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. There are limitations or risks related to receiving services through telehealth as compared to an in-person visit as described below.
I hereby consent to participate in a virtual rehabilitation, education, and lifestyle medicine program offered by Medical Group (the “Program”). The Program may include, depending on the specific program in which I am enrolled, telemedicine visits, vital sign monitoring, supervised physical exercise, nutritional counseling, stress management, smoking cessation, group education, and other health-related activities. The intensity and content of the activities I perform will be based on my clinical condition as determined by my care team. 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.
Services may be provided by different members of the care team acting within the scope of their professional licensure or certification and under applicable supervision requirements.
In the course of my participation in exercise, I will be asked to complete the activities unless such symptoms as fatigue, shortness of breath, chest discomfort, or similar occurrences appear. At that point, I have been advised that it is my complete right to stop exercise and that it is my obligation to inform the program personnel of my symptoms. I recognize and hereby state that I have been advised that I should immediately upon experiencing any such symptoms inform the program personnel of my symptoms. I understand that during the performance of in home exercise, a trained observer may periodically monitor my performance and monitor my vital signs, or make other observations for the purpose of monitoring my progress and/or condition. I also understand that the observer may reduce or stop my exercise program when findings indicate that this should be done for my safety and benefit.
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. Every effort will be made to minimize these occurrences through risk stratification, proper staff assessment of my condition before each exercise session, staff supervision during exercise, and my own careful control of exercise effort. Additional risks specific to my program are described in Section 2 below.
I understand that no exercise or rehabilitation program is risk-free and that outcomes are not guaranteed. I understand and accept that virtual care has associated risks as compared with in-person healthcare. It may be more difficult for a clinician to complete a physical examination or manage certain complaints or urgent problems, in which case I may be referred to in-person or emergency care. I accept that there is an increased risk of miscommunication with my healthcare provider, an increased risk of interception of electronic communications, and additional uncertainties related to my privacy. If I become uncomfortable with these limitations, I may terminate the session at any time. I understand that virtual care is not the same as in-person healthcare and that if my clinician determines I would be better served by in-person care, I may be asked to seek such care at an appropriate location.
Technical Failures. I understand that technical failures, internet interruptions, device malfunctions, or platform outages may delay or interrupt virtual services or the transmission of monitoring data. Medical Group is not responsible for events caused by such failures outside its reasonable control. If a session is interrupted by a technical failure, I will follow my care team’s reconnection instructions, and I will seek emergency medical care directly if I am experiencing or believe I may be experiencing a medical emergency.
I am responsible for maintaining a private and secure environment for my virtual care sessions. I should participate from a private location where other people cannot overhear my session and should use a private and secure internet connection. Public Wi-Fi connections should not be used. There is a small risk that someone could use technology to intercept a session despite the platform’s security safeguards.
State Law Compliance. Certain state laws may provide additional rights related to telehealth services. To the extent required by applicable state law, Medical Group will comply with such requirements, and the terms of this consent will be construed consistent with applicable state and federal law.
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 while we coordinate with your cardiologist, pulmonologist, or other physician to gather more information on your condition to ensure you can safely participate in our program. During the CCM program, your dedicated care management team will keep you informed and design a care plan for you. You have the right to withdraw from the CCM program at any time by notifying your care team. 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. You will be asked to wear the device during sleep to monitor blood oxygen levels throughout the night. This data is essential for assessing respiratory patterns during sleep and ensuring effective rehabilitation and treatment strategies.
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. If you choose to withdraw, please notify your care team so that appropriate action can be taken.
RPM Device Responsibility. I understand that I will be provided with remote monitoring devices as part of the Program. I am the only person who should use these device(s), and I will use them only as instructed and only for my own personal health monitoring. I will not transfer or share the device(s). I am aware that readings transmitted from RPM device(s) to Medical Group’s software platform are transmitted in a manner intended to be safe and secure, but no electronic transmission is entirely free of risk.
