CopilotIQ Medical Group Telehealth Informed Consent

Telehealth involves the use of secure electronic communications, information technology, or other means to enable a healthcare provider and a patient at different locations to communicate and share individual patient health information for the purpose of rendering clinical care.  This “Telehealth Informed Consent” informs the patient (“patient,” “you,” or “your”) concerning the treatment methods, risks, and limitations of using a telehealth platform.  

Services Provided:

Telehealth services offered by CopilotIQ Medical, P.A., CopilotIQ P.C., Provide Locums Healthcare Providers LLC (“CopilotIQ Medical Group”), and the CopilotIQ Medical Group’s engaged providers (our “Providers” or your “Provider”) may include a patient consultation, diagnosis, treatment recommendation, prescription, and/or a referral to in-person care, as determined clinically appropriate (the “Services”).  

CopilotIQ, Inc. does not provide the Services; it performs administrative, payment, and other supportive activities for CopilotIQ Medical Group and our Providers.

Electronic Transmissions:

The types of electronic transmissions that may occur using the telehealth platform include, but are not limited to:

• Appointment scheduling; 
• Completion, exchange, and review of medical intake forms and other clinically relevant information (for example: health records; images; output data from medical devices; sound and video files; diagnostic and/or lab test results) between you and your Provider via: 
  • asynchronous communications; 
  • two-way interactive audio in combination with store-and-forward communications; and/or 
  • two-way interactive audio and video interaction;
• Treatment recommendations by your Provider based upon such review and exchange of clinical information;
• Delivery of a consultation report with a diagnosis, treatment and/or prescription recommendations, as deemed clinically relevant; 
• Prescription refill reminders (if applicable); and/or 
• Other electronic transmissions for the purpose of rendering clinical care to you.

Expected Benefits:

• Improved access to care by enabling you to remain in your preferred location while your Provider consults with you.  Our telehealth services are available 8AM-5PM CST hours a day, 5 days a week.
• Convenient access to follow-up care.  If you need to receive non-emergent follow-up care related to your treatment, please contact your Provider by asking your dedicated nurse to schedule an appointment on your behalf, or by contacting your Provider directly through the patient app.  
• More efficient care evaluation and management. Your results are analyzed by our system and any anomalies are automatically escalated to your nurse or a Provider as appropriate. We strive to respond to patients that reach out within the same business day, and have after hours support on the weekends and holidays for critical issues.  

Service Limitations: 

• The primary difference between telehealth and direct in-person service delivery is the inability to have direct, physical contact with the patient. Accordingly, some clinical needs may not be appropriate for a telehealth visit and your Provider will make that determination.
• OUR PROVIDERS DO NOT ADDRESS MEDICAL EMERGENCIES. IF YOU BELIEVE YOU ARE EXPERIENCING A MEDICAL EMERGENCY, YOU SHOULD DIAL 9-1-1 AND/OR GO TO THE NEAREST EMERGENCY ROOM.  PLEASE DO NOT ATTEMPT TO CONTACT COPILOTIQ, INC., GROUP, OR YOUR PROVIDER.  AFTER RECEIVING EMERGENCY HEALTHCARE TREATMENT, YOU SHOULD VISIT YOUR LOCAL PRIMARY CARE PROVIDER.
• Our Providers are an addition to, and not a replacement for, your local primary care provider.  Responsibility for your overall medical care should remain with your local primary care provider, if you have one, and we strongly encourage you to locate one if you do not.
• CopilotIQ Medical Group does not have any in-person clinic locations. 

Security Measures:

The electronic communication systems we use will incorporate network and software security protocols to protect the confidentiality of patient identification and imaging data and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption.  All the Services delivered to the patient through telehealth will be delivered over a secure connection that complies with the requirements of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). 

Possible Risks: 

• Delays in evaluation and treatment could occur due to deficiencies or failures of the equipment and technologies, or provider availability.
• In the event of an inability to communicate as a result of a technological or equipment failure, please contact the CopilotIQ Medical Group at 615-412-8777 or support@copilotiq.com. 
• In rare events, your Provider may determine that the transmitted information is of inadequate quality, thus necessitating a rescheduled telehealth consult or an in-person meeting with your local primary care doctor.
• In very rare events, security protocols could fail, causing a breach of privacy of personal medical information.

Patient Acknowledgments:

I further acknowledge and understand the following:

1. Prior to the telehealth visit, I have elected to be assigned to the next available provider from CopilotIQ Medical Group, and have been given my Provider’s credentials.
2. If I am experiencing a medical emergency, I will be directed to dial 9-1-1 immediately and my Provider is not able to connect me directly to any local emergency services.
3. I may elect to seek services from a medical group with in-person clinics as an alternative to receiving telehealth services.
4. I have the right to withhold or withdraw my consent to the use of telehealth in the course of my care at any time without affecting my right to future care or treatment.
5. Federal and state law requires health care providers to protect the privacy and the security of health information.  I am entitled to all confidentiality protections under applicable federal and state laws.  I understand all medical reports resulting from the telehealth visit are part of my medical record.  
6. CopilotIQ Medical Group will take steps to make sure that my health information is not seen by anyone who should not see it. Telehealth may involve electronic communication of my personal health information to other health practitioners who may be located in other areas, including out of state. I consent to CopilotIQ Medical Group using and disclosing my health information for purposes of my treatment (e.g., prescription information) and care coordination, to receive reimbursement for the services provided to me, and for CopilotIQ Medical Group’s health care operations.
7. Dissemination of any patient-identifiable images or information from the telehealth visit to researchers or other educational entities will not occur without my consent unless authorized by state or federal law.
8. There is a risk of technical failures during the telehealth visit beyond the control of CopilotIQ Medical Group.  
9. In choosing to participate in a telehealth visit, I understand that some parts of the Services involving tests (e.g., labs or bloodwork) may be conducted at another location such as a testing facility, at the direction of my Provider.
10. Persons may be present during the telehealth visit other than my Provider who will be participating in, observing, or listening to my consultation with my Provider (e.g., in order to operate the telehealth technologies). If another person is present during the telehealth visit, I will be informed of the individual’s presence and his/her role.
11. My Provider will explain my diagnosis and its evidentiary basis, and the risks and benefits of various treatment options.  
12. I understand that by creating a treatment plan for me, my Provider has reviewed my medical history and clinical information and, in my Provider’s professional assessment, has made the determination that the provider is able to meet the same standard of care as if the health care services were provided in-person when using the selected telehealth technologies, including but not limited to, asynchronous store-and-forward technology.
13. I have the right to request a copy of my medical records.  I can request to obtain or send a copy of my medical records to my primary care or other designated health care provider by contacting CopilotIQ Medical Group at: www.AthenaHealth.com  A copy will be provided to me at reasonable cost of preparation, shipping and delivery.  
14. It is necessary to provide my Provider a complete, accurate, and current medical history.  I understand that I can log into my “Portal” at htts://www.athenahealth.com/patient-login at any time to access, amend, or review my health information.
15. There is no guarantee that I will be issued a prescription and that the decision of whether a prescription is appropriate will be made in the professional judgement of my Provider.  If my Provider issues a prescription, I have the right to select the pharmacy of my choice.
16. There is no guarantee that I will be treated by a CopilotIQ Medical Group provider. My Provider reserves the right to deny care for potential misuse of the Services or for any other reason if, in the professional judgment of my Provider, the provision of the Services is not medically or ethically appropriate.  
17. CopilotIQ records all consultations on the CopilotIQ software platform. We use these recordings for purposes of quality, training, and platform improvement purposes. Our uses of your Personal Information complies with our Privacy Policy and Notice of Privacy Practices.

Additional State-Specific Consents: The following consents apply to patients accessing CopilotIQ Medical Group’s website for the purposes of participating in a telehealth consultation as required by the states listed below:

Alaska: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.

Iowa: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.

Idaho:  I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.

Indiana:  I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.

Kentucky: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.

Maine:  I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here; Or, the Maine Board of Osteopathic Licensure’s website, here.

Oklahoma: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here; Or, the Oklahoma Board of Osteopathic Examiners’ website, here.

Oregon: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.

Rhode Island:  I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here.

Texas: I have been informed of the following notice:

NOTICE CONCERNING COMPLAINTS -Complaints about physicians, as well as other licensees and registrants of the Texas Medical Board, including physician assistants, acupuncturists, and surgical assistants may be reported for investigation at the following address: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018, Assistance in filing a complaint is available by calling the following telephone number: 1-800-201-9353, For more information, please visit our website at www.tmb.state.tx.us.  

AVISO SOBRE LAS QUEJAS- Las quejas sobre médicos, asi como sobre otros profesionales acreditados e inscritos del Consejo Médico de Tejas, incluyendo asistentes de médicos, practicantes de acupuntura y asistentes de cirugia, se pueden presentar en la siguiente dirección para ser investigadas: Texas Medical Board, Attention: Investigations, 333 Guadalupe, Tower 3, Suite 610, P.O. Box 2018, MC-263, Austin, Texas 78768-2018, Si necesita ayuda para presentar una queja, llame al: 1-800-201-9353, Para obtener más información, visite nuestro sitio web en www.tmb.state.tx.us   

Vermont: I have been informed that if I want to register a formal complaint about a provider, I should visit the medical board’s website, here; Or, the Vermont Board of Osteopathic Examiners’ website, here. 

CopilotIQ Terms of Use

IF THIS IS A MEDICAL EMERGENCY OR CRISIS SITUATION, DIAL 9-1-1 IMMEDIATELY

Carefully read these terms and conditions of use (“Terms of Use”) as they govern your access to and use of CopilotIQ, Inc.’s (“CopilotIQ,” “we,” “us,” and “our”) Platform. Your acceptance of, and compliance with, these Terms of Use is a condition to your use of the following:

• copilotiq.com (our “Website”);
• CopilotIQ (our “App”);
• The CopilotIQ compatible devices (our “Devices”);
• Any products (“Products”) available for purchase through our Website and App; and
• The services (“Services”) made available through our Website, App, and Devices.

The non-medical business support services, our Website, App, and Devices are collectively referred to as our “Platform.”

