Terms & Conditions

1.1 Contracting parties

This agreement is between the individual identified at enrollment, referred to as the Member or you, and the legal entity identified at enrollment doing business as Pure Access Health, referred to as PAH or we. A person paying for another adult's membership is a financial sponsor only unless that person has separate lawful authority to make health care decisions or receive health information. Each adult member has an individual clinical relationship and privacy rights.

Membership rights and privileges are personal to the enrolled Member and are nonassignable and nontransferable. The Member may not transfer, delegate, sublicense, share, or permit any family member, friend, acquaintance, or other nonmember to exercise or receive any right, privilege, service, clinical access, consultation, recommendation, advice, prescription-related assistance, or other benefit provided by PAH under the Member's membership. The clinical and contractual relationship created by these Terms exists solely between PAH and the enrolled Member. Information or advice provided by PAH for a Member's care may not be treated as individualized medical advice for a nonmember, and the Member is not authorized to obtain or relay PAH advice on behalf of a nonmember as a substitute for that person's own clinical relationship.

1.2 Formation and effective date

Membership begins on the effective date entered at enrollment after PAH accepts enrollment and the parties complete the required documents and payment arrangements. A website inquiry, payment attempt, application download, or unsolicited message alone does not establish acceptance. PAH will communicate acceptance or rejection and return any payment collected for an enrollment it does not accept. These formation provisions do not eliminate obligations arising from clinical care actually undertaken.

1.3 Adult eligibility and identity

PAH's membership program is for adults age 18 and older. You must provide accurate identifying and contact information and information necessary for safe treatment. PAH may verify identity, decision-making authority, and eligibility for a discounted category. Enrollment depends on practice capacity, the services offered, and PAH's ability to provide appropriate care. Enrollment decisions must comply with applicable nondiscrimination requirements.

A guardian or healthcare agent must establish the scope and current effectiveness of the authority claimed. A financial power of attorney does not necessarily authorize healthcare decisions or access to medical records. Reasonable alternative identity verification will be considered when standard identification is unavailable.

1.4 Individual membership

Membership is personal and may not be shared, sold, transferred, or used to obtain care, prescriptions, testing, or medications for a nonmember. A relative, spouse, employer, or student sponsor does not receive clinical access through another person's account. General public education and legally required emergency or professional duties are not converted into membership benefits by this provision.

1.5 Relationship among documents

These terms, the completed enrollment schedule, and separately obtained applicable consents form the agreement. A service-specific consent governs that service. The Notice of Privacy Practices explains applicable privacy practices and rights and is not a blanket authorization for otherwise restricted disclosures. Included benefits must be identified accurately before enrollment. An expressly accepted individualized amendment controls over an inconsistent general term, subject to mandatory law. Mandatory law and nonwaivable rights control. A separately executed Medicare private contract governs matters within its scope; a specific clinical consent or disclosure authorization governs its particular subject. The completed enrollment schedule governs the selected commercial terms. PAH will expressly identify any earlier membership agreement being replaced and its replacement date. These provisions do not excuse a misleading statement in marketing or permit an undisclosed service limit or charge.

1.6 No waiver of professional duties

Membership purchases access to defined services; it does not buy a particular diagnosis, prescription, certification, referral, or outcome. Clinicians retain independent professional judgment. Nothing in these terms reduces the applicable standard of care or removes rights that cannot lawfully be waived. The Member may seek other clinicians and may decline proposed care after discussion of the reasonably foreseeable consequences. Care may be provided by appropriately licensed PAH clinicians or lawful coverage arrangements. PAH will identify the responsible clinician and explain material coverage changes. Membership does not guarantee that a named physician personally performs every service or remains available during every absence.

2.1 Included primary care

Within the completed service schedule and the clinician's scope of practice, membership may include preventive visits, evaluation of common acute concerns, chronic disease management, medication review, health counseling, routine follow-up, and coordination with other clinicians. In-person appointments, telephone consultations, secure messages, and video visits are used as clinically appropriate. Access is based on medical need and safe scheduling, rather than a promise that every concern can be handled through the Member's preferred format. PAH will not impose an undisclosed numerical visit cap. Any actual visit or service limit must be stated in the completed enrollment schedule. Visit length and scheduling reflect clinical need, safe capacity, and the needs of other members.

