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Authorization to use and Disclose My Medical Information & Consent to Telehealth Services

OPEN PAYMENTS NOTICE

Last updated: April 29, 2025

AUTHORIZATION TO USE AND DISCLOSE MY MEDICAL INFORMATION AND CONSENT TO TELEHEALTH SERVICES
 
IMPORTANT: IF YOU ARE EXPERIENCING A LIFE-THREATENING EMERGENCY OR ARE IN CRISIS (E.G., SUICIDAL THOUGHTS), CALL 911 OR CONTACT THE 988 SUICIDE & CRISIS LIFELINE BY DIALING 988.
 
 
Acceptance of Terms
 
By clicking “I AGREE,” checking a related box, using any acceptance mechanism provided through the EONMeds platform, or otherwise affirmatively accepting this Consent, you acknowledge that you have read, understood, and agreed to be legally bound by this Authorization and Consent. If you do not agree, do not create an account or use the Service. You further grant agency authority to any party who clicks “I AGREE” or otherwise accepts these terms on your behalf.
 
 
Authorization to Use and Disclose My Medical Information
 
By accepting this Authorization, you authorize EONMeds, its affiliated healthcare providers, pharmacies, and contracted service partners (collectively, “Receiving Entities”) to use and disclose your personal health information (including Protected Health Information or “PHI”) for the following purposes:
 

  • To provide telehealth services, treatment, care coordination, prescription fulfillment, and follow-up support.

  • To send you information about your condition, medications, or relevant health-related services.

  • To facilitate your enrollment in support services or savings programs offered by pharmaceutical manufacturers, including copay assistance, coverage verification, reimbursement support, and educational or adherence programs.

  • To send you communications, promotions, or educational materials related to treatments or services you may be receiving or may qualify for.

  • To support necessary reporting requirements, forecasting models, pharmacy inventory planning, or 340B compliance, if applicable.

 
The recipients of this information may include:
 

  • Licensed medical providers and pharmacies involved in your care;

  • Service providers working on behalf of EONMeds or partner pharmaceutical programs;

  • Pharmaceutical manufacturers and their agents supporting treatment programs;

  • Your insurance plans, when required for billing or coverage support.

 
Sensitive Information
 You understand that your disclosed information may include sensitive health data such as mental health records, substance use history, reproductive health details, HIV status, genetic data, and other protected classifications. You acknowledge and authorize the disclosure of such information for the purposes outlined above.
 
 Remuneration Disclosure
You acknowledge that EONMeds or its partners may receive payment or other lawful compensation in connection with this Authorization or for communications sent to you under this agreement.
 
Right to Revoke
You may revoke this Authorization at any time by contacting privacy@eonmeds.com or submitting a written request. Revocation does not apply to information already disclosed or used in reliance on your prior authorization.
 
 Redisclosure Warning
You understand that once your medical information is shared with third parties as permitted under this Authorization, it may be redisclosed and may no longer be protected under certain privacy laws.
 
 No Obligation to Sign
You are not required to accept this Authorization in order to receive medical care or treatment from EONMeds. However, certain support services and communications may not be available if you choose not to authorize disclosure.
 
 Right to a Copy
You have the right to receive a copy of this Authorization for your records. Please contact us at privacy@eonmeds.com to request a copy.
 
 
Expiration
 
This Authorization will remain in effect for one year from the date of acceptance, or for the maximum period allowed under applicable state law, unless you revoke it earlier in writing.

INFORMED CONSENT REGARDING USE OF TELEHEALTH

Purpose
 
The purpose of this Informed Consent (“Consent”) is to provide you with clear information about telehealth services and to obtain your consent to receive healthcare and/or mental health care from licensed professionals (“Providers”) through the EONMeds telehealth platform, operated by Apollo Based Health, LLC and its affiliated entities (“EONMeds,” “we,” or “our”). This Consent applies to all users of our service, including adults and minors aged 13 to 17, where permitted by law. In the case of minors, this Consent must be acknowledged by a parent or legal guardian, and applies jointly to both the guardian and the minor.
 
 Use of Telehealth
 
Telehealth involves the use of secure technology—such as video, audio, electronic messaging, and digital records—to allow Providers and patients to interact while not physically present in the same location. These services may include diagnosis, treatment, monitoring, prescription fulfillment, and follow-up. They may also involve the transmission of medical images, personal health data, and communications between you and your Provider. Alternative options, including in-person care, may be available to you at any time. You should discuss all available options with your Provider.
 