CopilotIQ contracts with CopilotIQ Medical, P.A., and CopilotIQ P.C. (“Medical Group”), which are independent medical groups with a network of United States based health care providers (each, a “Provider”) to provide online telehealth clinical consultations, services, and/or treatment. The professional medical services provided by Medical Group through the use of our Platform are collectively referred to in this Terms of Use as the “Services.”

By clicking “Accept,” you acknowledge that you have read in its entirety, understand, and fully accept all terms and conditions contained in these Terms of Use, our Privacy Policy, and the Notice of Privacy Practices provided to you by Medical Group. If you do not agree to be bound by these Terms of Use and our Privacy Policy, you are not authorized to access or use our Platform and/or the Services; PROMPTLY EXIT THIS WEBSITE.

Binding Arbitration. These Terms of Use provide that all disputes between you and CopilotIQ that in any way relate to these Terms of Use, the Platform, and/or the Services will be resolved by BINDING ARBITRATION. ACCORDINGLY, YOU AGREE TO GIVE UP YOUR RIGHT TO GO TO COURT (INCLUDING IN A CLASS ACTION PROCEEDING) to assert or defend your rights under these Terms of Use. Your rights will be determined by a NEUTRAL ARBITRATOR and NOT a judge or jury and your claims cannot be brought as a class action. Please review Dispute Resolution; Arbitration Agreement for the details regarding your agreement to arbitrate any disputes with CopilotIQ.

1. Services Provided – No Medical Care or Advice

CopilotIQ is not a medical group and does not provide medical advice, care, and/or treatment. CopilotIQ provides administrative and management services to independent, physician-owned and operated, medical practices. Any telemedicine consults obtained through our Platform are provided by Providers, including but not limited to Medical Group. CopilotIQ licenses the “CopilotIQ” brand name to Medical Group and other affiliated medical practices that use our Platform to assist in the provision of Services. Each CopilotIQ-branded practice is owned and operated by a licensed physician. There is no single provider of medical care called “CopilotIQ.” Each CopilotIQ-branded practice engages a network of United States based clinicians who provide clinical telehealth services. The Providers deliver clinical services via the Platform to their patients. CopilotIQ does not provide medical advice or care, own or operate the medical practices, employ or in any way supervise the clinicians providing medical care, and control over the care provided is the sole responsibility of the independent medical practices and the Providers they employ. Services and practices may vary across Providers, and patients should contact the Providers at Medical Group directly for all questions concerning their medical care.

2. Not For Emergencies

Our Platform and the Services are not for medical emergencies or urgent situations. You should not disregard or delay seeking medical advice based on anything that appears or does not appear on our Platform. If you believe you are experiencing an emergency, call 9-1-1 immediately.

You should seek emergency help or follow up care when recommended by a Provider or when otherwise needed. You should continue to consult with your primary provider and other healthcare professionals as recommended. Always seek the advice of a physician or other qualified healthcare provider concerning questions you have regarding a medical condition and before stopping, starting, or modifying any treatment.

3. Risk of Telehealth Services

By using the Services, you acknowledge the potential risks associated with telehealth services. These include but are not limited to the following: information transmitted may not be sufficient (e.g. poor resolution of images) to allow for appropriate medical or health care decision making by the Provider; delays in evaluation or treatment could occur due to failures of electronic equipment; a lack of access to your medical records may result in adverse drug interactions or allergic reactions or other judgment errors; although the electronic systems we use incorporate network and software security protocols to protect the privacy and security of health information, those protocols could fail causing a breach of privacy of your health information.

4. Privacy Practices

You agree that information provided by you in connection with the Platform and the Services shall be governed by the Privacy Policy, which is hereby incorporated and made part of these Terms of Use. You also agree that information provided by you in connection with the Services shall also be governed by the applicable Medical Group Notice of Privacy Practices, and is hereby incorporated and made part of these Terms of Use.

5. Prescription Policy

Certain products available through the Platform require a valid prescription by a licensed healthcare provider. You will not be able to obtain a prescription product unless you have completed a consultation with one of the Providers through the Platform, the Provider has determined the prescription product is appropriate for you, and the Provider has written a prescription.

If a Provider determines a prescription product is appropriate for you and writes a prescription, you may fill the prescription at any pharmacy of your choice as prompted during your use of the Services.

You agree that any prescriptions that you acquire from a Provider will be solely for your personal use. You agree to fully and carefully read all provided product information and labels and to contact a physician or pharmacist if you have any questions regarding the prescription. We fully honor patient freedom of choice and, if you receive a prescription for a medication, you always have the option to instruct your Provider to transmit that prescription to the pharmacy of your choice.

6. Not an Insurance Product

We are not an insurer, nor do we offer an insurance plan or product. The amounts you pay to us for any Services obtained through the Platform are not insurance premiums. If you desire any type of health or other insurance, you will need to purchase such insurance separately.

7. Ownership of the Platform

The Platform contains confidential and proprietary information, materials, data, databases, contents, processes, methodologies, know-how, software, text, displays, images, video, audio, trademarks, logos, service marks, features and functionality, and the design, selection and arrangement thereof, are owned by CopilotIQ, its licensors or other providers of such material and are protected by United States and international copyright, trademark, patent, trade dress, trade secret and other intellectual property or proprietary rights laws (collectively, the “Content”).

These Terms of Use permit you to use the Platform for your personal, non-commercial use only. You must not reproduce, distribute, modify, create derivative works of, publicly display, publicly perform, republish, download, store or transmit any of the material on our Platform, including but not limited to Content, except: (a) your computer may temporarily store copies of such materials in RAM incidental to your accessing and viewing those materials; (b) you may store files that are automatically cached by your Web browser for display enhancement purposes; and (c) you may print or download one copy of a reasonable number of pages of the Platform for your own personal, non-commercial use and not for further reproduction, publication or distribution. You must not: (a) modify copies of any materials from the Platform or received through the Services; (b) use any illustrations, photographs, video or audio sequences or any graphics separately from the accompanying text; or (c) delete or alter any copyright, trademark or other proprietary rights notices from copies of materials from the Platform.

You may not frame or utilize framing techniques to enclose, or deep linking to, any name, trademarks, service marks, logo, content, or other proprietary information (including, without limitation, images, text, page layout, or form) of CopilotIQ without our express written consent.

You must not access or use any part of the Platform or any services or materials available through the Platform for outsourcing for others or as part of a service bureau business so otherwise for the benefit of unaffiliated third parties who pay directly for its benefit or for other similar commercial purposes, or otherwise exploited for any commercial purpose without express written consent of CopilotIQ.

If you print, copy, modify, download or otherwise use or provide any other person with access to any part of the Platform in breach of the Terms of Use, your right to use the Platform will cease immediately and you must, at our option, return or destroy any copies of the materials you have made. No right, title or interest in or to the Platform or any content on the Platform is transferred to you, and all rights not expressly granted are reserved by CopilotIQ. Any use of the Platform not expressly permitted by these Terms of Use is a breach of these Terms of Use and may violate copyright, trademark and other laws.

8. Availability of Services

CopilotIQ operates subject to state and federal regulations, and the Platform may not be available in your state. You represent that you are not a person barred from enrolling for or receiving the Platform under the laws of the United States or other applicable jurisdictions in which you may be located. Access to and use of the Platform is limited exclusively to users located in states within the United States where the Platform is available. Services are not available to users located outside the United States. Accessing the Platform from jurisdictions where content is illegal, or where we do not offer the Platform, is prohibited.

9. Access to Platform, Security, and Restrictions; Passwords

You are prohibited from violating or attempting to violate the security of the Platform, including, without limitation, (a) accessing data not intended for such user or logging onto a server or an account which the user is not authorized to access; or (b) attempting to probe, scan, or test the vulnerability of a system or network or to breach security or authentication measures without proper authorization; or (c) accessing or using the Platform or any portion thereof without authorization, in violation of these Terms of Use or in violation of applicable law.

You may not use any scraper, crawler, spider, robot or other automated means of any kind to access or copy data on the Platform, deep-link to any feature or content on the Platform, bypass our robot exclusion headers or other measures we may use to prevent or restrict access to the Platform.

Violations of system or network security may result in civil or criminal liability. CopilotIQ will investigate occurrences that may involve such violations and may involve, and cooperate with, law enforcement authorities in prosecuting users who are involved in such violations. You agree not to use any device, software, or routine to interfere or attempt to interfere with the proper working order or manner of the Platform or any activity being conducted on the Platform.

In the event access to the Platform or a portion thereof is limited requiring a user ID and password (“Protected Areas”), you agree to access Protected Areas using only your user ID and password as provided to you by us. You agree to protect the confidentiality of your user ID and password, and not to share or disclose your user ID or password to any third party. You agree that you are fully responsible for all activity occurring under your user ID. Your access to the Platform may be revoked by CopilotIQ at any time with or without cause. You agree to defend, indemnify, and hold CopilotIQ harmless from and against all third party claims, damages, and expenses (including reasonable attorneys’ fees) against or incurred by arising out of your breach of these Terms of Use or violation of applicable law, your use or access of the Platform, or access by anyone accessing the Platform using your user ID and password.

If you submit, upload, post, or transmit any health information, medical history, conditions, problems, symptoms, personal information, consent forms, agreements, requests, comments, ideas, suggestions, information, files, videos, images, or other materials to us or our Platform (“User Information”), you agree not to provide any User Information that (a) is false, inaccurate, defamatory, abusive, libelous, unlawful, obscene, threatening, harassing, fraudulent, pornographic, or harmful, or that could encourage criminal or unethical behavior, (b) violates or infringes the privacy, copyright, trademark, trade dress, trade secrets, or intellectual property rights of any person or entity, or (c) contains or transmits a virus or any other harmful component. You agree not to contact other Platform users through unsolicited e-mail, telephone calls, mailings, or any other method of communication. You represent and warrant to CopilotIQ and Medical Group that you have the legal right and authorization to provide all User Information to CopilotIQ and Medical Group for use as set forth herein and required by CopilotIQ and the Medical Group Provider.

