Telehealth Informed Consent

TELEHEALTH INFORMED CONSENT, PATIENT RIGHTS, AND AUTHORIZATION
FOR TREATMENT

Kora Health, LLC
Effective Date: March 30, 2026
Last Updated: March 30, 2026

I. INTRODUCTION AND PURPOSE

This Telehealth Informed Consent, Patient Rights, and Authorization for Treatment (“Consent”) is a binding agreement between you (“Patient,” “you,” or “your”) and OpenLoop Healthcare Partners, PC and its affiliated entities (including but not limited to OpenLoop Healthcare Partners California, PC, OpenLoop Healthcare Partners Colorado, PC, OpenLoop Healthcare Partners New Jersey Professional Corporation, OpenLoop Healthcare Partners, Wisconsin, S.C., OpenLoop Healthcare Partners Puerto Rico, P.C., and Reliant MD Medical Associates PLLC) (collectively, the “Practice”). This Consent governs all healthcare services provided to you through telehealth technology and must be read carefully, in its entirety, before you receive any medical services.

By signing this Consent, you acknowledge that you have read, understand, and voluntarily agree to its terms, and that you have had the opportunity to ask questions and have those questions answered to your satisfaction before providing your signature.

II. IDENTIFICATION OF PARTIES AND THEIR RESPECTIVE ROLES

A. Medical Services Provider

All medical services described in this Consent, including but not limited to clinical evaluation, diagnosis, treatment planning, prescribing, and ongoing medical management, are provided exclusively by the Practice. The Practice is a physician-led professional medical entity that employs or contracts with physicians and other licensed healthcare providers who hold active, unrestricted licenses in the state where you are physically located at the time of your consultation. The Practice exercises sole and exclusive authority over all clinical decisions, including whether to prescribe any medication, which medication to prescribe, dosage, duration of treatment, and all aspects of your medical care.

B. Technology Platform

Kora Health, LLC (“Platform”) is a technology platform and administrative services provider. The Platform provides the website, digital infrastructure, scheduling technology, payment processing, and administrative coordination that facilitate your access to the Practice and its licensed providers. The Platform does not provide medical services, does not employ physicians or other licensed healthcare providers for the purpose of rendering clinical care, does not exercise any control over clinical decisions, and does not practice medicine in any jurisdiction. No act or statement by the Platform, its employees, or its representatives constitutes medical advice, a medical diagnosis, or a recommendation for treatment.

C. Pharmacy Services

If your treating provider determines that a prescription medication is clinically appropriate for you, that prescription may be transmitted to one or more licensed pharmacies, which may include but are not limited to RedRock Pharmacy, Health Warehouse, Precision Compounding Pharmacy, and Triad Rx (each, a “Pharmacy Partner”). Each Pharmacy Partner is an independently licensed pharmacy responsible for its own dispensing practices, compounding activities (if applicable), and regulatory compliance. Neither the Practice nor the Platform controls the operations of any Pharmacy Partner. Your relationship with a Pharmacy Partner is a separate relationship governed by applicable pharmacy law and the Pharmacy Partner’s own terms and policies.

D. How a Typical Telehealth Encounter Works

The following describes the general process for a telehealth encounter through the Platform. The specific steps may vary based on your clinical needs, your provider’s clinical judgment, and the requirements of the state where you are located.

Step 1: Health Assessment Questionnaire. You complete a health assessment questionnaire through the Platform. This questionnaire collects your medical history, current health conditions, medications, allergies, symptoms, weight management goals, and other information relevant to your clinical evaluation. The questionnaire is designed by the Practice and reviewed by licensed healthcare providers.

Step 2: Provider Review (Asynchronous). A licensed healthcare provider affiliated with the Practice reviews your completed questionnaire, health history, and any supporting documentation you have provided. The provider evaluates your responses against clinical criteria, contraindications, and applicable prescribing guidelines. This review may be conducted asynchronously (without a real-time interaction) in states where asynchronous prescribing is permitted under applicable telehealth law.