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.
Medical Group monitors certain vital sign alerts generated by remote patient monitoring devices, such as those from self-guided exercise sessions, daily check-ins, overnight pulse oximetry, or ECG monitoring. These alerts are not monitored continuously in real time. Instead, they are reviewed on demand, typically within one (1) business day.
Do not assume that your vital signs are being monitored at all times outside of live, supervised exercise sessions. You are responsible for monitoring your own condition between sessions.
If you experience chest pain, severe shortness of breath, dizziness, loss of consciousness, or any other concerning symptom:
● During a live supervised session: Immediately stop all activity and inform your Carda Health provider or exercise physiologist.
● Outside a live supervised session: Call 911 (or your local emergency number) immediately and follow emergency personnel instructions.
For non-emergency medical questions, contact your provider or care team. I understand and acknowledge that:
● Continuous monitoring does not occur outside of active, supervised session times.
● I understand that Medical Group does not provide continuous real-time monitoring outside of active supervised sessions and that delays in review of remotely transmitted data may occur. I acknowledge that I remain responsible for seeking emergency medical care when appropriate and for following the emergency procedures described in this Agreement.
● If I have questions about when monitoring is active, I may request confirmation from my provider or care team.
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. Many individuals in such programs also show improvements in their capacity for physical work. For those who are overweight and able to follow the physician and exercise physiologist’s recommended dietary plan, the Program may also aid in achieving appropriate weight reduction and control. I acknowledge that the Program is not risk-free and that clinical results are not guaranteed or assured.
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:
● Assessing, treating or providing other health related services by using virtual internet or telephone communication strategies (Telehealth).
● Providing treatment outcomes and identifying future rehab services that may be provided.
● Enabling an insurer or funder to determine any potential funding coverage further to my claim.
● Seeking payment for the services I received.
● As more fully described in Medical Group’s Notice of Privacy Practices.
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, including my rights to inspect and copy my protected health information, to request restrictions, to request confidential communications, to request an amendment, to receive an accounting of certain disclosures, and to receive notice of a breach. I understand that Medical Group may amend its Notice of Privacy Practices from time to time and that I may obtain a current copy upon request.
If people are close to you during a session, they may hear something you did not want them to know. You should be in a private place so other people cannot hear you. Your provider will tell you if someone else from their office can hear or see you.
Recording, Transcription, and AI-Assisted Documentation.
For quality assurance, training, and program improvement purposes, some virtual care sessions may be monitored and/or recorded. We may also use secure automated transcription tools, including artificial intelligence (“AI”) technology, to assist in creating and maintaining accurate clinical documentation. Recordings and transcripts will be stored securely in accordance with HIPAA and applicable state privacy laws and will only be accessed by authorized personnel. I understand that AI tools are used to assist clinicians and do not replace clinical judgment. If you do not wish to have your session recorded or monitored, please contact your clinician prior to your scheduled session so that alternative arrangements can be made.
I authorize my treating provider(s) and their authorized agents to use or disclose my personal information and my personal health information to any other parties involved in my healthcare as reasonably required. Such parties may include a physician, another healthcare provider, an additional member of Medical Group’s treatment team, relevant funders or payors, referral sources or my employer if it relates to the demands of my job, my functional ability or my ability to return to work. I have been informed that the information obtained from this rehabilitation program will be treated as privileged and confidential and will consequently not be released or revealed to any person without my express written consent. I do, however, agree to the use of de-identified information for research and statistical purposes as long as it does not identify my person or provide facts that could lead to my identification. I agree that Medical Group may use my email address and other contact information as a means of providing me information regarding my healthcare, including Telehealth, exercise progressions, appointment bookings and account notifications.
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. I understand that I may opt-out by replying STOP or reply HELP to receive more information. Message frequency varies. Message and data rates may apply. I acknowledge I have received, read, and agree to Medical Group’s Privacy Policy to learn how my data is used.