CopilotIQ or Medical Group may de-identify your information such that it is no longer considered protected health information or personally identifiable information. CopilotIQ or Medical Group may disclose, aggregate, sell, or otherwise use such de-identified information to third parties for analytics, research, or other purposes.

10. No Users Under 18 Years Old

In order to access the Platform and the Services, you represent and warrant that you are 18 years old or older. If you are under the age of 18, please do not attempt to register with us on the Platform or provide any personal information about yourself to us. If we learn that we have collected personal information from someone under the age of 18, we will promptly delete that information. If you believe we have collected personal information from someone under the age of 18, please Contact Us.

11. Your Account

You agree to: (a) provide true, accurate, current, and complete information when registering to use the Platform and establishing your account (“Registration Information”) and (b) maintain and promptly update the Registration Information to keep it true, accurate, current, and complete. If you provide any information that is untrue, inaccurate, not current, or incomplete, or we have reasonable grounds to suspect that such information is untrue, inaccurate, not current, or incomplete, we may suspend or terminate your account. You are entirely responsible for maintaining the confidentiality of any passwords and any usage and activities that occur in connection with your account. You agree not to allow others to access your account or utilize your password. Doing so will compromise the security of your account.

12. Accuracy and Integrity of Information; Colors

Although we attempt to ensure the integrity and accuracy of the Platform, we makes no representations, warranties, or guarantees whatsoever as to the correctness or accuracy of the Platform and Content thereon. It is possible that the Platform could include typographical errors, inaccuracies, or other errors, and that unauthorized additions, deletions, and alterations could be made to the Platform by third parties. In the event that an inaccuracy arises, please inform us so that it can be corrected. We reserve the right to unilaterally correct any inaccuracies on the Platform without notice. Information contained on the Platform may be changed or updated without notice. Additionally, CopilotIQ shall have no responsibility or liability for information or

Content posted to the Platform from any unaffiliated third party.

We have made significant efforts to accurately display the colors of our products that appear on the Platform. However, as the actual colors you see will depend on your monitor, we cannot guarantee that your monitor’s display of any color will be accurate.

13. Typographical Errors and Incorrect Pricing

In the event a Product or Service is listed at an incorrect price due to typographical error or error in pricing information received from our suppliers or business partners, we shall have the right to refuse or cancel any orders placed for a Product or Service listed at the incorrect price. We shall have the right to refuse or cancel any such orders whether or not the order has been confirmed and your credit or debit card charged. If your credit or debit card has already been charged for the purchase and your order is canceled, we shall promptly issue a credit to your credit or debit card account in the amount of the incorrect price.

14. Notice and Procedure for Making Claims of Copyright Infringement

To file a notice of infringement with us, please provide the following information to the CopilotIQ designated copyright agent listed below:

1. A description of the copyrighted work or other intellectual property that you claim has been infringed.
2. A description of the material that you claim is infringing the copyrighted work listed in item #1.
3. An address, telephone number, and an email address where the alleged infringing party can contact you.
4. The following statement: “I have a good faith belief that use of the copyrighted materials described above as allegedly infringing is not authorized by the copyright owner, its agent, or the law.”
5. The following statement: “I swear, under penalty of perjury, that the information in the notification is accurate and that I am the copyright owner or am authorized to act on behalf of the owner of an exclusive right that is allegedly infringed.”
6. Your electronic or physical signature.

CopilotIQ has registered a designated agent with the Copyright Office pursuant to 17 U.S.C. 512(c). Please send notifications of infringement and counter notifications to the designated agent at:

Attn: Legal
CopilotIQ, Inc.
600 12th Ave S, Suite 1000
Nashville, TN 37203
Telephone: (615) 412-8777
Email: legal@copilotiq.com

15. Orders and Purchases

Online Payments

You can purchase products or pay for Services on the Platform. To simplify the user experience on the Platform, you are able to pay for your purchases via the Platform with CopilotIQ serving as payment processing agent on your behalf. If you elect to purchase a Service from Medical Group, then the total price you pay includes the amount charged by Medical Group for the Service. We collect the amounts charged by Medical Group on your behalf and pass through to them the payment for their actual charges. Before making a purchase, you will see an itemized invoice listing the actual charges by Medical Group for the Services.

Subscription Terms

If you purchase a subscription to our Platform and/or Services, your subscription is continuous and will be automatically renewed at the end of the applicable subscription period, unless you cancel your subscription before the end of the then-current subscription period by Contacting Us. If you cancel your subscription, your account will automatically close at the end of your current billing period. CopilotIQ may change the price for your Platform subscription, from time to time and will communicate any price changes to you in advance and, if applicable, how to accept those changes. Price changes will take effect at the start of the next subscription period following the date of the price change. Subject to applicable law, you accept the new price by continuing to use the Platform after the price change takes effect. If you do not agree with a price change, you have the right to reject the change by unsubscribing prior to the price change going into effect.

We accept credit and debit cards issued by U.S. banks. If a credit card account is being used for a transaction, we may obtain preapproval for an amount up to the amount of the payment. If you enroll to make recurring payments automatically, all charges and fees will be billed to the credit card you designate during the setup process. If you want to designate a different credit card or if there is a change in your credit card, you must change your information online. This may temporarily delay your ability to make online payments while we verify your new payment information.

You represent and warrant that if you are making online payments that (a) any credit card, debit card and bank account information you supply is true, correct, and complete, (b) charges incurred by you will be honored by your credit/debit card company or bank, (c) you will pay the charges incurred by you in the amounts posted, including, without limitation, any applicable taxes, and (d) you are the person in whose name the card was issued and you are authorized to make a purchase or other transaction with the relevant credit card and credit card information. If we are unable to secure funds from the payment method you provide for any reason, including insufficient funds in the payment method or insufficient or inaccurate information provided by you when submitting electronic payment, we may undertake further collection action, including application of fees to the extent permitted by law. You acknowledge and agree that you will not dispute the charges from CopilotIQ, Medical Group, or any third party payment processor with the payment method company, provided the transactions correspond to the terms indicated in these Terms of Use.

16. Order Acceptance

We reserve the right, at our sole discretion, to refuse or cancel any order for any reason. Your account may also be restricted or terminated for any reason, at our sole discretion. For your convenience, you will not be charged until your payment method is authorized, the order information is verified for accuracy and your order is shipped. Some situations that may result in your order being canceled include limitations on quantities available for purchase, inaccuracies or errors in product or pricing information, or problems identified by our credit and fraud avoidance department. We may also require additional verifications or information before accepting any order. We will contact you if all or any portion of your order is canceled or if additional information is required to accept your order. If your order is canceled after your credit card (or other payment account) has been charged, we will issue a credit to your credit card (or other applicable payment account) in the amount of the charge.

17. Return Policy

You may return Products purchased on the Platform in accordance with our Return Policy.

18. Links to Other Sites

We make no representations whatsoever about any other website that you may access through the Platform. When you access a non-CopilotIQ website, please understand that it is independent from us, and that we have no control over the content on that website. In addition, a link to a non-CopilotIQ website does not mean that we endorse or accept any responsibility for the content, or the use, of the linked website. It is up to you to take precautions to ensure that whatever you select for your use or download is free of such items as viruses, worms, Trojan horses, and other items of a destructive nature. If you decide to access any of the third-party websites linked to the Platform, you do this entirely at your own risk.

19. Consent to Receive Calls, Text Messages, and Audio and/or Video Recording

By providing your mobile number, you are agreeing to be contacted by or on behalf of CopilotIQ at the mobile number you have provided, including calls and text messages, to receive informational, product or service related (e.g., progress tracking, reminders, etc.) messages and communications relating to the Platform. Message and data rates may apply. To stop receiving text messages text a reply to us with the word STOP. We may confirm your opt out by text message. If you subscribe to multiple types of text messages from us, we may unsubscribe you from the service that most recently sent you a message or respond to your STOP message by texting you a request to identify services you wish to stop. Please note, that by withdrawing your consent, some of the functions provided by the Platform may no longer be available to you. Keep in mind that if you stop receiving text messages from us you may not receive important and helpful information and reminders about your services.

CopilotIQ or your Provider may record (audio and video) all or part of your interaction with us or them (“Recordings”). Such Recordings are used for quality assurance and training purposes, to better deliver to you the products and services, and to help us improve the Platform. We will keep such Recordings confidential, and we will not publicly display such recordings unless legally required to do so, such as if subject to a court order. By accessing and using our Platform, you agree and consent to such Recordings for the purposes and uses set forth in these Terms of Use and as otherwise set forth in the Privacy Policy.

20. CAN-SPAM Act and Telephone Consumer Protection Act Compliance

CopilotIQ, Medical Group, and your Provider are committed to being compliant with the Controlling the Assault of Non-Solicited Pornography and Marketing Act (“CAN-SPAM Act”) and the Telephone Consumer Protection Act (“TCPA”). You consent to receive text messages from us as set forth in the above section, Consent to Receive Calls, Text Messages, and Audio and/or Video Recording. E-mails, newsletters, and text messages received from us are intended to fully comply with the CAN-SPAM ACT and the TCPA. In the event you receive an e-mail or text message from us which you do not believe is fully compliant with the CAN-SPAM Act or the TCPA, please Contact Us.

21. Electronic Communications

When you use the Platform, or send e-mails, messages, and other communications from your desktop or mobile device to us, you are communicating with us electronically. You consent to receive communications from us electronically. You agree that (a) all agreements and consents can be signed electronically and (b) all notices, disclosures, and other communications that we provide to you electronically satisfy any legal requirement that such notices and other communications be in writing. CopilotIQ, Medical Group, and your Provider may contact you by telephone, mail, or e-mail to verify your information. CopilotIQ, Medical Group, and your Provider may request further information from you and you agree to provide such further information to ensure that you have not fraudulently used the Platform. If you do not provide this information in the manner requested within 14 days of the request, we reserve the right to suspend, discontinue, or deny your access to and use of our Platform until you provide the information to us as requested.

