you must make your request in writing and submit it to VPC. If we are not able to comply with your request, we will respond with an explanation. VPC may deny your request for an amendment to your record. VPC may deny your request if it is not submitted in writing or does not include a reason to support the request. VPC may also deny your request if you ask VPC to amend information that:

We will retain your information for as long as your account is active or as needed to provide you Platform Services. We will retain and use your information as necessary to comply with our legal obligations, resolve disputes, and enforce our agreements. Right To An Accounting of Disclosures. You have the right to get a list of the disclosures VPC has made of your PHI. This list will include only certain types of disclosures that VPC has made. For example, this list will not include disclosures that VPC made for treatment, payment, or health care operations. It will not include disclosures you specifically approved. To ask for this list, you must submit your request in writing on the approved form. The form will be provided to you upon request. Right To Request Restrictions. You have the right to ask for a restriction or limitation on the PHI VPC uses or discloses for treatment, payment, or health care operations. You also have the right to ask for a limit on the PHI VPC discloses with someone who is involved in your care or in the payment for your care. Such a person may be a family member or friend. VPC is not required to comply with your request. If VPC does agree, we will fulfill your request unless the information is needed to provide you with emergency treatment or if otherwise required by law. To ask for restrictions, you must make your request in writing on a form that we will give you upon request. You must tell us:

Right To Request Confidential Communications. You have the right to request confidential communications of your PHI or medical matters. You may request that VPC communicate with you through specific means or at a specific location. You must make your request in writing on a form that will be provided to you upon request. VPC will fulfill all reasonable requests. Right To a Paper Copy of This Notice. You may ask VPC to give you a written copy of this Notice at any time. Even if you have agreed to get this Notice electronically, you still have a right to a paper copy of this Notice. If you click on a link to a third-party site, you will leave the VPC site you are visiting and go to the site you selected. We cannot control the activities of third parties, and as such, we are not responsible for any use or misuse of your PHI by such third parties. We cannot guarantee that they will adhere to the same privacy practices as VPC. By using our services, you agree not to hold VPC liable for any mishandling of your PHI by third-party sites. We encourage you to review the privacy policies of any other service provider from whom you request services. If you visit a third-party website that is linked to the VPC Platform, you should read that site’s privacy policy before providing any personal information.

  1. Revisions To This Notice

VPC is constantly innovating and implementing new features as part of its Platform Services. As a result, our privacy practices may change. We may revise this Notice to reflect any changes in our privacy practices. We reserve the right to make the revised Notice effective for PHI we already have about you. It also will be effective for any information we receive in the future. We will post a current version of the Notice on this Site prior to the change becoming effective. The effective date of this Notice is on the first page, in the top, left-hand corner. If we make any material changes we will notify you by email (sent to the e-mail address specified in your account) or by means of a notice on the VSee Platform prior to the change becoming effective.

  1. Social Media Widgets

Our Web site includes Social Media Features, such as the Facebook button. These Features may collect your IP address, which page you are visiting on our site, and may set a cookie to enable the Feature to function properly.

Social Media Features and Widgets are either hosted by a third party or hosted directly on the VPC Platform. Your interactions with these Features are governed by the privacy policy of the company providing it.

  1. Complaints

If you think your privacy rights have been violated, you may file a complaint with support@virtualpsychiatriccare.com. You may also file a complaint with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint. You may also contact us for further information about your privacy rights by emailing us at support@virtualpsychiatriccare.com

  1. ACCEPTANCE

By using the VPC Platform and Platform Services, you acknowledge your acceptance of this Privacy Policy and agree to its terms. If you do not agree with this policy, you should not use the VPC Platform and Platform Services. It is recommended that you read this privacy policy before the use of Platform Services to ensure that you have not missed any changes to the privacy policy. Your continued use of the Platform Services following any changes to the privacy policy signifies your acceptance of those changes.