Step 3: Clinical Decision. Based on the provider’s review, one of the following outcomes will occur: (a) the provider approves a treatment plan and issues a prescription for medication, if clinically appropriate; (b) the provider requests additional information from you, including potentially a synchronous (live video or audio) consultation, before making a clinical decision; (c) the provider determines that treatment is not clinically appropriate for you and declines to issue a prescription, in which case you will be notified and any applicable refund will be processed; or (d) the provider refers you to in-person care for conditions that cannot be appropriately managed through telehealth.

Step 4: Prescription Fulfillment. If your provider issues a prescription, the prescription is transmitted electronically to one of the Practice’s affiliated Pharmacy Partners (RedRock Pharmacy, Health Warehouse, Precision Compounding Pharmacy, or Triad Rx). The Pharmacy Partner compounds (if applicable), dispenses, and ships the medication directly to you.

Step 5: Ongoing Monitoring and Follow-Up. Your provider monitors your treatment through the Platform. You may be contacted for follow-up assessments, dosage adjustments, or additional consultations. You are responsible for completing follow-up questionnaires and promptly reporting any side effects, adverse reactions, or changes in your health status.

E. The Provider-Patient Relationship

When the Relationship Begins. A provider-patient relationship is established between you and the licensed healthcare provider who conducts your clinical evaluation. This relationship is established at the time the provider reviews your health information and begins clinical assessment, whether the evaluation is conducted synchronously (live) or asynchronously (store-and-forward). The provider-patient relationship exists between you and the individual provider, through the Practice. No provider-patient relationship exists between you and the Platform.

Scope of the Relationship. The provider-patient relationship established through the Platform is limited to the specific telehealth services offered through the Platform. Your provider may not be available for questions, concerns, or clinical issues outside the scope of the Platform’s services. For medical issues outside the scope of the Platform, including emergency care, in-person examinations, laboratory testing, and conditions not addressed through the Platform, you should contact your primary care physician or local healthcare provider.

Continuity of Provider. The Practice will make reasonable efforts to maintain continuity of care by assigning the same provider to your follow-up consultations when possible. However, continuity of a specific individual provider is not guaranteed, and your care may be transferred to another qualified provider within the Practice at any time. All providers within the Practice have access to your medical records maintained through the Platform.

Termination of the Relationship. The provider-patient relationship may be terminated by you at any time by withdrawing consent as described in Section VII. The provider may also terminate the relationship if, in the provider’s clinical judgment, continued treatment is no longer appropriate, if you fail to comply with the treatment plan, if you provide false or misleading health information, or if continued treatment would not meet the applicable standard of care. In the event of termination, the provider will make reasonable efforts to provide a transition plan to prevent abrupt discontinuation of treatment.

III. NATURE OF TELEHEALTH SERVICES

A. Definition of Telehealth

Telehealth is the delivery of healthcare services through electronic communications, information technology, or other means between a healthcare provider and a patient who are not in the same physical location. As used in this Consent, telehealth encompasses synchronous communication (live, real-time audio and video interaction), asynchronous communication (store-and-forward transmission of medical information, including but not limited to health questionnaires, medical history forms, photographs, and messages), remote patient monitoring, and any other form of electronic clinical communication permitted under applicable law.

B. Services Available Through Telehealth

The Practice may provide, through telehealth technology, the following types of services: initial health assessments and medical history reviews; evaluation of your eligibility for weight management medications; prescribing of prescription medications, including but not limited to compounded medications, when clinically appropriate; ongoing monitoring of your treatment and health status; medication dosage adjustments; follow-up consultations; health education and counseling related to weight management; and referrals to in-person providers when clinically indicated. Not all medical conditions or patients are appropriate for telehealth evaluation or treatment, and your provider retains sole discretion to determine whether telehealth services are clinically appropriate for your specific circumstances.

C. Asynchronous Evaluation

You understand and agree that your initial evaluation and certain follow-up interactions may be conducted asynchronously, meaning that you will submit health information, medical history, and responses to clinical questionnaires through the Platform’s technology, and a licensed provider will review this information and render clinical decisions at a later time, without a simultaneous real-time interaction. You understand that the provider may, in the provider’s sole clinical judgment, determine that an asynchronous evaluation is insufficient for your care and may require a synchronous (live audio-video) consultation before proceeding with treatment. You further understand that certain state laws may require synchronous communication before prescribing certain medications, and the Practice will comply with all such requirements. If the state in which you are physically located at the time of your consultation legally requires a synchronous audio-video or telephone interaction to establish a provider-patient relationship or to prescribe medication, the Practice will require you to complete such an interaction prior to any prescribing decision or commencement of treatment.