2.2 Office procedures and testing

Based on appropriate clinical indications and the clinician's professional judgment, a baseline EKG and/or spirometry may be provided as part of the Member's care. These services are not guaranteed benefits of Membership and will be performed only when clinically appropriate and when the necessary equipment, supplies, and qualified personnel are available. Membership does not create an entitlement to an EKG, spirometry, or any particular diagnostic test or procedure.

2.3 Reduced-cost arrangements

PAH has made certain laboratory services, imaging services, and medications available to Members at reduced and low cost. Availability, pricing, participating vendors, and clinical eligibility may vary and are subject to change. Reduced-cost arrangements do not guarantee the lowest available price or insurance reimbursement. Members remain free to use an outside laboratory, pharmacy, imaging center, or other healthcare provider of their choice.

2.4 Services outside the membership

Unless explicitly included at enrollment, membership excludes hospital and emergency department care, ambulance services, surgery, anesthesia, specialty consultations, advanced imaging, outside laboratory analysis, outside pharmacy charges, rehabilitation, durable medical equipment, home health, nursing facility care, and third-party facility fees. Membership does not include hospital privileges, round-the-clock bedside attendance, or responsibility for an outside clinician's decisions. Referral and coordination do not make PAH financially responsible for outside services.

Also excluded are obstetrical delivery, dental care, comprehensive vision care, inpatient psychiatric care, residential substance-use treatment, and services outside PAH's licensed capabilities. An outside service may generate separate facility and professional bills. PAH remains responsible for its own clinical decisions, referral communications, and follow-up duties.

2.5 Behavioral health and specialized needs

Primary care may include assessment and treatment of appropriate mental or behavioral health concerns within the treating clinician's competence. Membership does not promise comprehensive psychiatry, psychotherapy, detoxification, inpatient psychiatric care, or crisis response. Complex conditions may require specialist involvement or a different level of care. Any hormone, supplement, or other specialized service must be within the written scope and satisfy the prescription provisions below.

2.6 Forms and administrative services

Routine medically appropriate paperwork associated with PAH care may be provided within the scope stated at enrollment. Disability determinations, fitness-for-duty evaluations, extensive record reviews, legal testimony, depositions, occupational examinations, and certifications outside PAH's expertise are not automatically included. PAH may require an appointment, supporting records, or referral. No certification of an unsupported fact or retroactive excuse is guaranteed. Any separate fee must be disclosed and accepted before the work is undertaken.

3.1 Membership price and recurring term

The selected rate, billing interval, first payment date, and renewal date are supplied at enrollment. Fees pay for membership access and included services during the applicable period and are due even if no appointment is used. There is no minimum membership term. Monthly membership continues until terminated under Article IV. An annual prepayment is a payment option and does not remove the right to cancel. PAH will provide a copy of the completed price and renewal disclosures before charging. Annual prepayment does not automatically renew. Before collecting payment for a new annual term, PAH obtains a new affirmative annual election; conversion to monthly billing requires a separate affirmative monthly election and appropriate payment authorization. If no election is made, PAH will give expiration and care-transition instructions. A prepaid period is not repriced retroactively.

3.2 Payment authorization

Recurring charges require separate authorization through the secure payment process described in Article XVII. PAH will use payment information only for authorized charges. You must keep payment details current or arrange an accepted alternative. Withdrawal of an electronic payment authorization stops future debits as required by law but does not itself cancel membership or forgive an otherwise valid balance. Conversely, valid cancellation does not depend on completing a retention call or providing a reason.

A request that clearly both revokes automatic payment and cancels membership will be treated as both requests; PAH will not demand a second form. Any otherwise lawful final balance is itemized separately and is not debited under a revoked authorization. PAH may not switch to another payment instrument without authorization.