 Anticipated Benefits
 
Benefits of telehealth may include more accessible, timely, and convenient care; improved continuity of treatment; reduced travel time; and the ability to obtain medical or mental health support from the comfort of your home. Participation in mental health services may help decrease anxiety or depression, improve coping skills, strengthen relationships, and support emotional well-being.
 
 Potential Risks
 
While telehealth provides many advantages, there are also potential risks, including but not limited to:
 

  • Incomplete or delayed diagnosis due to the inability to perform a physical exam or measure vital signs

  • Errors or limitations caused by software bugs, device failures, or service interruptions

  • Miscommunication due to lack of physical cues

  • Unauthorized access, data loss, or breach of medical records due to technology or network failures

  • Limitations in access to your full medical history, which may impact treatment accuracy

  • Mental health services, like therapy, may cause temporary emotional discomfort

  • Delays in care due to Provider unavailability or connectivity issues

 
 
Emergency and Crisis Situations
 
Do not use telehealth for emergencies. If you are in a life-threatening situation or in crisis, call 911 or the 988 Suicide & Crisis Lifeline. If you require immediate or urgent medical care, visit the nearest emergency room or urgent care facility. Telehealth may not be appropriate in every case, and Providers may not respond immediately to communications sent through the platform. If you experience technical failure, please call EONMeds Support at 1-800-368-0038 (Mon–Fri, 9 AM–5 PM ET).
 
 
Privacy and Security
 
We use industry-standard security protocols to protect your information, including encryption and secure storage. Your personal and health data will not be shared without your consent, except when required by law or for treatment, payment, or healthcare operations. This may include mandated reporting for abuse, risk of harm, or public health obligations. You understand that using email or other electronic tools to communicate with Providers may introduce additional privacy risks beyond our control, such as access by your email provider.
 
 
Laboratory Services
 
Some services may require at-home diagnostic testing provided by third-party laboratories. These tests may generate false positives or false negatives and may affect your Provider’s ability to accurately diagnose or treat your condition. EONMeds and its affiliates cannot guarantee the reliability or accuracy of these tests.
 
 
Open Payments Disclosure
 
For informational purposes, visit the Open Payments database from the Centers for Medicare & Medicaid Services (CMS) to review financial relationships between healthcare providers and manufacturers of drugs or medical devices, as required under the federal Sunshine Act.
 
 
Your Acknowledgments and Responsibilities
 
By accepting this Consent (by clicking “I Agree” or other affirmative action), you acknowledge and agree that:
 

  • You consent to receive telehealth services via the EONMeds platform from physicians, nurse practitioners, physician assistants, or mental health professionals.

  • You understand the limitations of telehealth, including those described above, and the potential need for in-person care.

  • You acknowledge that certain technologies used in delivering care may still be in development and may experience functionality issues.

  • You understand that diagnostic tests and services may carry inherent limitations and that results may not be definitive.

  • You understand there is no guarantee of diagnosis, cure, or outcome, and your condition may remain the same or worsen.

  • You are encouraged to ask questions and discuss all options, risks, and alternatives with your Provider.

  • You understand your Providers will not record any telehealth sessions, and you agree not to record them either.

  • You agree to provide accurate, complete, and honest health information, including disclosing any past or current treatment.

  • You agree to receive communications related to your care—including emails containing personal health information.

  • You agree that your Provider will determine, in their sole discretion, whether it is medically appropriate to diagnose or treat your condition via telehealth.

  • You may withdraw your consent to telehealth at any time, in writing, without loss of care. However, Providers using EONMeds do not offer in-person care.

  • Withdrawal of consent will apply going forward and does not affect services or communications already delivered.

  • You may choose to use a pharmacy outside of EONMeds’ partner network. You may request your prescription to be sent to the pharmacy of your choice.

  • You agree to pay all costs associated with services received via EONMeds and understand that these services are not eligible for reimbursement by Medicare or other public payors.

 
 
Provider and Pharmacy Disclosures
 
EONMeds may contract with or refer to partner pharmacies including, but not limited to: 1st Choice Pharmacy, Mycelium Pharmacy, Beaker Pharmacy, and others. You may be prescribed medication by a Provider employed by or affiliated with a contracted medical group. You are free to seek services from other healthcare providers or pharmacies if you choose.
 
 
State Licensing and Complaints
 
If you have a concern about the quality of care you received, you may file a complaint with the medical board in your state.
California Residents:
 

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