Consent Form for LifeHealth Passport web and mobile

CTI GLOBAL

LIFEHEALTH PASSPORT

INFORMED CONSENT FOR TELEMEDICINE SERVICES, COLLECTION, USE AND DISCLOSURE OF PERSONAL AND HEALTH INFORMATION

Effective Date: [Insert Date]

Last Updated: [Insert Date]

Please read this Consent Form carefully before registering for or using the LifeHealth Platform (“Platform”). By creating an account, selecting “I Agree,” or otherwise accessing or using the Platform, you acknowledge that you have read, understood, and voluntarily agree to this Consent Form, together with the Privacy Policy and Terms of Use.

This Consent applies internationally and is intended to align with applicable healthcare and privacy laws, including the EU General Data Protection Regulation (GDPR), the UK GDPR, the U.S. Health Insurance Portability and Accountability Act (HIPAA), and other applicable healthcare and data protection legislation.

1. About CTI Global

The LifeHealth Platform is owned and operated by:

CTI Global

Registered Office

44 Wall Street

New York, NY 100005

United States

General Enquiries

support@lifehealth.global

2. Purpose of this Consent

This Consent explains:

• what information we collect;
• how your information is used;
• when your information may be shared;
• your rights regarding your information;
• the benefits and limitations of telemedicine;
• how you may grant or withdraw permissions relating to your health information.

3. Nature of the Platform

LifeHealth is a secure digital health platform that enables patients to consult with licensed healthcare professionals using electronic communications.

CTI Global provides the technology platform only.

Unless expressly stated otherwise:

• CTI Global does not practice medicine.
• CTI Global does not diagnose medical conditions.
• CTI Global does not prescribe medication.
• CTI Global does not replace your healthcare provider.
• CTI Global does not guarantee clinical outcomes.
• CTI Global does not provide emergency medical services.

Medical advice, diagnosis, treatment, referrals, prescriptions, and all clinical decisions remain solely the responsibility of the licensed healthcare professional providing your care.

Nothing in this Consent creates a physician-patient relationship between CTI Global and any user.

4. Information We Collect

Depending upon your use of the Platform, we may collect:

Personal Information

• Full name
• Date of birth
• Gender
• Email address
• Telephone number
• Residential address
• Government-issued identification where required
• Insurance information
• Emergency contact information

Health Information

• Medical history
• Current symptoms
• Diagnoses
• Allergies
• Medications
• Laboratory results
• Imaging reports
• Consultation notes
• Prescriptions
• Treatment plans
• Referral letters
• Vaccination history
• Other information provided by you or your treating healthcare provider

Technical Information

• Device information
• Operating system
• Browser information
• IP address
• Login history
• Device identifiers
• Security logs
• Diagnostic information
• Application usage information

5. How We Use Your Information

Your information may be processed for purposes including:

• establishing and managing your account;
• verifying your identity;
• facilitating telemedicine consultations;
• maintaining electronic health records;
• enabling secure communication between patients and healthcare providers;
• coordinating healthcare services;
• generating referrals and prescriptions;
• processing payments;
• customer support;
• fraud prevention;
• cybersecurity;
• legal and regulatory compliance;
• quality assurance;
• business continuity;
• improving Platform functionality through anonymized or de-identified analytics.

Your Personal Information and Health Information will never be sold.

6. Disclosure of Information

CTI Global discloses Personal Information only where reasonably necessary to provide healthcare services, operate the Platform, or comply with applicable law.

Information may be shared with:

• licensed healthcare professionals involved in your care;
• hospitals;
• pharmacies;
• laboratories;
• diagnostic facilities;
• imaging centers;
• payment processors;
• secure cloud hosting providers;
• technology service providers acting on our behalf;
• regulators and law enforcement authorities where legally required.

All third-party service providers processing information on behalf of CTI Global are contractually required to implement appropriate confidentiality, privacy, and security safeguards.

Government and Public Health Disclosures

Where CTI Global shares information with a government ministry, ministry of health, public health authority, regulatory body, research institution, international health organization, or any other organization authorized or mandated by law to receive health-related information for public health, epidemiological surveillance, healthcare planning, statistical analysis, regulatory oversight, or similar lawful purposes, such information shall, wherever legally permissible and consistent with the purpose of the disclosure, be provided only in anonymized or aggregated form so that no individual can reasonably be identified.

Personally identifiable information or Protected Health Information will only be disclosed where:

• disclosure is expressly required by applicable law;
• disclosure is required pursuant to a valid court order or other lawful legal process;
• disclosure is necessary to comply with mandatory disease notification or other statutory public health reporting obligations;
• the individual has expressly authorized the disclosure; or
• another lawful basis for disclosure exists under applicable legislation.

7. Patient-Controlled Access to Health Records

CTI Global is committed to maintaining patient autonomy over access to electronic health records.

Except where otherwise required or expressly permitted by applicable law, no healthcare professional, clinician, health worker, healthcare facility, or other authorized user shall be permitted to access a patient’s Personal Information or Health Information through the Platform unless the patient, or the patient’s legally authorized representative, has first granted that individual or organization explicit authorization through the Platform.

Patients may grant access to one or more healthcare professionals for the purposes of consultation, treatment, referral, ongoing care, or care coordination.

Patients may review, modify, or revoke previously granted access permissions at any time through the Platform. Revocation shall take effect prospectively and shall not invalidate any lawful access or processing that occurred before the revocation became effective.