22. External Services

The Platform may enable access to CopilotIQ’s and/or third-party services and websites, including social media sites (collectively and individually, “External Services“). You agree to use the External Services at your sole risk. We are not responsible for examining or evaluating the content or accuracy of any third-party External Services, and shall not be liable for any such third-party External Services. Data displayed by the Platform or External Service, including but not limited to financial, medical, and location information, is for general informational purposes only and is not guaranteed by CopilotIQ or its agents. You will not use the External Services in any manner that is inconsistent with the terms of these Terms of Use or that infringes the intellectual property rights of CopilotIQ or any third party. You agree not to use the External Services to harass, abuse, stalk, threaten, or defame any person or entity, and that we are not responsible for any such use. External Services may not be available in all languages or in your Home Country, and may not be appropriate or available for use in any particular location. To the extent you choose to use such External Services, you are solely responsible for compliance with any applicable laws. We reserve the right to change, suspend, remove, disable or impose access restrictions or limits on any External Services at any time without notice or liability to you.

23. Supplemental Terms Applicable to Providers

These supplemental terms apply to Providers in addition to the other provisions of these Terms of Use. In the event of a conflict between the supplemental terms and any other terms herein, the supplemental terms shall prevail.

To be a healthcare provider using the Platform (for purposes of this Section, “Provider” or “you”), you must be a licensed physician, nurse practitioner, or healthcare professional contracted or employed by the Medical Group, and must agree to comply with all laws, medical board rules, and other rules and regulations applicable to you as a Provider or otherwise. Your relationship with the CopilotIQ users (including, but not limited to, your Medical Group patients) is directly between you and the patient. The patient will never have a physician-patient relationship with CopilotIQ. CopilotIQ does not practice medicine and offers no medical services. As set forth more fully below, Provider is solely responsible for all agreements, consents, notices, and other interactions with patients and other consumers. Without limiting the generality of the foregoing, Provider and CopilotIQ are each responsible for all billings and collections from patients and other consumers, and CopilotIQ shall have no liability whatsoever to Provider with respect to any amounts owed by any patient or other consumer to Provider.

We do not provide any medical advice, legal advice, or representations in any way regarding any legal or medical issues associated with Provider, goods, or services offered by Provider, including but not limited to any compliance obligations or steps necessary to comply with any state or federal laws and regulations. Provider should seek legal counsel regarding any legal and compliance issues and should not rely on any materials or content associated with the Platform in determining Provider’s compliance obligations under the law. Provider and CopilotIQ agree that CopilotIQ is not providing to customers, patients, or anyone else, medical advice, or legal advice. THE PLATFORM IS NOT MEANT TO SUBSTITUTE OR MODIFY YOUR PROFESSIONAL JUDGMENT IN ANY WAY.

Provider will use the Platform only in accordance with applicable standards of good medical practice. While software products such as the Platform can facilitate and improve the quality of service that Provider can offer patients, many factors, including but not limited to the provider/patient relationship, can affect a patient’s outcome, and with intricate and interdependent technologies and complex decision-making, it is often difficult or impossible to accurately determine what the factors were and in what proportion they affected an outcome. Provider will advise patients, when reasonably necessary, that Services provided through the Platform may not be a complete or adequate substitute for in-person assessments by the Provider. Provider shall be solely responsible for its use of the Platform and the provision of medical services to Provider’s patients. In this regard, Provider releases CopilotIQ and waives any and all potential claims against CopilotIQ as a result of Provider’s use of the Platform and the provision of Services to Provider’s patients.

As a result of the complexities and uncertainties inherent in the patient care process, Provider agrees to defend, indemnify, and hold CopilotIQ harmless from any claim by or on behalf of any patient of Provider, or by or on behalf of any other third party or person claiming damage by virtue of a familial or financial relationship with such a patient, which is brought against CopilotIQ, regardless of the cause if such claim arises for any reason whatsoever, out of Provider’s use or operation of the Platform. To the extent applicable, Provider will obtain CopilotIQ’s prior written consent to any settlement or judgment in which Provider agrees to any finding of fault of CopilotIQ or defect in the Platform. CopilotIQ will promptly notify Provider in writing of any claim subject to this indemnification, promptly provide Provider with the information reasonably required for the defense of the same, and grant to Provider exclusive control over its defense and settlement.

If you submit, upload, transmit, or post any consents, notices, advice, recommendations, comments, files, videos, images, or other materials to us or our Platform (“Provider Content”) or provide any Provider Content to patients or other consumers, you agree not to provide any Provider Content that (a) is defamatory, abusive, libelous, unlawful, obscene, threatening, harassing, fraudulent, pornographic, or harmful, or that could encourage criminal or unethical behavior, (b) violates or infringes the privacy, copyright, trademark, trade dress, trade secrets, or intellectual property rights of any person or entity, or (c) contains or transmits a virus or any other harmful component. Provider is solely responsible for obtaining all necessary agreements and consents from, and providing all required notices to, patients and other consumers. You agree not to contact other users through unsolicited e-mails, telephone calls, mailings, or any other method of communication. You represent and warrant to CopilotIQ that you have the legal right and authorization to upload all Provider Content to the Platform. CopilotIQ shall have a royalty-free, irrevocable, transferable right, and license to use the Provider Content however CopilotIQ desires, including without limitation, to copy, modify, delete in its entirety, adapt, publish, translate, create derivative works from or sell or distribute such Provider Content or incorporate such Provider Content into any form, medium, or technology throughout the world. CopilotIQ is and shall be under no obligation: (i) to maintain any Provider Content in confidence; (ii) to pay to you any compensation for any Provider Content; or (iii) to respond to any Provider Content.

CopilotIQ does not regularly review Provider Content, but does reserve the right (but not the obligation) to monitor and edit or remove any Provider Content submitted to the Platform. You grant CopilotIQ the right to use the name that you submit in connection with any Provider Content. You agree not to use a false e-mail address, impersonate any person or entity, or otherwise mislead as to the origin of any Provider Content. You are and shall remain solely responsible for the content of any Provider Content you post to the Platform or provide to patients or other consumers. CopilotIQ and its affiliates take no responsibility and assume no liability for any Provider Content submitted by you or any third party.

24. No Third Party Rights

Unless expressly stated in these Terms of Use, nothing herein is intended to confer any rights, obligations, duties, or remedies, on any person other than you, CopilotIQ, Medical Group, and their affiliates. Nothing in the Terms of Use is intended to relieve or discharge the obligation or liability of any third persons to you, CopilotIQ, Medical Group, and its affiliates, nor shall any provision give any third parties any right of subrogation or action over against you, CopilotIQ, Medical Group, and its affiliates. The Platform is only provided for your benefit and may not be relied on by any third party.

25. Dispute Resolution; Arbitration Agreement

We will try to work in good faith to resolve any issue you have with the Platform, including Products and Services ordered or purchased through the Platform, if you bring that issue to the attention of our customer service department. However, we realize that there may be rare cases where we may not be able to resolve an issue to a customer’s satisfaction.

You and CopilotIQ agree that any dispute, claim, or controversy arising out of or relating in any way to these Terms of Use or your use of the Platform, including Products and Services ordered or purchased through the Platform, shall be determined by binding arbitration instead of in courts of general jurisdiction. Arbitration is more informal than bringing a lawsuit in court. Arbitration uses a neutral arbitrator instead of a judge or jury, and is subject to very limited review by courts. Arbitration allows for more limited discovery than in court, however, we agree to cooperate with each other to agree to reasonable discovery in light of the issues involved and amount of the claim. Arbitrators can award the same damages and relief that a court can award, but in so doing, the arbitrator shall apply substantive law regarding damages as if the matter had been brought in court, including without limitation, the law on punitive damages as applied by the United States Supreme Court. You agree that, by agreeing to these Terms of Use, the U.S. Federal Arbitration Act governs the interpretation and enforcement of this provision, and that you and CopilotIQ are each waiving the right to a trial by jury or to participate in a class action. This arbitration provision shall survive termination of these Terms of Use and any other contractual relationship between you and CopilotIQ.

If you desire to assert a claim against CopilotIQ, and you therefore elect to seek arbitration, you must first send to CopilotIQ, by certified mail, a written notice of your claim (“Notice“). The Notice to CopilotIQ should be addressed to: CopilotIQ, Inc., Attn: LEGAL NOTICE, 600 12th Ave S, Suite 1000, Nashville, TN 37203 (“Notice Address“). If CopilotIQ desires to assert a claim against you and therefore elects to seek arbitration, it will send, by certified mail, a written Notice to the most recent address we have on file or otherwise in our records for you. A Notice, whether sent by you or by CopilotIQ, must (a) describe the nature and basis of the claim or dispute; and (b) set forth the specific relief sought (“Demand“). If CopilotIQ and you do not reach an agreement to resolve the claim within 30 days after the Notice is received, you or CopilotIQ may commence an arbitration proceeding or file a claim in small claims court. During the arbitration, the amount of any settlement offer made by CopilotIQ or you shall not be disclosed to the arbitrator. Any arbitration brought under this section shall be brought in accordance with the Arbitration Rules and Procedures of Judicial Arbitration and Mediation Services, Inc. (“JAMS”) then in effect, by one commercial arbitrator with substantial experience in resolving intellectual property and commercial contract disputes, who shall be selected from the appropriate list of JAMS arbitrators in accordance with the Arbitration Rules and Procedures of JAMS. The prevailing party in any arbitration or other proceeding arising under this Agreement shall be entitled to receive reimbursement of its reasonable expenses (including reasonable attorneys’ fees, expert witness fees and all other expenses) incurred in connection therewith. Judgment upon the award so rendered may be entered in a court having jurisdiction or application may be made to such court for judicial acceptance of any award and an order of enforcement, as the case may be. Notwithstanding the foregoing, each party shall have the right to institute an action in a court of proper jurisdiction for injunctive or other equitable relief pending a final decision by the arbitrator. You and CopilotIQ agree that any cause of action arising out of or related to the Products, Platform, Services or this Agreement must commence within one (1) year after the cause of action arose; otherwise, such cause of action is permanently barred. You understand that, in return for agreement to this provision, CopilotIQ is able to offer the Service at the terms designated, and that your assent to this provision is an indispensable consideration to this Agreement.