IV. BENEFITS OF TELEHEALTH

Telehealth offers potential benefits including increased access to healthcare services, particularly for patients in areas with limited access to specialty providers; reduced travel time and associated costs; convenience of receiving care from your home, workplace, or other private location; and timely access to medical consultations. However, the Practice does not guarantee any specific clinical outcome from telehealth services, and the benefits described herein may not apply to all patients or all clinical situations.

V. RISKS AND LIMITATIONS OF TELEHEALTH

A. Technology-Related Risks

Telehealth services depend on technology, which may be subject to interruption, failure, or degradation. Potential technology-related risks include: delays in evaluation or treatment due to technology failures, internet connectivity issues, or equipment malfunctions; the possibility that information transmitted electronically may be insufficient to allow for appropriate medical decision-making; security risks associated with electronic transmission of personal health information, despite the implementation of reasonable security measures; and the possibility that a lack of access to your complete medical records may result in adverse drug interactions, allergic reactions, or other complications.

B. Clinical Limitations

Telehealth has inherent clinical limitations compared to in-person medical encounters. These limitations include: the inability of your provider to perform a hands-on physical examination; the possibility that certain physical findings, symptoms, or clinical conditions may not be detected or may be more difficult to assess through telehealth; the potential for misdiagnosis or failure to diagnose a condition that might have been identified during an in-person examination; limitations on the types and quantities of medications that may be prescribed through telehealth under applicable state and federal law; and the possibility that your clinical condition may require in-person evaluation, laboratory testing, or diagnostic imaging that cannot be performed through telehealth.

C. Privacy Risks

Despite reasonable efforts to protect your health information through encryption and other security measures, there is always a risk that electronic communications may be intercepted, accessed without authorization, or otherwise compromised. You accept this risk as a condition of receiving telehealth services.

D. Not a Substitute for Emergency Care

Telehealth services provided under this Consent are not intended to replace emergency medical services. If you experience a medical emergency, you should immediately call 911 or proceed to the nearest emergency department. The Practice does not provide emergency medical services through telehealth, and no provider will be available for emergency consultations. Symptoms that require emergency care include but are not limited to: chest pain, difficulty breathing, severe allergic reactions, signs of stroke, uncontrolled bleeding, loss of consciousness, or suicidal ideation.

VI. ALTERNATIVES TO TELEHEALTH

You have the right to receive healthcare services through in-person consultations with a healthcare provider in your local area as an alternative to telehealth. You may choose not to participate in telehealth services at any time, and this decision will not affect your right to seek healthcare through other means. You may also request a referral to an in-person provider at any time.

VII. RIGHT TO REFUSE OR WITHDRAW CONSENT

A. Voluntary Participation

Your participation in telehealth services is entirely voluntary. You have the right to refuse telehealth services at any time, before or during a consultation, without affecting your right to seek future care or any other legal right.

B. Withdrawal of Consent

You may withdraw this Consent at any time by providing written notice to the Practice at the contact information provided in this document. Withdrawal of consent will not affect the legality of any services provided prior to the date of withdrawal, and any prescriptions already transmitted to a pharmacy will remain subject to the pharmacy’s own dispensing policies and applicable law. You understand that withdrawal of consent may result in interruption of your treatment and that abrupt discontinuation of certain medications without medical supervision may pose health risks.

VIII. YOUR TREATING PROVIDER

A. Provider Assignment

The Practice will assign a licensed healthcare provider to evaluate your health information and render clinical decisions regarding your care. The provider assigned to you will hold an active, unrestricted license in the state where you are physically located at the time of your consultation. Your provider may be a physician (MD or DO), a nurse practitioner (NP or APRN), a physician assistant (PA), or another qualified healthcare professional authorized to practice medicine and prescribe medications under the laws of your state.