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. I agree that electronic signatures shall have the same force and effect as original handwritten signatures, and that electronic records and communications shall satisfy any requirement that such notices, agreements, disclosures, or other communications be in writing. I further consent that medical records released to or by Medical Group may be transmitted and stored electronically.
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. I understand that Medical Group will send my medical information to my insurance company. I must pay my share of the costs. I must pay for the cost of the care I receive if my insurance company does not pay or I do not have insurance. I understand that I have the right to say no to any treatment or procedure. I have the right to discuss all medical treatments with my provider. I have the right to ask about costs before I am treated.
Insurance covers the rehabilitation services for certain indications and each insurance company has its own set of coverage criteria. You should discuss coverage with your insurance provider.
Assignment of Benefits. I certify that the health insurance information I provide to Medical Group is accurate, and I am responsible for promptly notifying Medical Group of any changes. I assign to Medical Group the right to receive payment of insurance benefits otherwise payable to me for services provided by Medical Group under any medical insurance plan, health benefit plan, or other source of payment for healthcare services (including Medicare). I authorize Medical Group to submit claims on my behalf and authorize my plan to release to Medical Group information necessary to process such claims. I instruct my plan to pay Medical Group directly. To the extent direct payment is prohibited, I instruct my plan to make the check payable to me and mail it directly to Medical Group, and I agree to promptly sign over such payment to Medical Group.
1.10 Medical Records Release Authorization I authorize the release of the items below (as applicable to my program). I understand these records will only be used to aid in my treatment and will not be released to any person or agency without my authorization:
● Most recent doctor’s note
● EKG, echocardiogram, stress test and catheterization report
● GOLD grouping, 6MWT, spirometry, DLCO, and other relevant pulmonary function testing
● Discharge summary
● Medical history, including medication list
1.11 Acknowledgment of Universal Terms
I acknowledge that I have read this consent in its entirety. I further understand that there are remote risks other than those previously described that may be associated with this program. Despite the fact that a complete accounting of all remote risks is not entirely possible, I am satisfied with the review of these risks that was provided to me, and it is still my desire to participate.
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. If I am enrolled in more than one program, the terms for each applicable program apply. Program Transitions. I understand that I may transition between Carda programs over time based on my clinical condition, physician recommendations, or payer eligibility requirements, and that the applicable program-specific terms in Section 2 will apply during my participation in each such program. A new written consent is not required for such transitions unless Medical Group determines one is necessary.
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, including but not limited to: shortness of breath, oxygen desaturation, bronchospasm, acute exacerbation of COPD or other underlying pulmonary disease, respiratory failure, hypoxemia, dizziness or syncope related to low oxygen levels, and, in rare cases, respiratory arrest or death. I agree to stop any activity and notify Program personnel immediately if I experience worsening shortness of breath, chest tightness, wheezing, cyanosis (bluish discoloration of lips or fingertips), confusion, or any other concerning symptom.
Pulse Oximetry and Oxygen Monitoring.
If eligible, I will be provided with a continuous oxygen saturation (pulse oximetry) device for use during supervised sessions and, where clinically indicated, for overnight pulse oximetry readings. I agree to wear the device as instructed, including during sleep when prescribed, to monitor blood oxygen levels. This data is essential for assessing respiratory patterns and for adjusting my rehabilitation and treatment plan. I understand that the pulse oximetry device is an adjunct to clinical care and is not a substitute for emergency medical evaluation when symptoms occur.
Oxygen Equipment Safety.
If I use supplemental oxygen during the Program, I agree to: (i) follow my prescribing physician’s instructions for oxygen flow rate and duration; (ii) keep oxygen equipment away from open flames, smoking materials, and high-heat sources; (iii) ensure adequate ventilation and avoid use of petroleum-based products on or near oxygen equipment; (iv) inspect tubing and connections before each use; and (v) immediately notify my care team of any equipment malfunction or change in my oxygen needs. I understand that improper use of oxygen equipment poses a fire and burn hazard.