YOU AND COPILOTIQ AGREE THAT EACH MAY BRING CLAIMS AGAINST THE OTHER ONLY IN YOUR OR ITS INDIVIDUAL CAPACITY, AND NOT AS A PLAINTIFF OR CLASS MEMBER IN ANY PURPORTED CLASS OR REPRESENTATIVE PROCEEDING. Further, unless both you and CopilotIQ agree otherwise, the arbitrator may not consolidate more than one person’s claims with your claims, and may not otherwise preside over any form of a representative or class proceeding. The arbitrator may award declaratory or injunctive relief only in favor of the individual party seeking relief and only to the extent necessary to provide relief warranted by that party’s individual claim.

If this Agreement to Arbitrate provision is found to be unenforceable, then (a) the entirety of this arbitration provision shall be null and void, but the remaining provisions of these Terms of Use shall remain in full force and effect; and (b) exclusive jurisdiction and venue for any claims will be in state or federal courts located in and for Delaware. Both CopilotIQ and you agree to waive any and all rights to a jury trial in the event this agreement to arbitrate is found to be unenforceable.

26. Indemnification

You agree to defend, indemnify, and hold CopilotIQ and any affiliates harmless from and against any and all rights, demands, losses, liabilities, damages, claims, causes of action, actions, and suits (no matter whether at law or equity), fees, costs, and attorney’s fees of any kind whatsoever arising directly or indirectly out of or in connection with: (i) your use or misuse of the Platform, Products, Services, or any information posted on the Platform; (ii) your breach of the Terms of Use or Privacy Policy; (iii) the content or subject matter of any information you provide to CopilotIQ, Medical Group, your Provider, or a customer service agent; or (iv) any negligent or wrongful act or omission by you in your use or misuse of the Platform, Products, Services, or any information on the Platform, including without limitation, infringement of third party intellectual property rights, privacy rights, or negligent or wrongful conduct.

27.Disclaimer of Warranties

COPILOTIQ DOES NOT WARRANT THAT ACCESS TO OR USE OF THE PLATFORM WILL BE UNINTERRUPTED OR ERROR-FREE OR THAT DEFECTS IN THE PLATFORM WILL BE CORRECTED. THE PLATFORM, INCLUDING ANY CONTENT OR INFORMATION CONTAINED WITHIN IT OR ANY SERVICE RELATED TO THE PLATFORM, IS PROVIDED “AS IS,” WITH ALL FAULTS, WITH NO REPRESENTATIONS OR WARRANTIES OF ANY KIND, EITHER EXPRESSED OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, QUALITY OF INFORMATION, QUIET ENJOYMENT, AND TITLE/NON-INFRINGEMENT. COPILOTIQ DOES NOT WARRANT THE ACCURACY, COMPLETENESS, OR TIMELINESS OF THE INFORMATION OBTAINED THROUGH THE PLATFORM.

YOU ASSUME TOTAL RESPONSIBILITY AND RISK FOR YOUR USE OF THE PLATFORM, PLATFORM-RELATED SERVICES, SERVICES, AND LINKED WEBSITES. COPILOTIQ DOES NOT WARRANT THAT FILES AVAILABLE FOR DOWNLOAD WILL BE FREE OF VIRUSES, WORMS, TROJAN HORSES, OR OTHER DESTRUCTIVE PROGRAMMING. YOU ARE RESPONSIBLE FOR IMPLEMENTING PROCEDURES SUFFICIENT TO SATISFY YOUR NEEDS FOR DATA BACK UP AND SECURITY.

WARRANTIES RELATING TO PRODUCTS OR SERVICES OFFERED, SOLD, AND DISTRIBUTED BY COPILOTIQ ARE SUBJECT TO SEPARATE WARRANTY TERMS AND CONDITIONS, IF ANY, PROVIDED WITH OR IN CONNECTION WITH THE APPLICABLE PRODUCTS OR SERVICES.

28. Limitation of Liability Regarding Use of Platform and Services

COPILOTIQ AND ANY THIRD PARTIES MENTIONED ON THIS PLATFORM ARE NEITHER RESPONSIBLE NOR LIABLE FOR ANY DIRECT, INDIRECT, INCIDENTAL, CONSEQUENTIAL, SPECIAL, EXEMPLARY, PUNITIVE, OR OTHER DAMAGES WHATSOEVER (INCLUDING, WITHOUT LIMITATION, THOSE RESULTING FROM LOST PROFITS, LOST DATA, OR BUSINESS INTERRUPTION) ARISING OUT OF OR RELATING IN ANY WAY TO THE PLATFORM, PLATFORM-RELATED SERVICES, SERVICE, CONTENT, OR INFORMATION CONTAINED WITHIN THE PLATFORM, AND/OR ANY LINKED WEBSITE, WHETHER BASED ON WARRANTY, CONTRACT, TORT, OR ANY OTHER LEGAL THEORY AND WHETHER OR NOT ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. YOUR SOLE REMEDY FOR DISSATISFACTION WITH THE PLATFORM, PLATFORM-RELATED SERVICES, SERVICES, AND/OR LINKED WEBSITES IS TO STOP USING THE PLATFORM AND/OR THOSE SERVICES. TO THE EXTENT ANY ASPECTS OF THE FOREGOING LIMITATIONS OF LIABILITY ARE NOT ENFORCEABLE, THE MAXIMUM AGGREGATE LIABILITY OF COPILOTIQ TO YOU WITH RESPECT TO YOUR USE OF THE PLATFORM AND SERVICES IS $500 (FIVE HUNDRED DOLLARS).

29. Force Majeure

We will not be deemed to be in breach of these terms or liable or deemed to have defaulted for any breach of these Terms of Use or our Privacy Policy for any failure or delay in fulfilling or performing any term of these Terms of Use, when and to the extent such failure or delay is caused by or results from acts beyond our reasonable control, including, without limitation, the following force majeure events (“Force Majeure Event(s)”): (a) acts of God; (b) flood, fire, earthquake, explosion, pandemic, or epidemic; (c) war, invasion, hostilities (whether war is declared or not), terrorist threats or acts, riot or other civil unrest; (d) government order, law, or actions; (e) embargoes or blockades in effect on or after the date of this Agreement; (f) national or regional emergency; and (g) other events beyond the reasonable control of CopilotIQ. We will do our best to communicate with you and to provide notice within thirty (30) days of the Force Majeure Event, stating the period of time the occurrence is expected to continue. We shall use diligent efforts to end the failure or delay and ensure the effects of such Force Majeure Event are minimized. CopilotIQ shall resume the performance of its obligations as soon as reasonably practicable after the removal of the cause.

30. Copyright & Trademark Information

Copyright ©2022 CopilotIQ, Inc. All rights reserved. All trademarks, logos, and service marks (“Marks”) displayed on the Site are our property or the property of other third parties. You are not permitted to use these Marks without our prior written consent or the consent of such third party which may own the Marks.

31. Revisions; General

CopilotIQ reserves the right, in its sole discretion, to terminate your access to all or part of the Platform, with or without cause, and with or without notice. In the event that any of the Terms of Use are held by a court or other tribunal of competent jurisdiction to be unenforceable, such provisions shall be limited or eliminated to the minimum extent necessary so that these Terms of Use shall otherwise remain in full force and effect. These Terms of Use constitute the entire agreement between CopilotIQ and you pertaining to the subject matter hereof. In its sole discretion, CopilotIQ may from time-to-time revise these Terms of Use by updating this posting. You should, therefore, periodically visit this page to review the current Terms of Use, so you are aware of any such revisions to which you are bound. Your continued use of the Platform after revisions to these Terms of Use shall constitute your agreement to the revised Terms of Use. Certain provisions of these Terms of Use may be superseded by expressly designated legal notices or terms located on particular pages within the Platform.

32. Contact Us

CopilotIQ, Inc.
40 Burton Hills Blvd, Suite 200
Nashville, TN 37215
Telephone: (615) 412-8777
Email: privacy@copilotiq.com

Consent to Receive Texts and Emails from CopilotIQ, Inc. and its Business Partners

By providing your cell phone number and email address to CopilotIQ, Inc. (“CopilotIQ”), you are agreeing to be contacted by or on behalf of Copilot and our business partners identified below at the email address and the telephone number provided, including emails to your email address and text (SMS) messages to your cell phone and other wireless devices, and the use of an automatic telephone dialing system, artificial voice, and prerecorded messages, to provide you with marketing and promotional materials relating to CopilotIQ’s products and services, and products and services of the identified business partners.

You may opt-out of receiving text (SMS) messages from CopilotIQ or its subsidiaries at any time by replying with the word STOP from the mobile device receiving the messages.

You need not provide this consent in order to purchase any products or services from CopilotIQ. However, you acknowledge that opting out of receiving text (SMS) messages may impact your experience with the service(s) that rely on communications via text (SMS) messaging.

Business partners:

•  CopilotIQ, P.C.
•  CopilotIQ Medical, P.A.

Assignment of Benefits

I hereby assign to CopilotIQ Medical, P.A., and its affiliates, CopilotIQ, P.C. and Burton Hills Medical Services, P.C. (collectively, “Group”) all my right, title, and interest in any and all health insurance or other health care benefits payable to me or on my behalf by any insurance payer, including Medicare, private insurance and any other health plan for medical treatment rendered by Group. The assignment will remain in effect until revoked by me in writing. I authorize the release of pertinent information necessary to process my medical claim. I also authorize direct payment to Group of all insurance benefits payable to me for such medical treatment. In the event an insurance payer pays me directly, I agree to immediately pay such amounts to Group.

I understand that my insurance payer may pay less than the actual bill for services. I acknowledge that I am still responsible for paying Group for any and all amounts not paid by my insurance payer, including non-covered charges and all copayments, coinsurance, and deductibles. I understand that if my insurance requires a referral, I am responsible for obtaining one prior to my appointment. In the event any collection action is necessary to collect amounts I owe to Group, I agree to pay all expenses associated with such action, including but not limited to collection agency fees and attorneys’ fees.

