Patient Consent Agreement

Agreement Terms & Conditions

I, [Name will appear here], the "Patient", agree to enroll in the Remote Patient Monitoring Services and have read and understand the terms and conditions below between RPM Solutions LLC and you the "Patient."

Medical Record Sharing

1. PURPOSE

The purpose of this Agreement is to permit the sharing of the Patient's health information, including electronic health records (EHRs), between the Patient and the Company in compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and related regulations.

2. PERMISSION TO SHARE HEALTH INFORMATION

The Patient gives permission to the Company to receive and access the Patient's health information, including EHRs, for the purpose of providing healthcare-related services and support, improving the quality of care, and conducting healthcare operations.

3. HIPAA COMPLIANCE

The Company is committed to maintaining the privacy and security of the Patient's health information in compliance with HIPAA. This includes implementing and maintaining appropriate administrative, physical, and technical safeguards to prevent unauthorized use or disclosure of the Patient's health information.

4. LIMITATION ON USE AND DISCLOSURE

The Company will use or disclose the Patient's health information only as permitted or required by this Agreement and in compliance with HIPAA. Any other use or disclosure not provided for in this Agreement will require additional authorization from the Patient.

5. PATIENT'S RIGHTS

The Patient has the right to revoke this permission at any time by providing written notice to the Company. However, revocation of permission will not affect any actions taken before the receipt of the revocation.

6. TERM AND TERMINATION

This Agreement will remain in effect until it is terminated by either the Patient or the Company. Upon termination of this Agreement, the Company will cease use and disclosure of the Patient's health information and will destroy or return all health information received from the Patient, unless it is infeasible to do so.

Consent to Use of Standard SMS Text Messaging

By signing below, the Patient hereby provides consent for the Company to send SMS text messages to the mobile phone number provided by the Patient. This consent applies to messages sent for any purpose related to the services provided by the Company, such as appointment reminders, treatment updates, or other healthcare-related communications.

- ACKNOWLEDGEMENTS OF SECURE ALTERNATIVES

The Company provides secure alternatives to standard SMS text messaging. These secure alternatives are designed to mitigate the security vulnerabilities associated with standard SMS text messaging and to protect the privacy and confidentiality of the Patient's personal information.

- PREFERENCE FOR STANDARD SMS TEXT MESSAGING

The Patient has expressed a preference for standard SMS text messaging and requests that the Company use this method of communication.

- ASSUMPTION OF RISK

By opting for standard SMS text messaging over the secure alternatives provided by the Company, the Patient accepts and assumes all risks associated with this method of communication, including the potential disclosure of the Patient's personal information.

- WITHDRAWAL OF CONSENT

The Patient understands that consent to receive standard SMS text messaging can be withdrawn at any time by notifying the Company in writing or replying "STOP" within message sent.

By signing this Agreement, the Patient acknowledges that they have read and understood the terms of this Agreement and agrees to be bound by these terms.

Terms and Conditions of Use

SERVICES

During the term of this Agreement, Company will provide seven (7) days per week, twenty-four (24) hours per day the monitoring and notification services identified in the Services and Authorization Confirmation Form (collectively, the "Services"). In the event a signal is received from the System, every reasonable effort will be made to promptly contact you to determine whether it is necessary to contact a Notification Party. If Company is informed by someone at your premises to disregard a signal or any request for assistance, Company in its sole discretion and without liability may elect not to alert a Notification Party that is an emergency authority or may advise such Notification Party to disregard request for assistance.

YOUR RESPONSIBILITIES

You are responsible for: (i) installing and testing the System in accordance with any applicable instructions, including performing a range test, GPS lock test, and a signal test, and testing the System on a monthly basis; (ii) ensuring suitable electrical service for installation and operation of the System, including any permits or licenses that may be required; and (iii) ensuring that your telephone line is in good working order if it is used with the System. You may not alter, modify or attempt repairs on the System, or move the System to a new address, except pursuant to instructions from Company or authorized service representative. Company relies on the information you provide about your location and your personal emergency contacts. You must immediately notify Company in the event your contact information, or that of a personal emergency contact, changes.

ASSIGNEES AND SUBCONTRACTORS

Company may transfer or assign this Agreement to any third party. Company may use subcontractors to provide the Services. This Agreement shall apply to any assignee or subcontractor and protect them in the same manner as it applies to and protects Company, including but not limited to Iot Services LLC, a South Carolina company. The Company is not responsible, however, for any work, including monitoring, which is done negligently by any third party. You may not transfer or assign this Agreement without prior written approval by Company. Subscriber has entered into a written agreement with Installing Company RPM Solutions LLC, hereinafter referred to as the "Installer," for the monitoring of an electronic alarm system at Subscriber's premises, and Subscriber designates Installer as its exclusive agent to deal with Statewide Monitoring Corp. The Installer has selected Statewide Monitoring Corp., (hereinafter referred to as "Central Office") to monitor the PERS System. Central Office is authorized to record and maintain audio and video transmissions, data, and communications. The subscriber is responsible for all alarm permits and permit fees, agrees to file for and maintain any permits required by applicable law and indemnify or reimburse Installer and Central Office for any fines relating to permits or false alarms.