3.3 Additional charges and billing questions

Separate charges must be identified in the service schedule or disclosed before the Member agrees to the item or service. PAH will provide an itemized explanation on request. No undisclosed cancellation penalty, retroactive enrollment fee, or automatic conversion of a discounted plan into a higher rate will be imposed. Members should report suspected billing errors promptly; doing so does not waive statutory dispute, cardholder, or bank rights. PAH will investigate disputed amounts and correct substantiated errors.

3.4 Late or unsuccessful payments

PAH will give notice of an unsuccessful payment and a reasonable opportunity to correct it. Nonpayment may lead to termination only through the applicable notice and care-transition process. Administrative account restrictions must not improperly obstruct urgent clinical follow-up or access to medical records. Any returned-payment charge or late fee must be separately disclosed, lawful, and expressly accepted; no such fee is created solely by this paragraph.

3.5 No insurance billing

PAH does not bill health insurance at all. Membership is not an insurance policy, a health maintenance organization contract, or a promise to pay third-party claims. You should maintain appropriate separate coverage for care beyond PAH. Outside providers may bill your insurance under their own arrangements. PAH does not guarantee that membership fees, prescriptions, referrals, or outside services will be covered, credited to a deductible, or reimbursed. An invoice is not a representation that an insurer must pay it.

3.6 Public programs and tax arrangements

Medicare and Medicaid enrollment require individual review before PAH accepts payment for services subject to those programs. A generic membership agreement does not substitute for any required Medicare opt-out affidavit or private contract. PAH will not collect fees prohibited by a public program. HSA, FSA, HRA, employer, and cafeteria-plan treatment depends on the actual arrangement and applicable rules. PAH does not promise tax eligibility; member-only separately charged items may prevent the arrangement from satisfying the federal DPC definition. Employer-paid expenses cannot also be claimed as the Member's unreimbursed expense. Medicaid managed care, dual eligibility, TRICARE, and other public programs require program-specific review. Declining to bill a program does not by itself permit private collection from its beneficiaries. The treating clinician's Medicare status and any required private contract must be confirmed before covered services are provided under a private-pay arrangement. This agreement is not a Medicare private contract. Eligibility to contribute to an HSA and eligibility to reimburse a fee from an HSA are different questions. Federal changes beginning in 2026 do not make every DPC arrangement eligible. PAH's separately charged member-only benefits require particular review. Acceptance of a payment card or a patient's choice not to use a benefit does not establish tax qualification.

3.7 Price changes and estimates

PAH will give at least 60 calendar days' written notice of a proposed recurring price increase or material reduction in included services, unless a different mandatory rule applies. A Member who submits cancellation before the change takes effect may finish the 30-day transition at the prior price. Changes are prospective. Where applicable, PAH will provide uninsured or self-pay good faith estimates and information about billing-dispute rights. An estimate does not replace disclosure of the recurring membership charge. For qualifying uninsured or self-pay services scheduled 3–9 business days ahead, the good faith estimate is generally due within one business day of scheduling; for services scheduled at least 10 business days ahead, or an estimate requested before scheduling, it is generally due within three business days. An estimate describes expected charges and does not compel treatment.

A qualifying patient may use the federal patient-provider dispute process when a provider's bill is at least $400 above that provider's good faith estimate, subject to eligibility and filing rules, generally including filing within 120 calendar days of the initial bill. An internal billing discussion does not pause an external deadline. CMS assistance is available at 1-800-985-3059 or cms.gov/medical-bill-rights. Employer or other sponsorship does not authorize automatic conversion to personal payment. If sponsorship ends, PAH will explain the effective date, available individual plans, and transition arrangements, and obtain a new personal payment authorization before charging the Member. A separate sponsor agreement must define the sponsor's obligations; this agreement does not create an employer benefit plan or authorize sharing individual clinical information with the sponsor.