COPD Exacerbations and Symptom Escalation.
I will promptly notify Medical Group of any increase in cough, sputum production, change in sputum color, new fever, increased shortness of breath at rest, or any other sign of a possible exacerbation. If symptoms are severe or rapidly worsening, I will call 911 or seek emergency care rather than wait for the next Program session. I understand that Medical Group does not provide continuous real-time monitoring outside of supervised sessions and that I am responsible for monitoring my own condition between sessions, consistent with Section 1.4.
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, which may include telemedicine visits, cardiovascular monitoring, supervised physical exercise, dietary counseling, smoking cessation, stress reduction, and health education. The levels of exercise I perform will be based on the condition of my heart and circulation as determined by my care team. I understand that cardiac rehabilitation involves exercise-induced cardiac risks, including but not limited to: abnormal heart rhythms (arrhythmias), abnormal increases or decreases in blood pressure, angina or chest discomfort, lightheadedness or syncope, myocardial infarction (heart attack), stroke, and, in rare cases, sudden cardiac death. Every effort will be made to minimize these risks through risk stratification, pre-session assessment, staff supervision during exercise, and my own careful control of exercise effort.
Arrhythmia and ECG Monitoring Limitations.
If I am provided with an ECG or heart-rate monitoring device, I understand that data from such devices is reviewed on demand by Medical Group personnel, typically within one (1) business day, and is not continuously monitored in real time. ECG and heart-rate data collected outside supervised sessions may be reviewed retrospectively. If I experience palpitations, irregular heartbeat, fainting, near-fainting, chest pain, or severe shortness of breath outside a supervised session, I will call 911 and not rely on the device to alert Medical Group.
Symptom Escalation.
I agree to stop exercise and notify program personnel immediately if I experience chest pain or pressure, unusual shortness of breath, dizziness, lightheadedness, palpitations, leg pain or swelling, or any other concerning symptom. I follow the emergency protocol set forth in Section 1.4.
Adherence and Medication.
I am expected to attend the prescribed sessions and to follow my care team’s instructions regarding any prescribed medications, exercise, diet, stress management, and smoking cessation. I will inform Medical Group of any changes to my medications or medical condition.
2.C Intensive Cardiac Rehabilitation (ICR) Program
If I am enrolled in Carda’s Intensive Cardiac Rehabilitation Program, delivered in collaboration with Dr. Dean Ornish Lifestyle Medicine, PC pursuant to the Ornish Lifestyle Medicine Program curriculum (the “ICR Program”), I consent to the following program-specific terms in addition to the Universal Terms in Section 1 and the Cardiac Rehabilitation terms in Section 2.B.
Structured ICR Curriculum and Group Sessions.
The ICR Program treatment plan includes four equally weighted elements: physical exercise, stress management, group support, and nutrition. The ICR Program is delivered in scheduled, real-time (live), virtual group sessions via a HIPAA-compliant video platform, typically in 4-hour sessions, twice each week, for nine weeks, for a total of 72 hours (18 sessions). I will be enrolled in a cohort with other patients. Program staff will provide education and experiential sessions and will monitor my response and progress.
Physician Review and Appropriateness for Enrollment.
Before I am enrolled in the ICR Program, the clinical team will meet with me to discuss my health and medical history and to review my medical records to confirm my physician’s assessment that it is safe and appropriate for me to enroll in this virtual program. The ICR Program is physician-directed: all therapeutic decisions regarding my health and medical care remain the responsibility of my personal physician and treating providers.
Individualized Treatment Plan.
If I am enrolled, the clinical team will create an individualized treatment plan for me based on the evidence-based Ornish Lifestyle Medicine Program guidelines, my physical status, my medical history, and my medical test results. I will receive clear instructions regarding the amount and kinds of exercise I should do, as well as dietary guidelines, stress management techniques, and group support. Program staff will adjust my treatment plan based on my progress and response.
