By proceeding with CMC Tele-MD (Telemedicine consultation), the patient understands and agrees to the following:

DATA AND INFORMATION DISCLOSURE

1. The Patient attests to the truthfulness, correctness and completeness of all information provided to his/her physician for the physician to provide the best medical care during the patient's use of telemedicine consultation.

2. The patient understands that the medical decisions or evaluations relayed by the physician and consultant(s) are solely based on the information and data provided by the patients and that the insufficiency of the information transmitted (e.g. poor resolution of images) may affect the appropriate medical decisions made by the physician and consultant(s).

3. The Patient understands that it is his/her duty to inform the physician of electronic interactions regarding his/her care that he/she may have with other healthcare providers.

DATA PRIVACY

4. The Patient understands that the laws that protect privacy and the confidentiality of medical information also apply to telemedicine, and that no information obtained in the use of telemedicine which identifies the patient will be disclosed to researchers or other entities without consent.

5. The Patient understands that he/she has the right to withhold or withdraw consent to the use of telemedicine in the course of care at any time, without affecting his/her right to future care or treatment.

6. The Patient agrees to pay the corresponding charges for telemedicine consultation prior to the actual telemedicine consultation.

7. The Patient understands that he/she has the right to inspect all information obtained and recorded in the course of a telemedicine interaction, and may receive copies of this information for a reasonable fee.

8. The patient understands that stable internet connection is required for an efficient telecommunication with his/her doctor.

9. The patient understands that security protocols of the Telemedicine platform (“Doxy.me”) could fail, causing a breach of privacy of personal medical information. Capitol Medical Center shall not be held liable for loss or damage due to technical failures of the server.

REFUND / CHANGE IN SCHEDULE

10. The Patient understands that refund of consultation fee is not allowed for any reason.

11. The Patient understands that the Doctor's availability is not guaranteed even if a confirmation of schedule for telemedicine consultation is provided by the Telemedicine Concierge.

12. The Patient understands that rescheduling is an option in case of refund of doctor's unavailability.

OTHER MATTERS

13. The Patient understands that telemedicine may involve electronic communication of personal medical information to medical practitioners who may be located in other areas, including areas out of the geographical region.

14. The Patient understands that a variety of alternative methods of medical care may be available to him/her, and may choose one or more of these at any time.

15. The Patient understands that he/she may expect the anticipated benefits from the use of telemedicine in his/her care, but that no results can be guaranteed or assured.

16. The patient understands that delays in medical evaluation and treatment could occur due to deficiencies or failures of the equipment.

17. The patient understands that lack of access to complete medical records may result in adverse drug interactions or allergic reactions or other judgment errors.

18. The patient agrees to share his/her personal and sensitive personal information to the staff of Capitol Medical Center to be used in all transactions related to Telemedicine.