4.1 Cancellation by the Member

The Member may cancel at any time by written notice to PAH. There is no minimum membership term. Notice may be provided through the designated secure portal, the cancellation email at enrollment, or written delivery to the designated practice address. A clear written statement that the Member wishes to end membership is sufficient; no special wording or explanation is required. A legally authorized representative may act when appropriate. PAH will provide an accessible alternative when needed. PAH will also honor any cancellation method required by applicable law, including an appropriate electronic method when enrollment occurred electronically. A clear request received by appropriate PAH staff will be routed rather than rejected for an immaterial addressing error. Identity checks must not become an unreasonable obstacle. A disputed balance does not prevent submission of cancellation.

4.2 Additional thirty day term

The date PAH receives written notice is the notice date. Membership continues for an additional thirty (30) calendar days after that date, and the Member remains responsible for the applicable membership fee through the termination date. Membership benefits remain active during that period. The date of receipt is day zero; termination occurs at the end of day thirty. For example, notice received September 20 results in termination at the end of October 20. PAH will send written confirmation of receipt, the termination date, and the estimated final balance.

4.3 Purpose and limits of the transition period

This additional period supports completion of pending paperwork, coordination of care, appropriate prescription-related matters, medical-record responsibilities, and reasonable administrative, professional, legal, and regulatory obligations associated with concluding active care. The paid 30-day period is a contractual PAH policy; it is not represented as a universal Maryland or federal requirement. It is not an additional administrative penalty. Record retention, lawful disclosures, and other duties may continue after membership ends without creating additional recurring membership charges.

4.4 Final accounting and prepaid amounts

Payments already covering any part of the final 30 days will be credited. PAH will charge only the uncovered portion through the termination date and will not round the obligation up to an extra full billing cycle. For monthly billing, partial-cycle fees are prorated using the applicable monthly fee divided by the actual number of days in that billing cycle. For an annual prepayment, the earned amount is the prepaid annual fee multiplied by elapsed covered days divided by total days in that prepaid term. Any unused balance after the termination date is refundable; no retroactive loss of the annual discount applies. Any transition days beyond a prepaid annual term are charged at the equivalent daily annual rate. PAH will issue a final statement and any refund within 30 calendar days after termination, or sooner if required by law.

4.5 Termination by PAH with or without cause

PAH may terminate membership with or without cause for any lawful, nondiscriminatory, nonretaliatory reason, subject to professional duties, appropriate notice, continuity of care, and avoidance of patient abandonment. Reasons may include nonpayment, threatening conduct, misuse of services, materially false information, a breakdown of the therapeutic relationship, practice closure, or a clinical need beyond PAH's capabilities. PAH ordinarily will provide at least 30 calendar days' written notice and will allow additional transition time when legally or clinically required. PAH will not impose the Member-initiated additional 30-day obligation as a separate penalty when PAH initiates termination.

4.6 Safety restrictions and transition responsibilities

Credible threats, violence, or serious safety risks may require immediate restrictions on office entry or communication channels. Those restrictions do not automatically erase clinical or record-transfer duties. PAH will determine safe arrangements, provide available transition instructions, and refund unearned fees when contracted access is discontinued. During an ordinary notice period, PAH will address appropriate urgent primary care needs, pending results, and reasonable transition matters within its scope. New long-term treatment may be deferred or transferred when starting it would be unsafe.

4.7 After termination and reenrollment

After the termination date, new routine membership services and recurring membership charges cease. Properly incurred balances remain payable, and record access remains available under applicable law. Pending results will be handled and transferred appropriately rather than ignored because membership ended. Reenrollment is subject to capacity and PAH's then-current written policy, including any disclosed waiting period; acceptance is not guaranteed and no new fee may be charged without disclosure. No fixed reenrollment waiting period is established by these Terms. Any subsequently adopted waiting period must be disclosed before it applies and must be lawful and nonretaliatory. PAH cannot guarantee another clinician's acceptance or a prescription beyond what is safe and lawful.