SYSTEM EQUIPMENT

Depending on the Services selected, the System may include a base station (wired or cellular), mobile device cradle charger, pendant and an automatic fall detection pendant. Company, in its sole discretion, may repair or replace the System if it becomes damaged or is defective. If (i) the System has previously been disassembled, repaired or modified by someone other than us or our authorized service representative; or (ii) the System has been damaged as a result of the negligence or misconduct by any person other than us or our authorized service representative, you shall pay us the replacement price of up to Three Hundred Fifty Dollars ($350.00). The System and all monitoring software, computer codes and monitoring information remain Company's sole and exclusive property. THE SYSTEM SHOULD BE TESTED ON A MONTHLY BASIS TO CONFIRM IT IS WORKING PROPERLY.

WARRANTY; DISCLAIMER; LIMITATION OF LIABILITY

COMPANY MAKES NO GUARANTEES OF ANY KIND RELATING TO THE SYSTEM OR THE SERVICES AND EXPRESSLY DISCLAIMS ALL WARRANTIES WHETHER EXPRESS OR IMPLIED, WRITTEN OR ORAL, WITH RESPECT TO THE SYSTEM OR THE SERVICES, INCLUDING WITHOUT LIMITATION ANY WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. IF THE COMPANY IS FOUND LIABLE FOR ANY LOSS OR DAMAGE DUE TO ITS NEGLIGENCE OR THE FAILURE TO PERFORM ITS OBLIGATIONS IN THIS AGREEMENT, INCLUDING MONITORING THE SYSTEM, IN ANY RESPECT AT ALL, THE COMPANY'S MAXIMUM LIABILITY WILL BE $250.00.

ARBITRATION, LIMITATION ON LAWSUITS; WAIVER OF JURY TRIAL

To the extent permitted by law, no lawsuit or any other legal proceeding brought in connection with this Agreement shall be brought or filed more than one (1) year after the incident giving rise to the claim occurred. Any dispute between the parties or arising out of this Agreement, including issues of arbitrability, shall, at the option of any party, be determined by final and binding arbitration in New York County, New York before a neutral, independent arbitrator in accordance with the JAMS General Arbitration Rules & Procedures (www.jamsadr.com).

SYSTEM EQUIPMENT

Depending on the Services selected, the System may include a base station (wired or cellular), mobile device cradle charger, pendant and an automatic fall detection pendant. Company, in its sole discretion, may repair or replace the System if it becomes damaged or is defective. If (i) the System has previously been disassembled, repaired or modified by someone other than us or our authorized service representative; or (ii) the System has been damaged as a result of the negligence or misconduct by any person other than us or our authorized service representative, you shall pay us the replacement price of up to Three Hundred Fifty Dollars ($350.00). The System and all monitoring software, computer codes and monitoring information remain Company's sole and exclusive property. THE SYSTEM SHOULD BE TESTED ON A MONTHLY BASIS TO CONFIRM IT IS WORKING PROPERLY.

LIMITATIONS OF THE SYSTEM AND THE SERVICES

Company is not responsible for the promptness, sufficiency or adequacy of the action of any Notification Party with respect to a medical alert from your System. Company will not send any of its personnel to your location in response to an emergency signal. Neither the System nor the Services can prevent death, bodily or personal injury, or any other harm or damage to you or others who use them. The System does not detect 100% of falls. If able, users should always push their help button when they need assistance. The System and the Services rely on the availability of your home telephone service provider, cellular network coverage, and the availability of global positioning system ("GPS") data to operate properly. These systems are provided by a third party and cannot be controlled by Company. There is always a chance that the System may fail to operate properly. The 911 emergency services line is an alternative to the System and the Services.

WARRANTY; DISCLAIMER; LIMITATION OF LIABILITY

COMPANY MAKES NO GUARANTEES OF ANY KIND RELATING TO THE SYSTEM OR THE SERVICES AND EXPRESSLY DISCLAIMS ALL WARRANTIES WHETHER EXPRESS OR IMPLIED, WRITTEN OR ORAL, WITH RESPECT TO THE SYSTEM OR THE SERVICES, INCLUDING WITHOUT LIMITATION ANY WARRANTY OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. IF THE COMPANY IS FOUND LIABLE FOR ANY LOSS OR DAMAGE DUE TO ITS NEGLIGENCE OR THE FAILURE TO PERFORM ITS OBLIGATIONS IN THIS AGREEMENT, INCLUDING MONITORING THE SYSTEM, IN ANY RESPECT AT ALL, THE COMPANY'S MAXIMUM LIABILITY WILL BE $250.00. THE COMPANY WILL ASSUME A GREATER LIABILITY, BUT ONLY FOR AN ADDITIONAL CHARGE TO BE AGREED UPON BY YOU AND THE COMPANY. IF THE COMPANY DOES SO, A RIDER WILL BE ATTACHED TO THIS AGREEMENT. THE COMPANY EXPRESSLY DENIES ALL LIABILITY FOR ANY OTHER LOSS OR DAMAGE WHICH MAY OCCUR PRIOR TO, AT OR AFTER SIGNING THIS AGREEMENT. THIS INCLUDES LIABILITY BASED ON CONTRACT, TORT, NEGLIGENCE, WARRANTY (INCLUDING MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE) AND ANY OTHER THEORY OF LIABILITY, AS WELL AS THE FOLLOWING TYPES OF DAMAGES: DIRECT, INDIRECT, SPECIAL, INCIDENTAL, CONSEQUENTIAL (DAMAGES THAT RESULT FROM AN ACT, BUT DO NOT DIRECTLY RELATE TO THE ACT) AND PUNITIVE (DAMAGES USED TO MAKE AN EXAMPLE OF SOMEONE).

