Patient Consent for Telehealth Services

1. Purpose of This Consent

This document provides you with important information about telehealth services offered through MedRelay. By checking the consent box during your consultation request or by using the Platform, you confirm that you have read, understood, and agree to the terms outlined below.

2. Nature of Telehealth Services

Telehealth involves the delivery of healthcare services through electronic communications, including asynchronous (questionnaire- based) and synchronous (video) consultations. Through MedRelay, you will be connected with a licensed Canadian nurse practitioner (NP) who will review your health information, assess your condition, and determine an appropriate treatment plan, which may include a prescription.

Your consultation may include the review of your medical history, symptoms, current medications, and allergies. The NP may ask follow-up questions through the Platform's secure messaging system.

3. Risks and Limitations of Virtual Care

I understand that telehealth has inherent limitations compared to in-person medical consultations, including but not limited to:

• The NP cannot perform a physical examination, which may limit the accuracy of the assessment;
• Technical difficulties (e.g., poor internet connection) may disrupt or delay the consultation;
• There is a risk that the information transmitted may be insufficient for appropriate medical decision-making;
• The NP may determine that the consultation is not appropriate for virtual care and recommend an in-person visit instead;
• Delays in evaluation and treatment may occur due to the asynchronous nature of some consultations;
• As with any healthcare service, there is a possibility of adverse reactions to prescribed medications.

4. Alternatives to Telehealth

I understand that I have the right to seek in-person care at any time. Alternatives to telehealth include visiting a family physician, walk-in clinic, nurse practitioner clinic, or hospital emergency department. I may choose to discontinue the telehealth consultation at any time and seek in-person care.

5. Right to Withdraw Consent

I understand that my consent is voluntary and that I may withdraw my consent at any time by contacting MedRelay at support@medrelay.ca. Withdrawing consent may affect the ability of the NP to provide or continue treatment. Withdrawal of consent does not affect the validity of any actions taken before the withdrawal.

6. Privacy and Confidentiality

I understand that my personal health information will be collected, used, and disclosed as described in MedRelay's Privacy Policy. This includes sharing my health information with:

• The nurse practitioner assigned to my consultation, for the purpose of providing clinical care;
• My designated pharmacy, for the purpose of filling any prescriptions;
• MedRelay's secure systems, for record-keeping and platform functionality.

All data is stored in Canada (AWS ca-central-1, Montreal) and handled in compliance with applicable federal and provincial privacy legislation, including PIPEDA, PHIPA, HIA, PIPA, HIPA, and PHIA.

7. Emergency Situations

I understand that MedRelay is NOT an emergency service. If I am experiencing a medical emergency, including but not limited to chest pain, difficulty breathing, severe bleeding, thoughts of suicide or self-harm, or any other life-threatening condition, I will:

• Call 911 or go to my nearest emergency department immediately;
• Contact a crisis line such as Talk Suicide Canada: 988 (call or text) if experiencing a mental health crisis;
• NOT rely on MedRelay for urgent or emergency care.

8. Consent to Share Information with Pharmacy

I consent to the transmission of my prescription and relevant health information to the pharmacy I designate during my consultation. This information will be transmitted by secure electronic fax or e-prescribing. I understand that the pharmacy is an independent entity and is subject to its own privacy policies and professional obligations.

9. Accuracy of Information

I confirm that all information I provide through the Platform, including my medical history, symptoms, current medications, and allergies, is accurate and complete to the best of my knowledge. I understand that providing inaccurate or incomplete information may result in inappropriate treatment and could put my health at risk.

10. Electronic Consent

By checking the consent checkbox during the consultation process or by submitting a consultation request on the Platform, I acknowledge that:

• I have read and understood this Informed Consent for Telehealth Services;
• I have had the opportunity to ask questions (by contacting support@medrelay.ca);
• I voluntarily consent to receive telehealth services through MedRelay;
• I consent to the collection, use, and disclosure of my personal health information as described;
• My electronic acceptance constitutes a valid signature under applicable Canadian law.

11. Contact Information

If you have any questions about this consent form, please contact us:

• Email: support@medrelay.ca
• Privacy: privacy@medrelay.ca
• Website: medrelay.ca