Effective Date: 12/13/2020

These Medical Terms of Service (“Medical Services Terms”) govern your use of the Nurse Practitioner services, including Telehealth Services, and any additional services provided by Plant Based NP LLC and our affiliated service providers (“Plant Based NP LLC”, “we”, “us”, “our”). Please read the Medical Services Terms carefully before using the Nurse Practitioner Services. By using the Services at Plant Based NP LLC, including the Telehealth Services, and any additional services provided by Plant Based NP LLC, you agree to be bound by these Terms. If you are accepting these Services Terms for another person (“Family Member”), as such Family Member’s guardian, conservator, custodian, and/or parent of a minor child Family Member, you agree to the terms, conditions, and notices contained or referenced herein on behalf of such Family Member.

Please Refer to our Privacy Policy for information on how your information is used and disclosed, and how you can get access to the information.

DO NOT use the Nurse Practitioner Services, including Telehealth Services, for emergency or urgent medical matters. For all urgent or emergency matters that you believe may immediately affect your health, you must act immediately – call 911, or go to the nearest emergency room or urgent care facility.

1. Updates to the Medical Terms of Service

   • We may modify these Medical Services Terms from time to time. We will notify you of material changes by posting the amended terms one the Plant Based NP LLC website, at www.plantbasednp.com/MTOS at least 30 days before the effective date of the changes. If we have your e-mail on file, we will also notify you of material changes to the Medical Services Terms by e-mail at least 30 days before the effective date of the changes. Please ensure your e-mail address is current so you will receive notice of any material changes. If you do not agree with the proposed changes, you should discontinue your use of the Nurse Practitioner (and any other) Services prior to the effective date of change. If you continue to use the Services provided by Plant Based NP LLC after the effective date, you will be bound by the Medical Services Terms.

2. Your Financial Responsibility; Assignment of Benefits

   • You agree to pay Plant Based NP LLC all applicable charges at the prices then in effect for the Medical Services provided to you, or another person on whose behalf you are accepting these Medical Services Terms and/or payment responsibility (such as your children, or other family members). You will be charged for the Services provided to you by a Plant Based NP LLC healthcare provider. You authorize Plant Based NP LLC to charge your chosen payment method for the Nurse Practitioner Services provided to you or your Covered Family Member. The third-party services provider who manages your Payment Method may impose terms and conditions on you, which are independent of these Nurse Practitioner Terms of Service; and you agree to comply with all of those terms. Plant Based NP LLC may accumulate charges that you’ve incurred for the Nurse Practitioner Services and submit them as one or more aggregate charges during or at the end of each billing cycle. Plant Based NP LLC reserves the right to correct any billing errors or mistakes, even if payment has already been requested or received.

   • If applying for reduced payment via sliding scale, you agree to supply all necessary documentation to Plant Based NP LLC. You understand that sliding scale coverage may be removed or altered at any time.

3. Appointments: Missed/Late Cancellation

   • You understand and agree that if you do not show for your appointment, or you cancel your appointment with less than 24 hours’ notice, we reserve the right to charge you a $25 fee for missed/late cancelled appointment.

4. Permission to Treat

   • You give permission to the healthcare providers of Plant Based NP LLC to medically care for you and your Covered Family Member. You may withdraw this consent at any time by no longer seeking Nurse Practitioner Services from Plant Based NP LLC.

   • You understand and agree that as part of providing Services to you, your Protected Health Information (as defined by HIPAA), including test results, may be released to and by an online personal health record and via communication with Plant Based NP LLC’s healthcare team electronically.