ARBITRATION, LIMITATION ON LAWSUITS; WAIVER OF JURY TRIAL

To the extent permitted by law, no lawsuit or any other legal proceeding brought in connection with this Agreement shall be brought or filed more than one (1) year after the incident giving rise to the claim occurred. Service of process may be made by personal service, traced overnight mail, or certified mail to each party's address as set forth in this Agreement unless otherwise provided by the receiving party in writing. Any dispute between the parties or arising out of this Agreement, including issues of arbitrability, shall, at the option of any party, be determined by final and binding arbitration in New York County, New York before a neutral, independent arbitrator in accordance with the JAMS General Arbitration Rules & Procedures (www.jamsadr.com). In any such arbitration, the parties may conduct discovery to the same extent as would be permitted in a court of law. The arbitrator shall issue a written decision stating the essential findings and conclusions on which the award is based, and shall have full authority to award all remedies which would be available in court. The arbitrator may award the prevailing party his, her or its expenses and fees of arbitration, including reasonable attorney's fees, witness fees, in such proportion as the arbitrator decides. Any judgment upon the award rendered by the single arbitrator may be entered in any court having jurisdiction thereof. The parties agree that they may bring claims against each other only in their individual legal capacity, and not, whether by litigation or arbitration, as a class action plaintiff or class action member in any purported class or representative proceeding.

In addition, where permissible by law, each of the parties hereby waives its rights to a jury trial of any claim or action based upon or arising out of this Agreement, directly or indirectly, and/or the relationship that is being established among the parties hereunder. The scope of this waiver is intended to cover all disputes that may be filed in court, including without limitation contract, tort, breach of duty, and all other common law and statutory claims. This waiver is irrevocable and may not be modified either orally or in writing. This waiver applies to any future amendments, renewals, supplements or modifications of or to this Agreement. In the event of litigation covered by the scope of this waiver, this Agreement may be filed in court as a waiver of jury trial and written consent to a trial by the court. In any jurisdiction that prohibits or declines to enforce pre-dispute jury trial waivers, any dispute between the parties or arising out of this Agreement shall be determined by binding arbitration, in accordance with this Agreement's arbitration provision, as the exclusive remedy for such controversy, claim or dispute.

THIRD PARTY INDEMNIFICATION AND NO SUBROGATION

You hereby indemnify Company against any third party claim (including claims for property damage, personal injury or death) connected with or resulting from Company's performance under this Agreement, including failure of the System or the Services or Company's negligence. You further agree to pay Company (i) any amount which a court orders Company to pay or which Company reasonably agrees to pay in connection with such claims; and (ii) the amount of Company's reasonable attorneys' fees and any other losses or costs that Company may pay in connection with the harm or damage giving rise to such claims including, without limitation, contribution, indemnification or subrogation.

ENTIRE AGREEMENT

This Agreement constitutes the entire agreement and understanding between you and Company concerning the subject matter hereof and supersedes all prior discussions, agreements and representations, whether oral or written. This Agreement and the respective rights and obligations of the parties hereto shall be governed by and construed in accordance with the laws of the State of New York, without regard to conflict of law provisions. Any equipment or services the Company provides to you in the future are subject to the terms of this Agreement. This Agreement cannot be changed except by a writing that both you and the Company sign. If any provision of this Agreement is found to be invalid, the remaining provisions are still effective. In the event that it should become necessary for Company to institute legal proceedings to collect payments due under this Agreement or to otherwise enforce any provision of this Agreement, you agree to reimburse Company for all of its reasonable attorneys' fees and costs, in connection with any such proceeding, to the extent permitted by law.

UPDATES

Company may post updates to these Terms and Conditions of Use on its website and may also mail updated Terms and Conditions of Use to the Subscriber's address on file.

ACKNOWLEDGMENTS

By signing this Agreement you acknowledge that (i) the Company has informed you, and you acknowledge, that a copy of the JAMS General Arbitration Rules & Procedures are publicly available on the JAMS website at www.jamsadr.com; (ii) the Company has provided You with ample time to review and consider this Agreement, including the Arbitration; Limitation of Lawsuits; Waiver of Jury Trial provisions, and ask questions regarding the Agreement; (iii) You have not requested additional time to consider any provision of this Agreement.