I consent to receive online bills and Explanation of Benefits from CopilotIQ electronically. If you wish to obtain a paper copy of any such document or information, the paper copy will be mailed to you upon request at no cost. To request a paper copy of any such document or information, you may contact us 1-800-930-5144 or by email at info@copilotiq.com. You have the right to withdraw your consent at any time by choosing to resume paper delivery of your monthly bill statement. To elect to resume paper delivery of your monthly bill statement, please visit our website at www.CopilotIQ.com. After you successfully sign in, please navigate to where you may manage your statement delivery preferences, follow the instructions provided, and save your changes. In order to ensure that we are able to provide you with important notices and other information, you must update us with any change in your email address. To update the email address on your account, please visit our website at www.CopilotIQ.com. After you successfully sign in, please navigate to where you may change email address, follow the instructions provided, and save your changes. If you fail to update your email address and we receive a response that our email was undeliverable, the email that CopilotIQ is required by law to provide or make available to our members in writing will be deemed to have been received by you on the date the email was sent.

I certify that I have read and understand the foregoing and received a copy thereof. I am the patient, the patient’s legal representative, or am otherwise duly authorized by the patient to sign the above and accept its terms on his/her behalf.

CopilotIQ  Privacy Policy

At CopilotIQ, Inc. (“CopilotIQ”) your privacy is important to us. Our Privacy Policy describes the information we collect, how we collect the information, the reasons we collect information, and how we share or use the information we collect. This Privacy Policy also describes the choices you have with the information we collect, including how you can manage, update, or request to delete information.

Please take a moment to review this Privacy Policy. You may scroll through this Privacy Policy or use the headings below. It is important that you understand this Privacy Policy. By using our Platform, you are agreeing to the terms of this Privacy Policy. If you have any questions or concerns about this Privacy Policy, you may Contact Us at any time.

Table of Contents

I. Who is CopilotIQ?

II. Key Terms & Definitions and Our Privacy Policy

When does our Privacy Policy apply?
When does our Privacy Policy not apply?
Our Privacy Policy and Terms of Use.

III. Personal Information

What is Personal Information?
What types of Personal Information do we collect?
Health Information
How do we collect your Personal Information?
How do we use your Personal Information?
How do we share your Personal Information?
How do I access and correct my Personal Information?

IV. Who may use the Services?

V. Children’s Privacy

VI. Does CopilotIQ respond to Do Not Track signals?

VII. Data Security

VIII. California’s Shine the Light Law.

IX. Changes to our Privacy Policy

X. Contact Us

I. Who is CopilotIQ?

CopilotIQ is helping seniors improve diabetes and/or hypertension by providing a connected device to take daily readings with world-class licensed nurses to guide care. Our goal is to help people reduce medications and live healthier lives.

CopilotIQ is not a medical group or a health care provider. CopilotIQ provides its users with the ability to obtain a telemedicine consultation provided by independent medical practitioners including, but not limited to, CopilotIQ Medical, P.A. and CopilotIQ P.C. (“Medical Group”), an independent medical group with a network of United States based health care providers (each, a “Provider”). Medical Group (or your own medical provider if you do not use a Medical Group Provider) is responsible for providing you with a Notice of Privacy Practices describing its collection and use of your health information, not CopilotIQ.

II. Key Terms & Definitions and Our Privacy Policy

It is helpful to start by explaining some of our key terms and definitions used in this Privacy Policy.

• our “App(s)”: means CopilotIQ, our mobile application
• our “Devices”: means CopilotIQ devices including a glucose meter, blood pressure cuff, digital scale, and those manufactured by our hardware partners including Biotel and Withings.
• “Personal Information”: means any information relating to an identified or identifiable individual and any information listed here.
• our “Platform”: means our Website and App
• “Privacy Policy”: means this privacy policy.
• “Products”: means any products available for purchase on our Platform.
• our “Services”: means any services provided through our Platform.
• our “Terms of Service” means our terms of use located here.
• our “Website(s)” Our websites, including:

• www.CopilotIQ.com
• app.copilotiq.com
• prod.copilotiq.com and associated API’s

• “CopilotIQ,” “we,” “us,” or “our“: means  CopilotIQ, Inc.

When does our Privacy Policy apply?

This Privacy Policy describes the types of information we may collect from you when:
• You visit or use our Platform, including our Website and App;
• You use and/or wear our Devices;
• You connect our Devices to a mobile device running our App;
• We communicate in e-mail, text message, and other electronic messages between you and us; and
• We communicate in person, such as on the phone or through a telehealth visit.

When does our Privacy Policy not apply?

This Privacy Policy does not apply to information collected by any other website operated either by us or by a third party, unless the website is listed above or links to this Privacy Policy. It also does not apply to any website that we may provide a link to or that is accessible from our Platform.

This Privacy Policy does not apply to information collected from users who log-in to the password-protected and secure portions of our Platform (“Secure Platform”). The Secure Platform allows users who obtain the Services (“Customers”) to perform certain functions or obtain the Services (such as telehealth visits from Medical Group or Providers). All information collected and stored by us or added by Customers into such Secure Platforms is considered Protected Health Information (“PHI“) and/or medical information and is governed by applicable state and federal laws that apply to that information, for example the Health Insurance Portability and Accountability Act (“HIPAA”). How we use and disclose such PHI is in accordance with the applicable Notice of Privacy Practices provided to you by the Medical Group. We will not use or disclose information collected from the Secure Platform or received from Medical Group or your Provider for advertising, marketing, or other use-based data mining purposes. We will not sell any PHI.

Our Privacy Policy and Terms of Use.

This Privacy Policy is incorporated into our Terms of Use, which also apply when you use our Platform.

III. Personal Information

What is Personal Information?

Personal information is information from and about you that may be able to personally identify you. We treat any information that may identify you as personal information. For example, your name and e-mail address are personal information.

What types of Personal Information do we collect?

We may collect and use the following personal information (hereinafter, collectively referred to as “Personal Information”):

Categories of Personal Information and Specific Types of Personal Information Collected:

• Personal Identifiers:  a real name, birth date, e-mail address, address, or Patient ID.
• Information that identifies, relates to, describes, or is capable of being associated with a particular individual:  name, username or online identifier, physical characteristics or description, shipping address, home address, billing address, social security number, telephone number, cellular number, credit card number, debit card number, or any other financial information, patient lifestyle goals, insurance policy number health or medical information, weight, body mass index (BMI), whether you are a smoker or non-smoker, medical conditions, family medical history, medications currently taking or prescribed, heart rate, step count, distance traveled, glucose and oxygen saturation levels, active and resting energy levels, sleep analysis, blood pressure readings, workout history, your activity levels, and accelerometer data.
• Characteristics of protected classifications under California or federal law: Race, Color, Age, National Origin, Medical Condition, Genetic Information or Disability
• Biometric information:    Health Data, Genetics
• Internet or other electronic network activity information: IP address, device mode, device ID, OS version, device language, operating system, browser type, browsing history, search history, and information regarding a consumer’s interaction with an Internet Web site, application, or advertisement.
• Geolocation data:  Physical location or movements, local time, and local time zone.
• User Generated Content:  Information you provide to be published or displayed (hereinafter, “Posted”) on public areas of our Website or transmitted to other users of the Website or other third parties.

Health Information

Some Personal Information we collect may constitute PHI under HIPAA. As set forth above, your Provider will provide you with a Notice of Privacy Practices describing their collection and use of your health information, not CopilotIQ. We will only collect and use PHI for the purposes of providing the Services and we only collect the minimum amount necessary to fully perform and provide the Services on our Platform. We may combine your PHI with Personal Information that we have either obtained from you or through a third-party, such as your Provider, health insurer, employee benefits program, or other health care providers. PHI will not be used for any other purpose, including marketing, without your consent.

How do we collect your Personal Information?

We collect most of this Personal Information directly from you. For example, when we speak to you by phone, text message, and e-mail. Additionally, we will collect information from you when you visit our Website or App and fill out forms, use our Software, wear or use one of our Devices, or purchase our Services.

We may also collect Personal Information in the following ways:

• From your mobile device or smart watch.
• From third-party apps you choose to connect your mobile device to, such as Apple Health or Google Fit.
• When You Use A Premium Feature. When you choose to participate in a premium service, we collect additional information from you related to those services. Some premium features are paid services.
• When you make payments through the Platform. We do not collect or store financial account information, though we may receive transaction identifiers and summary information that does not include credit card or bank account numbers.
• When You Contact Us. When you contact CopilotIQ directly, such as when you contact our Customer Support team, we will receive the contents of your message or any attachments you may send to us, as well as any additional information you choose to provide.

We will also collect information automatically as you navigate through our Platform. We use the following technologies to automatically collect data:

