Telehealth Consent

COMPREHENSIVE TELEHEALTH AUTHORIZATION, INFORMED CONSENT & NOTICE OF PATIENT RIGHTS

Effective Date: July 23, 2025
Governing Entity: Dr Telx LLC and Affiliated Professional Entities
Contact: support@drtelx.com

**IMPORTANT: READ THIS DOCUMENT IN FULL BEFORE USING OUR SERVICES**

By accessing the Dr Telx platform, initiating a medical consultation, or submitting any personal health information, you acknowledge and agree to the terms of this legally binding Telehealth Authorization and Informed Consent. Your use of our services constitutes your voluntary and informed acceptance of all provisions herein.

If you do not understand any section or have questions, please contact us prior to proceeding.

1. ABOUT DR TELX

This Telehealth Consent outlines how medical services are provided through telehealth by affiliated professional entities operating under and with the support of Dr Telx LLC (“Dr Telx,” “we,” “our,” or “us”).

Dr Telx includes the following entities:

Dr Telx LLC, a Washington-based management services organization (MSO)
TXMD of California, P.C.
TXMD of Kansas, P.C.
TXMD of Texas, P.C.
Digital Medical Care, P.C.

(collectively referred to as “Dr Telx”).

All medical services delivered through the Dr Telx platform are provided exclusively by licensed healthcare professionals employed or contracted by the Affiliated Medical Practices. Dr Telx LLC does not practice medicine, prescribe treatment, or employ providers. Its role is limited to providing administrative, technical, and compliance support.

2. NO EMERGENCY SERVICES

The Dr Telx platform is not intended for emergency care. If you are experiencing a medical emergency, including symptoms such as chest pain, difficulty breathing, severe bleeding, suicidal ideation, or loss of consciousness, call 911 immediately or go to the nearest emergency room.

Dr Telx does not provide crisis intervention, trauma care, or any service requiring immediate, in-person evaluation.

3. NATURE, SCOPE, AND LIMITATIONS OF TELEHEALTH

Telehealth is the delivery of healthcare services via secure digital means (video, phone, text, or asynchronous messaging). You acknowledge and accept that:

No physical examination will occur; evaluations are based entirely on the information and visual data you provide
Diagnostic accuracy may be limited by the absence of tactile feedback, imaging, lab testing, or physical presence
You may receive clinical advice, prescriptions, or referrals based on your symptoms and disclosed history
Telehealth is not a substitute for routine primary care, preventive care, or long-term management of chronic diseases

Providers may recommend in-person follow-up or referral at any time. You agree to seek in-person medical attention when directed or when symptoms warrant.

4. PROVIDER DISCRETION & RIGHT TO DECLINE

Licensed providers affiliated with Dr Telx retain complete professional autonomy in determining whether telehealth is clinically appropriate for your condition. They may:

Decline to treat you
Recommend in-person care instead
Refuse to prescribe medication or renew prescriptions
Terminate the encounter without issuing a diagnosis

Submitting payment or intake forms does not guarantee diagnosis, treatment, or prescription issuance.

5. YOUR LEGAL RESPONSIBILITIES

By using this platform, you affirm that you:

Are truthfully representing your identity, age, medical history, symptoms, and current medications
Will not use multiple accounts to circumvent clinical or administrative recommendations
Have reviewed and understand this Consent and the linked Terms of Use, Privacy Policy, and HIPAA Notice
Will respond in a timely manner to all provider communications via email, SMS, and the secure portal

You acknowledge that omissions or inaccuracies may lead to medical errors or adverse outcomes, for which Dr Telx and its providers are not responsible.

6. RISKS AND WARNINGS ASSOCIATED WITH TELEHEALTH

By proceeding, you acknowledge the inherent limitations and risks of remote care, including but not limited to:

Misdiagnosis or delayed diagnosis due to incomplete or unclear information
Inability to identify certain conditions that require physical examination or imaging
Medication interactions or adverse reactions due to incomplete disclosure of your medical history
State-specific care restrictions, which may affect treatment eligibility
Delays in care due to technological issues, scheduling delays, or administrative complications

You agree that telehealth carries risks, and you accept these risks voluntarily.