B. Provider Qualifications

You have the right to know the name, professional licensure, and qualifications of any provider who evaluates or treats you. This information will be made available to you before or at the time of your consultation through the Practice’s patient portal or upon request.

C. Provider Discretion

You understand and agree that all clinical decisions, including the decision to prescribe or not prescribe any medication, are made by your treating provider in the exercise of the provider’s independent clinical judgment. Neither the Platform nor any other party influences, directs, or controls the clinical decisions of your treating provider. Your provider may determine, in the provider’s sole discretion, that: you are not a candidate for the treatment you have requested; a different treatment is more appropriate for your clinical condition; additional information, testing, or in-person evaluation is required before a treatment decision can be made; or treatment should be discontinued or modified based on your clinical response or health status.

D. How to Verify Your Provider’s Credentials

You have the right to verify the credentials of any healthcare provider who evaluates or treats you through the Platform. To verify your provider:

State Medical Board Verification. You may verify your provider’s medical license, including license status, expiration date, and disciplinary history, through the medical licensing board in the state where your provider is licensed. A directory of all state medical boards is available at the Federation of State Medical Boards website (fsmb.org). You may also search for your provider through the National Practitioner Data Bank (npdb.hrsa.gov).

Request Through the Platform. You may request your provider’s name, professional designation (MD, DO, NP/APRN, PA), license number, and state of licensure by contacting the Platform at care@koramd.com or (855) 597-1248, or by contacting the Practice at patientsupport@openloophealth.com or (855) 597-1248. This information will be provided to you promptly upon request.

Patient Portal. Your provider’s name and professional designation are available through the patient portal (Tellescope) after your clinical evaluation is complete.

All providers delivering care through the Platform are credentialed by the Practice. The Practice’s credentialing process includes verification of licensure, education, training, board certification (where applicable), malpractice history, and disciplinary history.

IX. PRESCRIBING LIMITATIONS AND MEDICATION INFORMATION

A. No Guarantee of Prescription

You understand that completion of a health assessment, payment of any fee, or enrollment in any membership does not guarantee that you will receive a prescription for any medication. The decision to prescribe is a clinical decision made solely by your treating provider based on your individual health status, medical history, and clinical presentation.

B. Medication Types

If your provider determines that a prescription medication is appropriate, the medication prescribed may be an FDA-approved brand-name medication, an FDA-approved generic medication, or a compounded medication prepared by a licensed pharmacy in accordance with Section 503A or Section 503B of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. Section 353a or 21 U.S.C. Section 353b), as applicable. Compounded medications are not FDA-approved products; they are prepared by a licensed pharmacy based on an individual patient prescription. The FDA does not verify the safety or efficacy of compounded medications. You acknowledge and understand that compounded medications differ from commercially manufactured, FDA-approved medications and may carry risks that differ from or exceed the risks associated with FDA-approved medications, including risks related to variability in potency, purity, quality, sterility, and formulation. You have the right to request that your provider prescribe an FDA-approved medication instead of a compounded medication, and your provider will discuss the benefits, risks, and availability of FDA-approved alternatives with you. The specific medication prescribed will depend on your provider’s clinical judgment, your health status, medication availability, and other clinical and practical considerations.

C. Controlled Substances

The Practice does not prescribe controlled substances (as defined by the U.S. Drug Enforcement Administration under 21 U.S.C. Section 812) through the telehealth services described in this Consent.

D. Telehealth Prescribing Compliance

The Practice complies with all applicable federal and state laws governing the prescribing of medications through telehealth, including but not limited to the Ryan Haight Online Pharmacy Consumer Protection Act (21 U.S.C. Section 829(e)), applicable state telemedicine practice acts, and applicable state pharmacy laws. Certain states impose specific requirements or limitations on telehealth prescribing, and your provider will comply with all such requirements applicable to the state where you are physically located.

X. TECHNOLOGY REQUIREMENTS

To participate in telehealth services, you must have access to: a device capable of connecting to the internet (such as a computer, tablet, or smartphone); a reliable internet connection; and the ability to access the Platform’s website or patient portal. You are responsible for ensuring that your technology and internet connection are adequate for telehealth consultations. The Practice and the Platform are not responsible for technical failures on your end that prevent or interrupt telehealth services.