Attendance and Adherence Expectations.
I understand that regular attendance and adherence to the treatment plan are essential to maximize the potential benefits of the ICR Program. While my participation is voluntary and I may withdraw at any time without penalty, I agree to prioritize attendance and to follow Program staff instructions regarding exercise, nutrition, stress management, and group support activities.
Emergency Support / Lifestyle Partner Recommendation.
I agree to identify a “Lifestyle Partner” — an adult family member or friend — and to provide that person’s name and cell phone number to Medical Group. I will make every reasonable effort to have my Lifestyle Partner available and present at my location during ICR Program sessions in case I need assistance. I will notify the clinical team in advance of any change to my location, emergency contact, or Lifestyle Partner. I accept full responsibility for my own health and well-being regardless of whether the Lifestyle Partner is present. In the event of a medical emergency during a session, Medical Group may call 911 on my behalf. I understand that the presence of a Lifestyle Partner is in addition to, and not a substitute for, the emergency procedures described in Section 1.4.
Virtual vs. Facility-Based Monitoring Differences.
I understand that the ICR Program is delivered virtually and that monitoring during virtual sessions differs from monitoring in a facility-based setting. In a facility-based ICR program, clinical staff are physically present and can directly observe and respond to clinical events. In the virtual ICR Program, staff observe me remotely via video and rely on my self-report, on my Lifestyle Partner, and on any remote monitoring devices that may be in use. I understand that response times in a virtual setting depend on emergency medical services in my location and on the availability of my Lifestyle Partner.
Group Sessions and Cohort Confidentiality.
I understand that the ICR Program is a group experience. I agree to respect and maintain the privacy and confidentiality of other cohort members — “what is discussed in the group stays in the group.” I will not disclose to any third party the identity of, or any information shared by, any other cohort member. While Medical Group requires participants to maintain confidentiality, Medical Group cannot guarantee that other participants will comply with these obligations, and I should share only information I am comfortable sharing in a group setting. I further understand that any discussion, comments, suggestions, or peer support shared by other participants during group sessions are educational and supportive in nature, are not individualized medical advice, and should not be relied upon as a substitute for the clinical advice of my own physician or treating providers.
No Recording, Screenshots, or Sharing.
To maintain confidentiality, I agree not to: (i) share any ICR Program session link with anyone not authorized to attend; (ii) record (audio or video), photograph, screenshot, or otherwise capture any session content; or (iii) share any session information that may compromise the privacy of any group member. I further agree that during ICR Program sessions, no person other than me and my Lifestyle Partner will be present in the room or area where I am connected. Violation of these rules may result in removal from the ICR Program.
Proprietary Materials.
The resources and documents on the Empower learning management system and other ICR Program materials are proprietary. They are provided to me as an enrolled participant to support my learning and lifestyle changes. I will not download, distribute, or share these documents or resources with anyone other than my Lifestyle Partner.
Technology Requirements.
Participation in the ICR Program requires access to a laptop computer or tablet with a camera and a reliable, secure, and private internet connection. To maintain privacy, public Wi-Fi connections should not be used.
No Guarantee of Outcomes.
I understand and acknowledge that the ICR Program is not risk-free and that clinical results are not guaranteed or assured. Outcomes vary based on individual factors including but not limited to underlying health conditions, adherence, and external circumstances.
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. I have read this document carefully, understand the potential limitations and risks of receiving services via Telehealth, and have had my questions answered to my satisfaction. I also acknowledge I have received, read and agree to the Terms of Service, Privacy Policy, Consent Terms, and Notice of Privacy Practices. I understand that this consent will remain in effect while I am enrolled in any Carda Health program and does not replace any previously signed consent that remains in effect. I have the right to decline to participate or to withdraw my consent at any time. Withdrawing consent does not alter financial responsibilities for services already rendered.