7. TECHNOLOGY REQUIREMENTS AND LIMITATIONS

You are solely responsible for ensuring that you have:

A working phone, tablet, or computer
Secure, high-speed internet access
A private, quiet space free from interruptions
Up-to-date software to enable secure communication

Dr Telx is not responsible for any technical or hardware issues on your end that may interfere with your ability to receive care.

8. PAYMENT, FEES, AND REFUND POLICY

By proceeding, you understand and agree that:

All payments are final, non-refundable, and non-transferable, regardless of clinical outcome
Your payment covers the provider’s time, expertise, and evaluation — not a guaranteed diagnosis or prescription
Failure to respond to your provider, complete your intake, or follow-up in a timely manner does not qualify for a refund
If using insurance, you may still be responsible for co-pays, deductibles, or uncovered services

Any billing concerns should be addressed in writing to support@drtelx.com.

9. HIPAA PRIVACY NOTICE

Dr Telx complies with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Your Protected Health Information (PHI) will only be used or disclosed:

To provide care (treatment), coordinate payment, and support healthcare operations
When legally required (e.g., reporting abuse, threats, or communicable diseases)
When authorized by you in writing

You may review the full HIPAA Notice of Privacy Practices at: [Insert link to hosted PDF or web version].

10. EMAIL & SMS COMMUNICATION CONSENT

You authorize Dr Telx to contact you via unencrypted email and SMS, which may include:

Clinical instructions and care coordination
Appointment reminders and lab alerts
Medication updates and refill notices
Limited promotional messages about Dr Telx services

You understand these may contain sensitive medical data and do not meet HIPAA encryption standards. You may revoke this consent in writing, but it may impair the delivery of your care.

11. MEDICARE, MEDICAID, AND GOVERNMENT PAYOR CONSENT

If you are a Medicare or Medicaid beneficiary, you:

Consent to direct billing of your government insurance plan
Acknowledge that some services may not be covered under Medicare/Medicaid policies
Accept financial responsibility for non-covered services or charges
Agree to assignment of benefits to Dr Telx and/or the affiliated medical provider

12. THIRD-PARTY PAYORS AND ASSIGNMENT OF BENEFITS

If services are billed to an insurance plan, employer, or health benefits provider, you authorize:

Disclosure of your PHI for the purpose of verifying eligibility and submitting claims
Payment of benefits directly to the treating provider or affiliated practice
Responsibility for any unpaid balance, co-pay, or denied claim

You acknowledge that benefit verification does not guarantee coverage or payment.

13. MINORS AND DEPENDENTS

If the patient is under the age of 18 or otherwise legally incapable of consent:

This Consent must be completed by a parent, guardian, or legally authorized representative
The signing adult affirms they have legal authority to make healthcare decisions on behalf of the patient
All obligations, consents, and acknowledgments herein apply equally to the minor and the adult consenter

14. STATE LICENSURE RESTRICTIONS

Providers may only deliver care to patients who are physically located in states where they hold an active license. You agree not to:

Falsify your geographic location
Use VPNs or spoofing tools to circumvent geographic restrictions

Violation of this section may result in immediate termination of services and permanent account deactivation.

15. ACKNOWLEDGMENT OF UNDERSTANDING AND CONSENT

By proceeding with any Dr Telx services, you certify that:

You have read this entire document carefully and in full
You understand and accept the risks, limitations, and responsibilities outlined
You are legally authorized to consent to medical care for yourself or the named patient
You consent to receive telehealth services from providers affiliated with Dr Telx
You agree to comply with all clinical, technological, and legal terms stated herein

CONTACT INFORMATION

Dr Telx LLC
Email: support@drtelx.com
Website: https://drtelx.com
Mailing Address: 1030 N Center Pkwy, Kennewick, WA 99336