• Cookies. We and our service providers may use cookies, web beacons, and other technologies to receive and store certain types of information whenever you interact with our Platform or Services through your computer or mobile device. A “cookie” is a small file or piece of data sent from a website and stored on the hard drive of your computer or mobile device. Some of the cookies we use are “session” cookies, meaning that they are automatically deleted from your hard drive after you close your browser at the end of your session. Session cookies are used to optimize performance of the Website and to limit the amount of redundant data that is downloaded during a single session. We also may use “persistent” cookies, which remain on your computer or device unless deleted by you (or by your browser settings). We may use persistent cookies for various purposes, such as statistical analysis of performance to ensure the ongoing quality of our Platform and/or the Services. We and third parties may use session and persistent cookies for analytics and advertising purposes, as described herein. On your computer, you may refuse to accept browser cookies by activating the appropriate setting on your browser, and you may have similar capabilities on your mobile device in the preferences for your operating system or browser. However, if you select this setting you may be unable to access or use certain parts of our Platform or the Services. Unless you have adjusted your browser or operating system setting so that it will refuse cookies, our system will issue cookies when you direct your browser to our Platform.
• Facebook Pixel and Instagram. We use Facebook Pixel and Instagram, a web analytics and advertising service provided by Facebook Inc. (“Facebook”) on our Platform. With its help, we and our customers can keep track of what users do after they see or click on a Facebook or Instagram advertisement, keep track of users who access our Platform or advertisements from different devices, and better provide advertisements to our target audiences. The data from Facebook Pixel and Instagram is also saved and processed by Facebook. Facebook can connect this data with your Facebook or Instagram account and use it for its own and others advertising purposes, in accordance with Facebook’s Data Policy which can be found at https://www.facebook.com/about/privacy/. Please click here if you would like to withdraw your consent for use of your data with Facebook Pixel https://www.facebook.com/settings/?tab=ads#_=_.
• Google Analytics. We use Google Analytics, a web analytics service provided by Google, Inc. (“Google”) to collect certain information relating to your use of our Platform. Google Analytics uses cookies, to help our Platform analyze how users use our Website. You can find out more about how Google uses data when you visit our Platform by visiting “How Google uses data when you use our partners’ sites or apps”, (located at www.google.com/policies/privacy/partners/). For more information, please visit Google and pages that describe Google Analytics, such as www.google.com/analytics/learn/privacy.html.
• Google Ads (AdWords). Google Ads (AdWords) remarketing service is provided by Google Inc. You can opt-out of Google Analytics for Display Advertising and customize the Google Display Network ads by visiting the Google Ads Settings page: http://www.google.com/settings/ads. Google also recommends installing the Google Analytics Opt-out Browser Add-on – https://tools.google.com/dlpage/gaoptout–  for your web browser. Google Analytics Opt-out Browser Add-on provides visitors with the ability to prevent their data from being collected and used by Google Analytics. For more information on the privacy practices of Google, please visit the Google Privacy Terms web page: https://policies.google.com/privacy?hl=en.
• Other third party tools. We use other third-party tools which allow us to track the performance of our Platform. These tools provide us with information about errors, app and website performance, and other technical details we may use to improve our Platform and/or the Services. For more information related to these third-party analytics providers please review How do we collect your Personal Information?.

How do we use your Personal Information?

We may use your Personal Information for the following purposes:

• Operate, maintain, supervise, administer, and enhance our Platform or the Services, including monitoring and analyzing the effectiveness of content on the Platform, aggregate site usage data, and other usage of the Platform and/or the Services such as assisting you in completing the registration process.
• Provide our Products and Services to you, in a custom and user-friendly way.
• Provide you with information, Products, or Services that you request from us or that may be of interest to you.
• To provide you notices or about your account.
• Contact you in response to a request.
• To notify you about changes to our Platform and/or the Services or any Products we offer or provide through them.
• Fulfill any other purpose for which you provide it.
• To carry out our obligations and enforce our rights arising from any contracts entered into between you and us, including for billing and collection.
• To respond to law enforcement requests, court orders, and subpoenas and to carry out our legal and contractual obligations.
• Authenticate use, detect fraudulent use, and otherwise maintain the security of our Platform and the safety of others.
• Any other purpose with your consent.

How do we share your Personal Information?

We may share Personal Information with third parties in certain circumstances or for certain purposes, including:

• Our business purposes. We may share your Personal Information with our affiliates, vendors, service providers, and business partners, including our data hosting and data storage partners, analytics and advertising providers, technology services and support, and data security advisors. We may also share your Personal Information with professional advisors, such as auditors, law firms, and accounting firms.
• Your healthcare providers or family. With your consent, we may share your information, including information collected from your use of our Platform, with your health care providers and/or family members (e.g., immediate family or friends) that you designate to receive your information.
• Other health-focused mobile apps. With your consent, we may share your profile information and data collected from your connected devices with other health-focused mobile applications installed on your mobile device to help you track your health and wellness information. If you share your information with these apps, your Personal Information, including your health information, will be used in accordance with privacy policies for those separate apps, not this Privacy Policy.
• With your consent. We may share your Personal Information if you request or direct us to do so.
• Compliance with law. We may share your Personal Information to comply with applicable law or any obligations thereunder, including cooperation with law enforcement, judicial orders, and regulatory inquiries.
• Business Transfer. We may share your Personal Information to a buyer or other successor in the event of a merger, divestiture, restructuring, reorganization, dissolution, or other sale or transfer of some or all of our assets, whether as a going concern or as part of a bankruptcy, liquidation, or similar proceeding, in which Personal Information held by us about our users are among the assets transferred.
• To enforce our rights. We may share your Personal Information to enforce any applicable terms and conditions and Terms of Use, and to ensure the safety and security of our Services and our users.
• De-identified information. We may also disclose de-identified information, so that it cannot be reasonably used to identify any individual, with third parties research, or similar purposes.
• To improve our Platform. We may use your Personal Information for internal testing, research, analysis, and product development, including to develop and improve our website/application, and to develop, improve, or demonstrate our products and services.
• To market our products and services. We may share your Personal Information with affiliates and third parties to market our products and services.
• Third Party Analytics. We use Google Analytics to understand and evaluate how visitors interact with our Platform and/or the Services. These tools help us improve our Platform and/or the Services, performance, and your experience.

Your choices about how we share your Personal Information.

This section of our Privacy Policy provides details and explains how to exercise your choices. We offer you choices on how you can opt out of our use of tracking technology, disclosure of your Personal Information for our advertising to you, and other targeted advertising. We do not control the collection and use of your information collected by third parties. These third parties may aggregate the information they collect with information from their other customers for their own purposes. You can opt out of third parties collecting your Personal Information for targeted advertising purposes in the United States by visiting the National Advertising Initiative’s (NAI) opt-out page and the Digital Advertising Alliance’s (DAA) opt-out page.

Each type of web browser provides ways to restrict and delete cookies. Browser manufacturers provide resources to help you with managing cookies. Please see below for more information.

• Google Chrome
• Internet Explorer
• Mozilla Firefox
• Safari (Desktop)
• Safari (Mobile)
• Android Browser
• Opera
• Opera Mobile

For other browsers, please consult the documentation that your browser manufacturer provides.

If you do not wish to have your e-mail address used by CopilotIQ to promote our own Products and Services, you can opt-out at any time by clicking the unsubscribe link at the bottom of any e-mail or other marketing communications you receive from us or logging onto your Account Preferences page. This opt out does not apply to information provided to CopilotIQ as a result of a product purchase, or your use of our Platform and/or the Services. You may have other options with respect to marketing and communication preferences through our Platform.

You may also see certain ads on other websites because we participate in advertising networks. Ad networks allow us to target our messaging to users through demographic, interest-based, and contextual means. These networks track your online activities over time by collecting information through automated means, including through the use of cookies, web server logs, and web beacons. The networks use this information to show you advertisements that may be tailored to your individual interests.

How do I access and correct my Personal Information?

You can review and change your Personal Information by logging into our Services and visiting either the “About You” or “Health Details” sections of our Platform. You may also Contact Us to inform us of any changes or errors in any Personal Information we have about you to ensure that it is complete, accurate, and as current as possible or to delete your account. We cannot delete your personal information except by also deleting your account with us. We may also not be able to accommodate your request if we believe it would violate any law or legal requirement or cause the information to be incorrect.

IV. Who may use the Services?

This Privacy Policy applies to all personal uses of our Platform globally and you should not use the Platform and/or the Services if you do not agree to the Privacy Policy and Terms of Use. If you are located in the United States your information is stored in the United States. By using or downloading the Platform, you agree that your Personal Information, including any information about your health that you provide directly to us or that we collect through your use of the Platform and/or the Services, may be transferred to and stored in the United States.

CopilotIQ operates subject to state and federal regulations, and the Platform and/or the Services may not be available in your state. You represent that you are not a person barred from enrolling for or receiving the Services under the laws of the United States or other applicable jurisdictions in which you may be located. Access to and use of the Platform and/or the Services is limited exclusively to users located in states within the United States where the Platform and/or the Services is available. The Platform and/or the Services are not available to users located outside the United States. Accessing the Platform and/or obtaining the Services from jurisdictions where content is illegal, or where we do not offer the Platform and/or the Services, is prohibited.

V. Children’s Privacy

CopilotIQ understands the importance of protecting children’s privacy in the interactive online world. Our Platform is not designed for, or intentionally targeted at, children 13 years of age or younger. It is not our policy to intentionally collect or maintain information about anyone under the age of 13. No one under the age of 13 should submit any Personal Information the Platform, and if we learn that we have collected or received Personal Information from a child under 13, we will delete that information. If you are the parent or guardian of a child under 13 years of age whom you believe might have provided us with their Personal Information, you may Contact Us to request the Personal Information be deleted.

We do not knowingly collect or sell Personal Information from children under the age of 18. If you are between 13 and 18 years of age, you must get permission from your parents or legal guardian before using our Platform. If you are under the age of 18, do not use or provide any information on or to the Platform or through any of its features. If we learn we have collected or received Personal Information from a child under the age of 18 without verification of parental consent, we will delete it. If you are the parent or guardian of a child under 18 years of age whom you believe might have provided use with their Personal Information, you may Contact Us to request the Personal Information be deleted.

VI. Does CopilotIQ respond to Do Not Track signals?

Some web browsers have a “Do Not Track” feature. This feature lets you tell websites you visit that you do not want to have your online activity tracked. These features are not yet uniform across browsers. Our Platform is not currently set up to respond to those signals.

VII. Data Security

We have taken steps and implemented administrative, technical, and physical safeguards designed to protect against the risk of accidental, intentional, unlawful, or unauthorized access, alteration, destruction, disclosure, or use. The Internet is not 100% secure and we cannot guarantee the security of information transmitted through the Internet. Where you have been given or you have chosen a password, it is your responsibility to keep this password confidential.

The sharing and disclosing of information via the internet is not completely secure. We strive to use best practices and industry standard security measures and tools to protect your data. However, we cannot guarantee the security of Personal Information transmitted to, on, or through our Services. Any transmission of Personal Information is at your own risk. We are not responsible for the circumvention of any privacy settings or security measures contained on our Platform, in your operating system, or mobile device.

VIII. California’s Shine the Light Law.

California Civil Code Section 1798.83 (California’s “Shine the Light” law) permits users of our Platform and/or the Services that are California residents and who provide Personal Information in obtaining products and services for personal, family, or household use to request certain information regarding our disclosure of Personal Information to third parties for their own direct marketing purposes. If applicable, this information would include the categories of Personal Information and the names and addresses of those businesses with which we shared your Personal Information with for the immediately prior calendar year (e.g. requests made in 2021 will receive information regarding such activities in 2020). You may request this information once per calendar year. To make such a request, please Contact Us using the information below.