   • You understand and agree that your healthcare provider at Plant Based NP LLC is NOT your primary care provider. Your provider at Plant Based NP LLC provides you with specialty Services related to Lifestyle Care, Plant Based Nutrition, Culinary Care, and/or Health and Wellness Coaching. If you wish to receive Primary Care services, you must arrange a relationship with a primary care provider outside of Plant Based NP LLC. Furthermore, you understand and agree to continue to seek care from your Primary Care Provider and any other applicable healthcare providers while receiving care from Plant Based NP LLC. You agree to keep all of your applicable healthcare providers informed of the care you receive from Plant Based NP LLC, and any changes in your health as a result. If you take medications, and as a result of care, they need to be adjusted, it is your responsibility to reach out to the prescriber of said medication to receive a prescription for any changes; increase, decrease, or discontinuation.

5. Service Termination

   • You may terminate your use of the Services provided at Plant Based NP at any time by not using the Services any more. We may terminate your use of Services at Plant Based NP at any time in our reasonable discretion, for causes including, but not limited to:

   • The Patient fails to pay applicable fees owed in a timely manner;

   • The Patient has performed an act that constitutes fraud;

   • The Patient repeatedly fails to adhere to the recommended treatment plan;

   • The Patient is abusive, or presents an emotional or physical danger to the staff or other patients of Practice;

   • Practice discontinues operation; and

   • Practice has a right to determine whom to accept as a patient, just as a patient has the right to choose his or her care provider. Practice may also may terminate a patient without cause as long as the termination is handled appropriately (without violating patient abandonment laws).

6. Health Services Disclaimer

   • Mental Health: We may discuss sensitive aspects of your life; you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, or helplessness. If at any point you experience significant increased distress, or have thoughts of harming yourself or others, you agree to notify your primary care provider, mental health provider, or seek emergency care by calling 911 or going to the nearest emergency room.

   • Disease Management: At times, our goals for patients with chronic disease may be reversal of disease. Throughout the course of treatment, it will be very important that you follow instruction fully – including the treatment plan, disease monitoring, etc.; and keep Plant Based NP LLC, your primary care and/or specialty provider updated about changes in your condition. Adjustments of treatments/medications may need to be performed more frequently than you have visits with either Plant Based NP LLC or your primary care or specialty provider. For any urgent or emergent situations, you should contact your primary care provider, seek care at the nearest emergency room or urgent care, or call 911.

7. Consent to Electronic Communications

   • You agree that Plant Based NP LLC may send the following to you by e-mail: Information regarding your care and health; legal disclosures; these Terms of Service; Patient Agreement Form; Consent for Treatment Forms; Patient Authorization Forms; Invoices; future changes to any of the above; and other notices, policies, communications, or disclosures and information related to the Nurse Practitioner Services. You agree that Plant Based NP LLC may contact you via e-mail, phone, text, or mail regarding the Medical Services. You consent to receive such communications electronically. You agree to update your contact information to ensure accuracy.

8. Disclaimers:

   • To the maximum extent not prohibited by law, Plant Based NP, its affiliates, its employees, and its providers will not be responsible for any loss or damage, including personal injury or death, resulting from anyone’s use of or inability to use the Services provided by Plant Based NP LLC.

   • The Services provided by Plant Based NP LLC are intended for use only within the United States and its territories. We make no representation that the Nurse Practitioner Services are appropriate or available for use outside the U.S.

   • Nurse Practitioner services provided via Telehealth may only be provided to patients who are physically present in the State of Ohio during their appointment. Patients utilizing Telehealth agree to only attend their visit if they are physically present in the State of Ohio; and agree that if they are not present in the state of Ohio, they will cancel their appointment and reschedule for a date and time that they will be present in the state of Ohio.

   • These Medical Terms of Service, and any other formal agreements between the Patient and Plant Based NP LLC, shall be governed and construed under the laws of the State of Ohio, and all disputes arising out of the Medical Terms of Service (or other formal agreements) shall be settled in the court of proper venue and jurisdiction for the Practice address in Columbus, OH. Per the Federal Arbitration Act (FAA), Patient agrees that any disputes be settled via arbitration, rather than via jury trial.

