Telehealth Informed Consent

1. Purpose of This Consent

This Telehealth Informed Consent explains the nature, benefits, risks, and limitations of receiving care via telehealth from Regulated with Loreta / The Regulated Nurse (“we,” “us”), provided by Loreta Labode, RN, under the physician supervision of Jean-Carlos Jimenez, MD.

By booking or attending a telehealth visit, signing intake forms that incorporate this consent, or otherwise indicating agreement, you acknowledge that you have read and understand this information and consent to telehealth services as described. Counsel may require a signed acknowledgment in the EHR (Optimantra) in addition to this Site page.

2. What Telehealth Means

Telehealth is the delivery of healthcare services using electronic communications, information technology, or other means between a provider in one location and a patient in another. Visits may occur by secure video, telephone, or other modalities we approve.

Telehealth may be used for consultations, follow-ups, education, review of labs and history, and care planning within our functional medicine practice model. It is not the same as an in-person physical examination in all respects; some conditions require in-person evaluation, imaging, or emergency care that we cannot provide remotely.

3. Who Provides Care

Clinical services are provided by Loreta Labode, RN, practicing under the supervision of Jean-Carlos Jimenez, MD. Care is delivered within applicable scope of practice, licensure, and supervisory rules. You may request information about credentials and the supervisory arrangement.

Contact: Loreta@regulatedwithloreta.com · 718-635-0514

4. Where You Must Be Located

You must be physically located in a state where we are authorized to provide care at the time of the visit. As of the effective date, New York is actively served; New Jersey may be reactivating; additional states may be added. We may verify your location and refuse or end a visit if you are outside our authorized jurisdictions.

You agree to disclose your actual physical location at each visit and not to misrepresent it.

5. Benefits, Risks & Limitations

6. Emergencies — Read Carefully

TELEHEALTH IS NOT FOR MEDICAL EMERGENCIES. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room immediately. Do not wait for a telehealth visit or email response.

Examples of emergencies include (without limitation) chest pain, difficulty breathing, severe allergic reaction, uncontrolled bleeding, suicidal thoughts with intent/plan, stroke symptoms, or sudden severe neurologic changes.

If a crisis arises during a telehealth visit, we may direct you to local emergency services and, where appropriate, contact emergency responders. Provide a reliable phone number and your physical address/location for each visit so emergency services can be guided if needed.

After-hours clinical coverage, if any, will be described in your patient materials. Website forms and general email are not monitored as emergency lines.

7. Privacy, Confidentiality & Technology

We use reasonable safeguards and HIPAA-aligned practices for clinical communications and records, including our EHR (Optimantra) and other vendors under appropriate agreements where required. Our Privacy Policy and HIPAA Notice of Privacy Practices (when published) describe how health information is used and disclosed.

You understand that telehealth involves electronic transmission of personal and health information. Absolute security cannot be guaranteed. You agree to participate from a reasonably private location, use a secure personal device/network when possible, and not record the visit without our prior consent (and any required consent of others on the call).

We may use email or messaging for non-urgent administrative or clinical follow-up. Unencrypted email has risks; ask us about preferred secure channels for sensitive information.

8. Labs, Supplements & Third Parties

Labs may be ordered through partners such as Quest, LabCorp, and Rupa Health. Supplements may be recommended and fulfilled through Fullscript or similar pharmacies/dispensaries. Those companies have their own privacy practices and terms. Results and fulfillment timelines are not fully within our control.

Recommendations are individualized; they are not a guarantee of outcome. Follow label directions and notify us of adverse reactions. Seek emergency care for severe reactions.

9. Voluntary Participation & Alternatives

Telehealth is voluntary. You may refuse telehealth or withdraw consent at any time without affecting your right to seek future care elsewhere, though we may be unable to continue as your remote provider if telehealth is declined and in-person care is not offered by this practice.

Alternatives include in-person care with another provider or traditional primary/specialty care in your community. We can discuss whether telehealth is appropriate for your situation.

10. Your Responsibilities

• Provide complete and accurate health history, medications, allergies, and location information
• Ensure your device, camera/microphone, and internet connection are adequate for the visit
• Be available at the scheduled time and cancel with at least 48 hours’ notice when possible (late cancel/no-show fees may apply per our Terms)
• Follow agreed care plans, lab instructions, and safety guidance, or tell us if you cannot
• Maintain another source of emergency and primary care as appropriate for your needs

11. Billing

This is a cash-pay practice. Telehealth visits and packages are charged as described at booking and in our Terms of Service. Insurance is generally not billed. You are responsible for payment and for any third-party lab or supplement costs.

12. Acknowledgment & Consent

By proceeding with telehealth services, you confirm that:

• You have read and understand this Telehealth Informed Consent
• You have had the opportunity to ask questions (contact Loreta@regulatedwithloreta.com or 718-635-0514)
• You consent to evaluation and treatment via telehealth by Loreta Labode, RN, under physician supervision as described
• You understand the risks, benefits, limitations, and emergency instructions
• You understand that Site educational content alone does not create a provider–patient relationship; that relationship begins when care is formally established through our clinical process

13. Questions

Questions about this consent: Loreta@regulatedwithloreta.com · 718-635-0514

This page is provided for transparency and pre-visit education. You may also be asked to acknowledge telehealth consent in our patient intake system (Optimantra) before care begins.