XI. PRIVACY AND CONFIDENTIALITY

A. Health Information Privacy

The Practice is subject to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) (42 U.S.C. Section 1320d et seq.) and its implementing regulations (45 C.F.R. Parts 160 and 164), as well as applicable state health information privacy laws. The Practice will use and disclose your protected health information in accordance with its Notice of Privacy Practices, which is available separately and incorporated herein by reference.

B. Platform Technology

The Platform implements reasonable administrative, physical, and technical safeguards to protect health information transmitted through its technology. However, you acknowledge that no electronic communication system is completely secure, and you accept the inherent risks of electronic communication as described in Section V of this Consent.

C. Recording

Your telehealth consultation may be recorded for quality assurance, treatment documentation, or compliance purposes. You will be notified if a consultation is being recorded, and your consent to recording will be obtained separately as required by applicable law.

D. Third-Party Access

You are responsible for ensuring the privacy of your surroundings during any telehealth consultation. The Practice and the Platform are not responsible for any third party who may overhear or view your consultation due to your failure to secure your environment.

XII. EMERGENCY PROTOCOLS

A. Location Disclosure

You agree to provide your current physical location (street address, city, state, and zip code) at the time of each telehealth consultation. This information is necessary for your provider to comply with state licensing requirements and to facilitate emergency services if needed.

B. Emergency Contact

You agree to provide the name and telephone number of an emergency contact who can be reached in the event of a medical emergency during or related to your telehealth services.

C. Emergency Procedures

If you experience a medical emergency at any time, including during a telehealth consultation, call 911 immediately. Do not rely on the telehealth platform or your provider for emergency services. If your provider determines during a consultation that you require emergency care, the provider will advise you to call 911 or proceed to the nearest emergency department and may, with your consent, contact emergency services on your behalf using the location information you have provided.

XIII. MEDICAL RECORDS

A. Creation and Maintenance

The Practice will create and maintain medical records of your telehealth consultations in accordance with applicable state and federal law. These records are the property of the Practice and will be maintained in accordance with applicable retention requirements.

B. Access to Records

You have the right to access and obtain copies of your medical records in accordance with applicable law, including HIPAA (45 C.F.R. Section 164.524). To request copies of your medical records, contact the Practice using the information provided below. The Practice may charge a reasonable fee for copies as permitted by applicable law.

C. Record Correction

You have the right to request amendment of your medical records if you believe the records contain inaccurate or incomplete information, in accordance with HIPAA (45 C.F.R. Section 164.526). The Practice will respond to such requests within the timeframes required by applicable law.

XIV. FEES AND FINANCIAL RESPONSIBILITY

A. Payment

You understand that the fees charged by the Platform cover access to the Platform’s technology, administrative coordination, and facilitation of your access to the Practice and its providers. Fees may also include the cost of medications if prescribed and dispensed. Payment of any fee does not guarantee that you will receive a prescription or any particular clinical outcome.

B. No Insurance Billing

The services described in this Consent are not billed to health insurance. You are responsible for all fees associated with your care.

C. Automatic Renewal

If you have enrolled in a subscription or membership plan, your plan will automatically renew in accordance with the terms and conditions presented to you at the time of enrollment. You may cancel your subscription at any time before the next renewal date by following the cancellation procedures described in the Platform’s terms and conditions.

D. Refund Policy

Refund eligibility is governed by the Platform’s terms and conditions, which are available separately and incorporated herein by reference.

XV. PATIENT RIGHTS

As a patient receiving telehealth services through the Practice, you have the following rights. These rights apply regardless of the state in which you are located and are in addition to any rights provided by the laws of your specific state.

A. Right to Privacy and Confidentiality

You have the right to have your personal health information kept confidential and to have that information used and disclosed only in accordance with applicable law, including HIPAA and applicable state privacy laws. You have the right to receive a copy of the Practice’s Notice of Privacy Practices, and you have the right to request restrictions on certain uses and disclosures of your health information.