9. Limitation of Liability

   • To the maximum extent not prohibited by law, in no event will we, our affiliates, providers, employees, or agents be liable for any consequential, exemplary, incidental, special, or punitive damages; including without limitation those relating to lost profits or the cost of substitute products or services arising out of or in connection with the Services we provide or from the use of or inability to use the Services we provide, whether based on contract, warranty, product liability, tort, or other legal theory; and even if we have been informed of the possibility of such damages.

   • Hold Harmless and Indemnity: Patients and/or recipients of services provided by Plant Based NP LLC shall fully defend, indemnify, and hold harmless Plant Based NP LLC from any and all claims, lawsuits, demands, causes of action, liability, loss, damage, and/or injury, of any kind whatsoever (including without limitation all claims for monetary loss, property damage, equitable relief, personal injury, and/or wrongful death), whether brought by an individual or other entity, or imposed by a court of law or by administrative action of any federal, state, or local governmental body or agency, arising out of, in any way whatsoever, and acts, omissions, negligence, or willful misconduct on the part of Plant Based NP LLC, its officers, owners, personnel, employees, agents, contractors, invitees, or volunteers. This indemnification applies to and includes, without limitation, the payment of all penalties, fines, judgments, awards, decrees, attorney’s fees, and related costs or expenses, and any reimbursement to Plant Based NP LLC for all legal fees, expenses, and costs incurred by it. No waiver of any default shall constitute a waiver of any other default or breach, whether of the same or other covenant or condition. No waiver, benefit, privilege, or service voluntarily given or performed by Plant Based NP LLC shall give the Patient and/or recipient of services any contractual right by custom, estoppel, or otherwise.

10. Telehealth Services and Permission

    • Plant Based NP LLC may provide certain Telehealth services to you. You consent to receive emails or other electronic communications from Plant Based NP LLC pertaining to your care and your health, which may include Protected Health Information. You understand that virtual encounters via phone, e-mail, video, or otherwise, could involve, and you hereby consent to the use of automated tools for diagnosis, care, treatment, or care pertaining to healthcare matters.

    • You give permission to Plant Based NP LLC and the Telehealth Services Providers to record and process your personal details and medical data. You may withdraw these permissions at any time by any time by no longer seeking Telehealth care from Plant Based NP LLC.

    • Telehealth is the delivery of healthcare services using technology when the healthcare provider and patient are not in the same physical location, and/or the virtual delivery of healthcare services, including by a medical provider or via digital or automated tools, including without limitation tools for medical or health-related diagnosis and treatment. Telehealth services may be used for diagnosis, treatment, care, follow-up, and/or patient education, and may include without limitation, the following: electronic transmission of patient medical records, medical images, and/or other patient data or information; synchronous and asynchronous interactions via audio, video, text, and/or data or other electronic communications; automated electronic or digital tools or services for diagnosis, care, treatment, and/or communication pertaining to healthcare or medical matters; and output, transmission or exchange of data from medical devices, sound and video files. Further, you understand it may be possible that your condition cannot be treated via Telehealth Services, or that information transmitted through the Telehealth Services may not be sufficient or of too poor image quality, or insufficient information or data to allow for appropriate medical decision making. Accordingly, you may be required to seek additional in-person medical care, alternative healthcare, or emergency services. If your health or medical problem or condition persists after use of Telehealth Services, you will immediately contact your primary care provider and seek appropriate in-person medical care, or emergency care, as appropriate.

