Telehealth Informed Consent

Pulse Whole Health I, P.C. (“the Practice,” doing business as Pulse Whole Health) provides integrative medicine, metabolic health, and weight management services to patients in the Commonwealth of Pennsylvania exclusively via telehealth. Care is provided by Allyson L. Norton, PA-C (PA license MA065203) under the supervision of David G. Marx, M.D. (PA license MD044360L).

This document explains what telehealth is, the benefits and limitations of receiving care via telehealth, the technology and security measures we use, and your rights and responsibilities as a telehealth patient. Your signed consent is required before your first visit.

Telehealth (also called telemedicine) is the delivery of healthcare services using electronic communications technologies that allow real-time, two-way audio and video interaction between you and your provider, even when you are in different locations. At Pulse Whole Health, telehealth services include:

• Initial consultations and comprehensive health assessments
• Follow-up visits and ongoing care for chronic conditions
• Review and interpretation of laboratory results
• Prescription of FDA-approved brand-name medications, including weight management medications such as GLP-1 receptor agonists (e.g., Wegovy, Zepbound) where clinically appropriate. The Practice does not prescribe compounded GLP-1 medications.
• Nutrition, lifestyle, and behavioral health counseling
• Recommendations for nutritional supplements and functional medicine protocols
• Secure messaging through the patient portal between visits

Healthcare providers are required by law to be licensed in the state where the patient is physically located at the time services are rendered. The Practice provides telehealth services only to patients physically located in the Commonwealth of Pennsylvania.

At the start of each telehealth visit, you will be asked to verify your physical location. If you are outside Pennsylvania at the time of a scheduled visit, the visit cannot proceed and will need to be rescheduled.

Telehealth offers several potential benefits:

• Improved access to integrative medicine care without the need to travel
• Convenience and scheduling flexibility, including evening and weekend appointments
• Reduced exposure to contagious illnesses common in clinic waiting rooms
• Ability to receive care from a comfortable, private environment
• Easier coordination of care for patients with mobility, transportation, or scheduling barriers

Telehealth has limitations that you should consider before consenting to care:

Examples of medical emergencies include, but are not limited to: chest pain, difficulty breathing, severe bleeding, loss of consciousness, suspected stroke, severe allergic reaction, thoughts of harming yourself or others, severe abdominal pain, signs of overdose, and sudden severe pain or trauma.

If you experience a mental health crisis or are having thoughts of suicide, call or text 988 (the Suicide & Crisis Lifeline) or go to your nearest emergency room.

The Practice uses HIPAA-compliant, encrypted technology platforms for all telehealth visits and communications:

• Patient portal and telehealth video sessions are conducted through Practice Better, an electronic health record platform that is bound by a Business Associate Agreement with the Practice and uses industry-standard encryption.
• Secure text messaging and voice communications with the Practice are conducted through Spruce Health, also bound by a Business Associate Agreement.
• Laboratory test ordering and results are processed through Rupa Health, also under a Business Associate Agreement.
• Email communications regarding scheduling, billing, and general administrative matters use a HIPAA-compliant email platform bound by a Business Associate Agreement.

To protect your privacy during a telehealth visit, you should:

• Join the visit from a private location where you cannot be overheard.
• Use a secure, password-protected internet connection (avoid public Wi-Fi).
• Inform your provider at the start of the visit if anyone else is present in the room with you.
• Use headphones or earbuds when possible to maintain audio privacy.
• Avoid using shared or public computers for the patient portal.

The Practice does not record telehealth visits as a routine practice. If a visit will be recorded for clinical, training, or quality improvement purposes, you will be asked for separate written consent before the recording begins, and you may decline.

You may not record any portion of a telehealth visit without the prior written consent of the provider. Recording without consent may violate Pennsylvania wiretapping and surveillance laws.

Your health information is protected by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and applicable Pennsylvania law. The Practice’s Notice of Privacy Practices describes in detail how your protected health information may be used and disclosed and your rights regarding your health information.

You will receive a copy of the Notice of Privacy Practices at the time of your first visit. You may also request a copy at any time by contacting the Privacy Officer at contact@pulsewholehealth.com, or view it on the Practice’s website.

Telehealth involves the electronic transmission of your health information. While the Practice uses HIPAA-compliant platforms with strong encryption, no electronic communication system is completely secure. By consenting to telehealth, you acknowledge and accept the small but inherent risk of electronic communications.

The Practice provides integrative medicine, which combines conventional medical care with evidence-informed complementary approaches such as nutrition, lifestyle counseling, supplements, and functional medicine. The following disclosures apply:

• Some of the approaches discussed and recommended may not have been evaluated or approved by the U.S. Food and Drug Administration.
• Nutritional supplements are not intended to diagnose, treat, cure, or prevent any disease.
• Integrative medicine is intended to complement, not replace, conventional medical care. You are encouraged to maintain a relationship with a primary care provider and any specialists involved in your care.
• You have the right to seek conventional or alternative treatment at any time.
• Individual results vary. The Practice makes no guarantees about specific outcomes from any treatment, supplement, lifestyle change, or protocol recommended.

By consenting to telehealth services, you agree to:

• Provide accurate, complete, and truthful information about your health history, current symptoms, medications, and supplements.
• Promptly inform your provider of any changes in your health status, medications, or treatment.
• Verify your physical location at the start of each visit.
• Provide a local emergency contact when requested.
• Use appropriate, private technology and a stable internet connection during visits.
• Take responsibility for the security of your patient portal credentials and not share them with others.
• Seek emergency care when appropriate — do not rely on telehealth in a medical emergency.
• Maintain a relationship with a primary care provider for comprehensive medical care.
• Pay for services in accordance with the Practice's fee schedule and Cancellation Policy.

You have the right to decline telehealth services at any time and to receive care from another provider. You may withdraw your consent to telehealth at any time by notifying the Practice in writing at contact@pulsewholehealth.com. Withdrawal of consent will not affect any care provided before withdrawal and will not affect your right to receive a copy of your medical records.

If you refuse telehealth or withdraw consent, the Practice may not be able to continue providing services to you. You will be assisted in identifying alternative care options.

The Practice operates as a cash-pay model. Fees are due at the time of service and are paid through the patient portal. The Practice does not bill insurance directly, but can provide a superbill at your request that you may submit to your insurance for possible reimbursement. Reimbursement is not guaranteed and depends on your individual insurance benefits.

The Practice’s current fees, cancellation policy, and other financial terms are described in the Cash Pay Financial Policy, Terms and Conditions, and Cancellation Policy documents that you will receive and acknowledge.

By signing below, I acknowledge and agree to the following:

• I have read and understand this Telehealth Informed Consent.
• I understand the nature of telehealth, including its benefits, risks, and limitations.
• I understand that telehealth is not appropriate for emergencies and that in an emergency I should call 911 or go to the nearest emergency room.
• I understand that I must verify my physical location at the start of each visit and provide a local emergency contact.
• I understand that the Practice provides telehealth services only to patients physically located in Pennsylvania.
• I understand the integrative medicine disclosures set out in Section 10, including that the Practice does not prescribe compounded GLP-1 medications or FDA Category 2 peptides.
• I understand how my health information will be used and disclosed (more fully described in the Notice of Privacy Practices).
• I consent to receive care via telehealth from Pulse Whole Health I, P.C., understanding that I may withdraw consent at any time.
• I accept financial responsibility for the services I receive.
• I have had an opportunity to ask questions and have my questions answered to my satisfaction.