Consent to Participate | Carda Health

Carda Health Unified Patient Consent and Authorization

This document is the unified consent form for all patients of Carda Health P.S.C., Cupid Medical, P.S.C., and their affiliated entities (collectively, "Medical Group," "Carda," "we," "us," or "our"). Section 1 applies to every Carda patient. Section 2 contains additional terms that apply only to the program(s) in which you are enrolled.

SECTION 1 — UNIVERSAL TERMS (Applicable to All Patients)

1.1 Purpose and Explanation of Services Consent to Treatment.

By participating in the Program, I voluntarily consent to the care, treatment, rehabilitation services, education, monitoring, and related services provided by Medical Group in connection with the Program.

The purpose of this consent is to inform you of the following:

  1. How Medical Group and your treating clinicians (including exercise physiologists, nurses, and physicians) will use and disclose the information you share,
  2. What other entities Medical Group might share information with, and
  3. the risks associated with this virtual care encounter and the program in which you are enrolled.

Telehealth and telerehabilitation ("Telehealth") involves the use of audio, video or other electronic communications to interact with you, consult with your healthcare provider and/or review your medical information for the purpose of diagnosis, therapy, follow-up and/or education. You agree to the use of the Telehealth platform utilized by Medical Group. You understand: The use of telehealth is voluntary, and I may withdraw my consent to, or stop receiving services through telehealth at any time.

I hereby consent to participate in a virtual rehabilitation, education, and lifestyle medicine program offered by Medical Group (the "Program")... Professionally trained clinical personnel will direct my activities and may monitor my vital signs to ensure I am participating at a safe and prescribed level.

1.2 General Risks and Virtual Care Disclosures

It is my understanding that there exists the possibility during exercise of adverse changes including abnormal blood pressure; fainting; disorders of heart rhythm; and very rare instances of heart attack, stroke, or even death... I understand that no exercise or rehabilitation program is risk-free and that outcomes are not guaranteed.

1.3 Remote Patient Monitoring (RPM) Daily Check-Ins.

You may be asked to participate in daily vital check-ins, including monitoring of blood pressure, heart rate, oxygen saturation and other relevant indicators of health. This information will assist in tracking your day-to-day health status and contributing to the personalized rehabilitation plan.

Chronic Care Management (CCM) Program

You may be placed on a medical hold and asked whether you would like to participate in a Chronic Care Management program... You may only be enrolled in one CCM program at a time.

Overnight Pulse Oximeter Readings

If eligible, you will be provided with a continuous oxygen saturation device that will be used for supervised sessions and overnight pulse oximeter readings.

By participating in remote monitoring activities, you contribute to (i) personalized care tailored to your specific needs, (ii) ongoing progress monitoring and adjustment of interventions, and (iii) overall program effectiveness and quality of care.

RPM Withdrawal. You have the right to withdraw your participation from remote patient monitoring at any time.

1.4 Emergency Protocol and Monitoring Limitations No Emergency Medical Services

Medical Group does not provide emergency medical services. If I believe I am experiencing a medical emergency, I will call 911 or seek immediate emergency medical care.

1.5 Benefits to Be Expected; No Guarantee of Outcomes

I understand that this medical treatment may or may not benefit my health status or physical fitness. Generally, participation will help determine what recreational and occupational activities I can safely and comfortably perform at home or on my own.

1.6 HIPAA, Confidentiality, and Use of Information

Confidentiality protections under federal and state law, including the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), apply to information used or disclosed during virtual care. I understand that Medical Group may collect, use and disclose my personal information and my personal health information for purposes of:

Acknowledgment of Notice of Privacy Practices

I acknowledge that I have received or been given the opportunity to receive Medical Group’s Notice of Privacy Practices, which contains a more complete description of the uses and disclosures of my health information and my rights under HIPAA...

Recording, Transcription, and AI-Assisted Documentation

For quality assurance, training, and program improvement purposes, some virtual care sessions may be monitored and/or recorded.

1.7 SMS / Text Message Communications Consent

I agree to receive communications by text message related to the care I receive, and customer care, including appointment reminders, clinical follow-up, and billing notifications.

1.8 Electronic Signatures, Records, and Communications

I consent to the use of electronic signatures, records, and communications in connection with my participation in the Program.

1.9 Financial Responsibility, Insurance, and Assignment of Benefits

I authorize Medical Group to file for insurance benefits to pay for the care I receive.

1.10 Medical Records Release Authorization

I authorize the release of the items below (as applicable to my program)...

1.11 Acknowledgment of Universal Terms

I acknowledge that I have read this consent in its entirety...

SECTION 2 — PROGRAM-SPECIFIC TERMS

The terms in this Section 2 apply only to the program(s) in which I am enrolled, as designated by Medical Group based on my clinical condition.

2.A Pulmonary Rehabilitation Program

If I am enrolled in Carda’s Pulmonary Rehabilitation Program, I consent to the following program-specific terms in addition to the Universal Terms in Section 1.

Program-Specific Risks

I understand that pulmonary rehabilitation carries risks specific to patients with chronic lung disease...

Pulse Oximetry and Oxygen Monitoring

If eligible, I will be provided with a continuous oxygen saturation (pulse oximetry) device for use during supervised sessions...

Oxygen Equipment Safety

If I use supplemental oxygen during the Program, I agree to: ...

2.B Cardiac Rehabilitation Program

If I am enrolled in Carda’s Cardiac Rehabilitation Program, I consent to the following program-specific terms in addition to the Universal Terms in Section 1.

Program-Specific Cardiac Risks

In order to improve my physical capacity and generally aid in my medical treatment for heart disease, I consent to participate in Carda’s virtual cardiac rehabilitation program...

2.C Intensive Cardiac Rehabilitation (ICR) Program

If I am enrolled in Carda’s Intensive Cardiac Rehabilitation Program, ...

Final Acknowledgment and Consent

I voluntarily consent to participate in Medical Group’s program(s) via telehealth, including any program-specific terms set forth in Section 2 that apply to the program(s) in which I am enrolled....