11. Other Services

In addition to Nurse Practitioner Services, Plant Based NP LLC may offer other services to clients. These include, but are not limited to:

• Health and Wellness Coaching (to non-patients): Health and Wellness Coaching is providing clients with general health and wellness advice related to Lifestyle Care and adopting a Whole Food Plant Based diet. It differs from Nurse Practitioner Services, in that the employee providing health coaching is doing so from a health coach role, not a nurse practitioner role. Clients receiving health coaching will not be provided with any personalized care or treatments, review of labs, prescription of medications, or any other services that are functions that a Nurse Practitioner may engage in but a health coach may not. Health and Wellness is not a substitution for Medical Care Services. Whereas Nurse Practitioner Services may only be supplied to patients who are physically present in the state(s) in which the Nurse Practitioner is licensed; Health and Wellness Coaching may be supplied to any clients who are in a location where the Health and Wellness Coaching supplied by Plant Based NP LLC is legal. If you plan to implement the information learned via Health and Wellness Coaching, you understand and agree the need to keep your primary care provider and/or other applicable healthcare providers up to date with changes you make in regards to health practices. Health and Wellness Coaching clients are held to all applicable Terms of Service within this document.

• Culinary Care: Culinary Care services include helping clients explore the link between food and health, educate them about the health promoting benefits of eating a Whole Food Plant Based diet, help them formulate health promoting meals, and learn how to prepare/cook said meals. Additional activities may include, but are not limited to, meeting at a grocery store to learn how to examine foods and shop for health promoting foods; cooking demonstrations (whether in person or virtual) to teach patients how to cook whole food plant based meals without the use of animal products or oil, etc. Plant Based NP LLC is not responsible or liable for any injury or harm that may occur at outside locations (e.g. the grocery store), injuries/harms that occur during cooking demonstrations, or injuries/harms that may occur while ingesting food in relation to Culinary Care Services. It is the client’s responsibility to inform the provider of any food allergies or sensitivities, to ask whether food items contain anything they are allergic or sensitive to, and to not eat any food items that contain anything they are allergic or sensitive to. Culinary Care services may be extended to both patients receiving Nurse Practitioner Services, and clients receiving Health and Wellness Coaching. Culinary Care clients are held to all applicable Terms of Service within this document.

• Sale of Food Based Supplements and/or Educational Materials: Plant Based NP LLC may recommend or have for purchase educational materials related to health, wellness, lifestyle care, or plant based eating. While educational materials are carefully curated, and contain – to the best of the organization’s knowledge – sound, safe, applicable advice; Plant Based NP LLC cannot be held responsible for the information contained within, nor negative outcomes that may arise from implementing strategies found within the educational materials. Clients should consult with their Plant Based NP LLC, their primary care providers and/or other applicable healthcare providers before changing health practices. Plant Based NP LLC may provide for purchase Food Based Supplements; which are food based items that studies have shown may have health benefits. Items may include, but are not limited to: dry teas, dry tea blends, dry spices and seasonings, dry herbs, dry herb blends, etc. These products will be produced and provided in accordance with Ohio’s “Cottage Food Production Operation” as defined in Chapter 3715 of the Ohio Revised Code to mean: a person, who in the person’s home, produces food items that are not potentially hazardous foods, including bakery products, jams, jellies, candy, fruit butter, and similar products specified in rules. The buyer should not consume any products that contain items they have allergies or sensitivities to. Plant Based NP LLC is not responsible for any injuries or harms that may arise from the consumption of Food Based Supplements it supplies for sale.

• Events and Activities: Events/activities will vary, and may be held at 3rd party locations. Participants understand and acknowledge that participation is voluntary, and hold Plant Based NP LLC harmless for any injuries or harm that may result from participation.

12. Additional/Miscellaneous Provisions

    • Patient acknowledges that Plant Based NP LLC and it’s providers do not participate in any health insurance or HMO plans. The Nurse Practitioner is not enrolled in Medicare in his role as a Nurse Practitioner. Patient acknowledges that federal regulations REQUIRE that healthcare providers not be enrolled in, or opt out of, Medicare so that Medicare patients may be seen by the healthcare provider. Neither the Practice nor Nurse Practitioner make any representations regarding third party insurance reimbursement of fees paid under this Agreement. The Patient shall retain full and complete responsibility for any such determination. If the Patient is eligible for Medicare, or during the term of this Agreement becomes eligible for Medicare, then Patient will sign a “Medicare Patient Understandings” Agreement. This agreement acknowledges your understanding that the Nurse Practitioner is not enrolled in Medicare, and as a result, Medicare cannot be billed for any services performed for you by the Nurse Practitioner. You agree not to bill Medicare or attempt Medicare reimbursement for any such services.