Nothing in this section limits access where disclosure or access is expressly authorized or required by applicable law, including:

• medical emergencies where the patient is unable to provide consent and access is necessary to protect the patient’s life or health or the life or health of another person;
• compliance with a lawful court order or other legally binding process;
• mandatory public health reporting obligations;
• protection against fraud, abuse, or significant security threats;
• any other circumstance in which applicable law permits or requires access without prior patient authorization.

All access to patient health records is subject to audit logging and monitoring. CTI Global maintains records of authorized access and may make such records available to patients where permitted by applicable law.

8. International Transfers

As LifeHealth operates internationally, your information may be transferred to countries outside your country of residence.

Where required by law, CTI Global implements appropriate safeguards including Standard Contractual Clauses, contractual confidentiality obligations, encryption, access controls, and other internationally recognized transfer mechanisms.

9. Telemedicine Consent

By using the Platform you acknowledge that:

• telemedicine involves healthcare delivered using electronic communications;
• your healthcare provider may not be able to conduct a physical examination;
• diagnosis depends upon the accuracy of the information you provide;
• technical failures may interrupt consultations;
• telemedicine may not be appropriate for every medical condition;
• emergency medical conditions require immediate in-person medical attention.

You understand that your healthcare provider may recommend an in-person consultation whenever clinically appropriate.

10. Risks

Potential risks include:

• delays caused by technical failures;
• incomplete clinical assessment;
• communication interruptions;
• cybersecurity incidents despite reasonable safeguards;
• inability to provide emergency intervention remotely.

11. Information Security

CTI Global maintains administrative, technical, and physical safeguards designed to protect Personal Information and Protected Health Information, including encryption, secure authentication, role-based access controls, audit logging, monitoring, disaster recovery planning, employee confidentiality obligations, and regular security testing.

While commercially reasonable safeguards are implemented, no electronic system can guarantee absolute security.

12. Data Retention

Information is retained only for as long as necessary to provide healthcare services, comply with applicable healthcare record retention requirements, satisfy legal obligations, resolve disputes, enforce legal rights, and comply with regulatory requirements.

When retention is no longer required, information is securely deleted or irreversibly anonymized.

13. Withdrawal of Consent

Where processing is based upon consent, you may withdraw your consent at any time using available Platform functionality or by contacting CTI Global.

Withdrawal of consent will not affect:

• processing already lawfully undertaken;
• information retained to satisfy legal obligations;
• information required to maintain existing clinical records.

Withdrawal of consent for telemedicine services may prevent continued use of certain Platform services.

14. Children

Individuals under eighteen (18) years of age may only use the Platform through an account established and managed by a parent or legal guardian where permitted by applicable law.

15. HIPAA Notice

Where HIPAA applies, Protected Health Information may be used or disclosed without separate authorization for treatment, payment, healthcare operations, mandatory reporting, judicial proceedings, and other disclosures permitted or required by applicable law.

Any disclosure requiring patient authorization under HIPAA will occur only after obtaining the required authorization.

16. Consent Acknowledgements

By selecting “I Agree”, you acknowledge and agree that:

☐ I have read and understood this Consent Form.

☐ I consent to CTI Global collecting and processing my Personal Information and Health Information for the provision of telemedicine services.

☐ I understand that CTI Global provides technology services and that healthcare services are provided by independent licensed healthcare professionals.

☐ I understand the benefits, limitations, and risks of telemedicine.

☐ I understand that LifeHealth is not an emergency medical service.

☐ I understand that healthcare professionals may only access my health records after I have explicitly granted them authorization through the Platform, except where access is otherwise permitted or required by applicable law.

☐ I understand that information shared with government authorities, ministries of health, public health organizations, or other legally mandated organizations will, wherever legally permissible, be disclosed only in anonymized or aggregated form unless identifiable disclosure is required by law or expressly authorized by me.

☐ I consent to the sharing of my information with healthcare providers and healthcare organizations involved in my treatment.

☐ I understand that my information may be transferred internationally using appropriate legal safeguards.

Optional Consents

☐ I consent to receive marketing communications from CTI Global.

☐ I consent to the use of anonymized or de-identified information for research, public health, healthcare quality improvement, product development, and statistical analysis.

17. Changes to this Consent

CTI Global may update this Consent Form from time to time to reflect changes in applicable law, technology, business operations, or healthcare practices. Material changes affecting the processing of your Personal Information or Health Information will be communicated before they take effect where required by applicable law. Continued use of the Platform following the effective date of an updated Consent Form constitutes acceptance of the revised terms unless renewed consent is required by law.

16. Consent Acknowledgements

By selecting “I Agree”, you acknowledge and agree that:

• I have read and understood this Consent Form.
• I consent to CTI Global collecting and processing my Personal Information and Health Information for the provision of telemedicine services.
• I understand that CTI Global provides technology services and that healthcare services are provided by independent licensed healthcare professionals.
• I understand the benefits, limitations, and risks of telemedicine.
• I understand that LifeHealth is not an emergency medical service.
• I understand that healthcare professionals may only access my health records after I have explicitly granted them authorization through the Platform, except where access is otherwise permitted or required by applicable law.
• I understand that information shared with government authorities, ministries of health, public health organizations, or other legally mandated organizations will, wherever legally permissible, be disclosed only in anonymized or aggregated form unless identifiable disclosure is required by law or expressly authorized by me.
• I consent to the sharing of my information with healthcare providers and healthcare organizations involved in my treatment.
• I understand that my information may be transferred internationally using appropriate legal safeguards.