B. Right to Informed Consent

You have the right to receive sufficient information about your condition, proposed treatment, potential risks and benefits, and available alternatives to make an informed decision about your care. You have the right to ask questions and receive clear, understandable answers before consenting to treatment.

C. Right to Refuse Treatment

You have the right to refuse any treatment, medication, or procedure recommended by your provider, even if your provider believes the treatment is in your best interest. You have the right to understand the potential consequences of refusing recommended treatment.

D. Right to Access Your Medical Records

You have the right to access, inspect, and obtain copies of your medical records, subject to applicable law and reasonable fees for copying.

E. Right to Know Your Provider’s Qualifications

You have the right to know the name, professional license type, license number, and state of licensure of any healthcare provider who evaluates or treats you. You have the right to verify your provider’s licensure through your state’s licensing board.

F. Right to File a Complaint

You have the right to file a complaint about your care, your provider, or any aspect of your experience without fear of retaliation or adverse effects on your treatment. Complaints may be directed to: the Practice, using the contact information provided in Section XVI of this Consent; the medical licensing board in the state where your provider is licensed (contact information for state medical boards is available at the Federation of State Medical Boards website, fsmb.org, or through your state government website); or the U.S. Department of Health and Human Services, Office for Civil Rights, for complaints related to privacy or discrimination (hhs.gov/ocr/complaints).

G. Right to Non-Discrimination

You have the right to receive care without discrimination on the basis of race, color, national origin, sex, age, disability, religion, sexual orientation, gender identity, or any other characteristic protected by applicable law, in accordance with Section 1557 of the Affordable Care Act (42 U.S.C. Section 18116) and applicable state and federal civil rights laws.

H. Right to Dignity and Respect

You have the right to be treated with courtesy, respect, and dignity throughout your care.

I. Right to a Second Opinion

You have the right to seek a second opinion from another healthcare provider at any time.

J. Right to Participate in Treatment Decisions

You have the right to be an active participant in decisions about your healthcare, including the right to discuss treatment options and to participate in the development of your treatment plan.

XVI. CONTACT INFORMATION

Practice (for clinical questions, medical records, and complaints):
OpenLoop Healthcare Partners, PC Privacy Officer: Katy Korman Phone: (844) 819-7956 Email: privacy@openloophealth.com Notice of Privacy Practices: https://openloophealth.com/notice-of-privacy-practices Patient Support: patientsupport@openloophealth.com, (855) 597-1248

Platform (for billing, membership, and administrative questions):
Kora Health, LLC 10503 Foundation Road, Austin, TX 78726 Phone: (855) 597-1248 Email: care@koramd.com Website: koramd.com

XVII. DURATION OF CONSENT

This Consent shall remain in effect for the duration of your relationship with the Practice, unless you withdraw your consent in writing as described in Section VII above. This Consent applies to all telehealth consultations, follow-up interactions, and related communications between you and the Practice facilitated through the Platform’s technology.

XVIII. ELECTRONIC SIGNATURE AND ACKNOWLEDGMENT

By clicking “I Agree,” “Submit,” or otherwise affirmatively consenting to this document through the Platform, you acknowledge and agree to the following:

(a) You have read this Telehealth Informed Consent, Patient Rights, and Authorization for Treatment in its entirety.

(b) You understand the nature of telehealth services, including their benefits, risks, and limitations, as described in Sections III through V of this Consent.

(c) You understand that you have the right to refuse telehealth services at any time.

(d) You have had the opportunity to ask questions about this Consent and the telehealth services to be provided, and any questions you have asked have been answered to your satisfaction.

(e) You voluntarily consent to receive telehealth services from the Practice under the terms described in this Consent.

(f) You agree that your electronic signature, whether provided by clicking a button, checking a box, or typing your name, constitutes your legal signature and is the legal equivalent of your handwritten signature for all purposes, in accordance with the Electronic Signatures in Global and National Commerce Act (15 U.S.C. Section 7001 et seq.) and applicable state electronic signature laws.

(g) You consent to the use of electronic records and electronic signatures for all transactions and communications contemplated by this Consent.

(h) You understand that a copy of this signed Consent will be available to you through your account on the Platform and that you may request a paper copy at any time by contacting the Practice or the Platform using the contact information in Section XVI.