    • Patient acknowledges that communications with the Nurse Practitioner using e-mail, facsimile, video chat, instant messaging, and cell phone are not guaranteed to be secure or confidential methods of communications. The practice will make an effort to secure all communications via passwords and other protective means. The practice will make an effort to promote the utilization of the most secure methods of communication, such as software platforms with data encryption, HIPAA familiarity, and a willingness to sign HIPAA Business Associate Agreements. This may mean that conversations over certain communication platforms are highlighted as preferable based on higher levels of data encryption, but many communication platforms, including email, may be made available to the patient. If the Patient initiates a conversation in which the Patient discloses “Protected Health Information (PHI)” on one or more of these communication platforms then the Patient has authorized the Practice to communicate with the Patient regarding PHI in the same format.

    • If for any reason any provision of this Medical Terms of Service shall be deemed, by a court of competent jurisdiction, to be legally invalid or unenforceable in any jurisdiction to which it applies, the validity of the remainder of the Terms of Service shall not be affected, and that provision shall be deemed modified to the minimum extent necessary to make that provision consistent with applicable law and in its modified form, and that provision shall then be enforceable.

    • We reserve the right to accept or decline patients based upon our capability to appropriately handle the patient’s lifestyle/primary care needs. We may decline new patients pursuant to the guidelines proffered in Section 5, because the Nurse Practitioner’s panel of patients is full (capped at 100 patients or fewer), or because the patient requires medical care not within the Nurse Practitioner’s scope of services.

    • Patient agrees to disclose all information relating to their health conditions and to actively collaborate with my provider to understand my treatment options and develop the best course of action.

    • Patient understands that their enrollment in Plant Based NP, LLC is a commitment to their ongoing health and wellness. Patient agrees to commit to the plans for their medical care which have been agreed upon by the patient and provider.

    • Patient agrees that they will be forthright with regard to their prescription medications and use.

    • Patient understands it is their responsibility to inform Plant Based NP, LLC of any changes to their credit/debit card or bank account information.

    • Patient understands that they have the right to speak in confidence with their Plant Based NP, LLC provider and to have their health care information protected. Patient understands that Plant Based NP, LLC will not disclose their information without their authorization or without a legal obligation to do so. Patient also understands that they have the right to review and receive a copy of their personal medical record and may request that their health care provider amend their record if they feel it is inaccurate or incomplete by contacting their Plant Based NP, LLC provider.

    • The patient agrees that if they have a complaint about Plant Based NP, LLC, they will first notify Plant Based NP LLC directly.

13. General Provisions

    • These Medical Terms of Service make up the entire agreement relating to your use of the Services provided by Plant Based NP LLC, and supersedes all prior agreements relating to the subject matter hereof.

    • We may change, suspend, or discontinue any Services at any time. We will try to give you prior notice of any material changes to the Services we provide. We will not be liable to you or to any third party for any modification, suspension, or discontinuance of our Services.

    • We may change, suspend, or discontinue any of our partnerships, including health system partnerships, at any time. We will provide you with notices of such changes as applicable.

    • These Nurse Practitioner Terms of Service do not confer any third-party beneficiary rights. You may not transfer any of your rights or obligations under these Medical Services Terms to anyone else without our consent. Plant Based NP LLC may assign our rights in connection with a merger, acquisition, sale of assets, or by operation of law or otherwise.

    • Even after termination, these Nurse Practitioner Terms of Service will remain in effect such that all terms that by their nature may survive termination will survive such termination.

14. If you have any questions about these Medical Terms of Service, please contact: patient@plantbasednp.com