IX. Changes to our Privacy Policy

We may update our Privacy Policy periodically to reflect changes in our privacy practices, laws, and best practices. We will post any changes we make to our Privacy Policy on this page with a notice that the Privacy Policy has been updated on our Website’s homepage or our App’s home screen. If we make material changes to our practices with regards to the Personal Information we collect from you, we will also notify you by e-mail to the e-mail address specified in your account and/or through a notice on the Platform. The date this Privacy Policy was last revised is identified at the top of the page. You are responsible for ensuring we have an up-to-date active and deliverable e-mail address for you, and for periodically accessing the Platform and reviewing this Privacy Policy to check for any changes.

X. Contact Us

If you have any questions, concerns, complaints or suggestions regarding our Privacy Policy or otherwise need to contact us, you may contact us at the contact information below or through the “Contact Us” page on the Platform.

How to Contact Us:

CopilotIQ, Inc.
40 Burton Hills Blvd, Suite 200
Nashville, TN 37215
Telephone: (615) 412-8777
Email: privacy@copilotiq.com

Informed Consent for Remote Patient Monitoring Services and Co-Payment

Remote Patient Monitoring (RPM) involves the use of electronic communications and devices that automatically record data to enable healthcare providers at different locations to monitor physiologic metrics and share individual patient medical information for the purpose of managing patient care. RPM services offered by your medical group, CopilotIQ Medical, P.A. (the “Medical Group”) may monitor a variety of physiologic metrics, including, without limitation blood pressure (systolic and diastolic), heart rate, glucose levels (pre and post meal), exercise, weight, steps walked, and sleep quantity and quality. Medical Group has partnered with CopilotIQ, Inc. (“CopilotIQ”) to provide you with the RPM services.

The electronic monitoring systems we use will incorporate network and software security protocols to protect the confidentiality of patient identification and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption.

These RPM services are an addition to, and not a replacement for, your primary care physician.  Responsibility for your overall medical care should remain with your local primary care doctor, if you have one, and we strongly encourage you to locate one if you do not.

Expected Benefits:

• Improved access to care by enabling you to remain in your home while a clinical care team obtains results at distant/other sites.
• More efficient care evaluation and management.

Possible Risks: 

• Delays in evaluation and treatment could occur due to deficiencies or failures of the equipment and technologies.
• In rare events, your provider may determine that the transmitted information is of inadequate quality, thus necessitating an in-person meeting with your local primary care doctor.
• In very rare events, security protocols could fail, causing a breach of privacy of personal medical information.

If you need to receive follow-up care, assistance in the event of an inability to communicate as a result of a technological or equipment failure, please contact your local physician.

By checking the box associated with “INFORMED CONSENT“, you acknowledge that you understand and agree with the following:

1. I hereby consent to receiving RPM services.  I understand that the RPM services are provided in connection with my current treatment plan with the Medical Group.
2. I understand that federal and state law requires health care providers to protect the privacy and the security of health information.  I understand that the Medical Group will take steps to make sure that my health information is not seen by anyone who should not see it, in accordance with Medical Group’s standard practices. I understand that RPM services may involve electronic communication or monitoring of my personal medical information to or by other health practitioners or clinical staff who may be located in other areas, including out of state.
3. I understand there is a risk of technical failures during the RPM services beyond the control of the Medical Group and CopilotIQ.  I agree to hold harmless Medical Group and CopilotIQ for delays in evaluation or for information lost due to such technical failures.
4. I understand that I have the right to withhold or withdraw my consent to RPM in the course of my care at any time, without affecting my right to future care or treatment. I understand that I may suspend or terminate use of the RPM services at any time for any reason or for no reason.  I understand that if I am experiencing a medical emergency, that I will be directed to dial 9-1-1 immediately and that Medical Group or Medical Group’s clinical staff are not able to connect me directly to any local emergency services.
5. I understand that I may expect the anticipated benefits from the use of RPM in my care, but that no results can be guaranteed or assured.
6. I understand that my healthcare information may be shared with other individuals for scheduling and billing purposes. Persons may be present during the consultation other than the Medical Group in order to operate the RPM technologies. I further understand that I will be informed of their presence in the consultation and thus will have the right to request the following: (1) omit specific details of my medical history/examination that are personally sensitive to me; (2) ask non-medical personnel to leave the consultation; and/or (3) terminate the consultation at any time.

Notice of Privacy Practices

copilotiq medical, p.a. Affiliated Covered Entity

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.

This Notice of Privacy Practices (the “Notice”) describes how CopilotIQ Medical, P.A., CopilotIQ P.C., and the members of its Affiliated Covered Entity (collectively “we” or “our”) may use and disclose your protected health information to carry out treatment, payment or business operations and for other purposes that are permitted or required by law.  An Affiliated Covered Entity is a group of health care providers under common ownership or control that designates itself as a single entity for purposes of compliance with the Health Insurance Portability and Accountability Act (“HIPAA”).  We have elected to voluntarily substantially comply with the standards set forth in HIPAA.  The members of the CopilotIQ Affiliated Covered Entity will share protected health information with each other for the treatment, payment, and health care operations of the CopilotIQ Affiliated Covered Entity and as permitted by HIPAA and this Notice of Privacy Practices.  For a complete list of the members of the CopilotIQ Affiliated Covered Entity, please contact the CopilotIQ Privacy Office.

“Protected health information” or “PHI” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical health or condition, treatment or payment for health care services.  This Notice also describes your rights to access and control your protected health information.

USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION:

Your protected health information may be used and disclosed by our health care providers, our staff, and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to support our business operations, to obtain payment for your care, and any other use authorized or required by law.

TREATMENT:

We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services.  This includes the coordination or management of your health care with a third party.  For example, your protected health information may be provided to a health care provider to whom you have been referred to ensure the necessary information is accessible to diagnose or treat you.

PAYMENT:

Your protected health information may be used to bill or obtain payment for your health care services.  This may include certain activities that your health insurance plan may undertake before it approves or pays for your services, such as:  making a determination of eligibility or coverage for insurance benefits and reviewing services provided to you for medical necessity.  

HEALTH CARE OPERATIONS:

We may use or disclose, as needed, your protected health information in order to support the business activities of this office.  These activities include, but are not limited to, improving quality of care, providing information about treatment alternatives or other health-related benefits and services, developing or maintaining and supporting computer systems, legal services, and conducting audits and compliance programs, including fraud, waste and abuse investigations.

USES AND DISCLOSURES THAT DO NOT REQUIRE YOUR AUTHORIZATION:

We may use or disclose your protected health information in the following situations without your authorization.  These situations include the following uses and disclosures:  as required by law; for public health purposes; for health care oversight purposes; for abuse or neglect reporting; pursuant to Food and Drug Administration requirements; in connection with legal proceedings; for law enforcement purposes; to coroners, funeral directors and organ donation agencies; for certain research purposes; for certain criminal activities; for certain military activity and national security purposes; for workers’ compensation reporting; relating to certain inmate reporting; and other required uses and disclosures.  Under the law, we must make certain disclosures to you upon your request, and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of the Health Insurance Portability and Accountability Act (HIPAA).  State laws may further restrict these disclosures.

USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION:

Other permitted and required uses and disclosures will be made only with your consent, authorization or opportunity to object unless permitted or required by law.  Without your authorization, we are expressly prohibited from using or disclosing your protected health information for marketing purposes.  We may not sell your protected health information without your authorization.  Your protected health information will not be used for fundraising.  If you provide us with an authorization for certain uses and disclosures of your information, you may revoke such authorization, at any time, in writing, except to the extent that we have taken an action in reliance on the use or disclosure indicated in the authorization.

YOUR RIGHTS WITH RESPECT TO YOUR PROTECTED HEALTH INFORMATION:

You have the right to inspect and copy your protected health information.  

You may request access to or an amendment of your protected health information.

You have the right to request a restriction on the use or disclosure of your protected health/personal information.  Your request must be in writing and state the specific restriction requested and to whom you want the restriction to apply.  We are not required to agree to a restriction that you may request, except if the requested restriction is on a disclosure to a health plan for a payment or health care operations purpose regarding a service that has been paid in full out-of-pocket.  

You have the right to request to receive confidential communications from us by alternative means or at an alternate location.  We will comply with all reasonable requests submitted in writing which specify how or where you wish to receive these communications.

You have the right to request an amendment of your protected health information.  If we deny your request for amendment, you have the right to file a statement of disagreement with us.  We may prepare a rebuttal to our statement and we will provide you with a copy of any such rebuttal.

You have the right to receive an accounting of certain disclosures of your protected health information that we have made, paper or electronic, except for certain disclosures which were pursuant to an authorization, for purposes of treatment, payment, healthcare operations (unless the information is maintained in an electronic health record); or for certain other purposes.  

You have the right to obtain a paper copy of this Notice, upon request, even if you have previously requested its receipt electronically by e-mail.

REVISIONS TO THIS NOTICE:

We reserve the right to revise this Notice and to make the revised Notice effective for protected health information we already have about you as well as any information we receive in the future.  You are entitled to a copy of the Notice currently in effect.  Any significant changes to this Notice will be posted on our web site.  You then have the right to object or withdraw as provided in this Notice.

BREACH OF HEALTH INFORMATION:

We will notify you if a reportable breach of your unsecured protected health information is discovered.  Notification will be made to you no later than 60 days from the breach discovery and will include a brief description of how the breach occurred, the protected health information involved and contact information for you to ask questions.

COMPLAINTS:

Complaints about this Notice or how we handle your protected health information should be directed to our HIPAA Privacy Officer.  If you are not satisfied with the manner in which a complaint is handled you may submit a formal complaint to the Department of Health and Human Services, Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.  We will not retaliate against you for filing a complaint.

We must follow the duties and privacy practices described in this Notice.  We will maintain the privacy of your protected health information and to notify affected individuals following a breach of unsecured protected health information.  If you have any questions about this Notice, please contact us at 615-412-8777 and ask to speak with our HIPAA Privacy Officer.