5.1 Business hours and appointments

Regular office hours, contact channels, holiday coverage, and urgent contact instructions are supplied at enrollment and the current practice notices. Routine visits, medication requests, forms, billing questions, and nonurgent messages should be addressed during business hours. Same-day or next-day appointments are access goals, subject to clinical triage and capacity, and are not unconditional guarantees. PAH may recommend a different location or level of care when clinically appropriate.

5.2 After hours boundaries

After-hours communications, generally approximately 5:00 PM to 9:00 AM Eastern Time and during weekends or office closures, are reserved exclusively for urgent medical concerns that cannot safely wait until normal business hours. Routine prescription refills, pill-count questions, paperwork, scheduling, and billing matters should be addressed during normal business hours. This does not promise continuous coverage or immediate response. For a medical emergency or potentially life-threatening condition, CALL 911 or seek immediate care at the nearest emergency department; do not wait for a PAH response. If outside the United States, call the local emergency number. A sent, delivered, or read indicator does not prove that a clinician has evaluated the issue.

5.3 Clinician unavailability

A clinician may be temporarily unavailable due to a personal medical problem, family illness or emergency, vacation, continuing education, another patient's needs, or a technology failure. PAH will communicate planned closures and available alternatives when practicable. An unexpected absence may prevent immediate response. This provision explains access limitations and does not excuse PAH from applicable professional duties or reasonable arrangements for continuity.

5.4 Emergencies

CALL 911 OR GO TO THE NEAREST EMERGENCY DEPARTMENT for an emergency or potentially life-threatening condition. Do not wait for a response from PAH by text, voicemail, portal message, email, or telehealth. Examples include possible stroke, severe chest pain, serious breathing difficulty, severe bleeding, or an immediate threat of self-harm or harm to another person. PAH is not an emergency medical service or a continuously monitored crisis line. For an urgent problem without a timely response, obtain care at an appropriate local facility.

5.5 Hospital and specialist coordination

PAH may help communicate clinical information to hospitals and specialists and review available discharge instructions. The admitting or consulting team remains responsible for its own care. The Member should promptly report an emergency visit, hospitalization, new specialist recommendation, or major medication change. Follow-up timing depends on the condition and available records. An outside provider's failure to transmit records can delay reconciliation but does not relieve PAH of duties regarding information already known.

5.6 Missed visits and interrupted access

Notify PAH promptly if an appointment cannot be kept. Repeated missed visits may prompt discussion of barriers, a revised care plan, or lawful termination if safe care cannot be maintained. Any no-show fee requires prior written disclosure and acceptance. If weather, outage, disaster, or other disruption materially interrupts access, PAH will communicate alternatives when practicable and make appropriate fee adjustments when the contracted service cannot be provided. No disruption clause waives the applicable standard of care.

6.1 Evaluation and informed decisions

The clinician determines the history, examination, testing, follow-up, and referrals necessary for safe evaluation. An in-person assessment may be required even when the Member prefers messaging or video. PAH will discuss material benefits, risks, and reasonable alternatives as appropriate to the decision. Consent to membership is not consent to every future procedure. Members may ask questions, seek a second opinion, or decline recommendations; the discussion and consequences may be documented.

6.2 Medication prescribing

Prescriptions require an appropriate clinical relationship, adequate evaluation, and compliance with applicable law. Membership does not guarantee antibiotics, sedatives, stimulants, opioid analgesics, hormones, or any requested medication. PAH may decline or discontinue a medication when contraindicated or outside its scope, while addressing any necessary safe transition. Refills may require current laboratory testing, an examination, medication reconciliation, or records from a prior clinician. Requests should be submitted before the supply runs out; no immediate refill is guaranteed.

The Member is responsible for keeping an accurate count of remaining pills and other prescribed medication supplies, tracking doses and remaining refills, and requesting renewals sufficiently in advance for review and processing during normal business hours. Members should allow for weekends, holidays, planned travel, pharmacy processing, and any required appointment, laboratory testing, or prior authorization. Do not wait until the medication has run out. Submit requests through PAH's designated refill channel and confirm pharmacy receipt when needed. Routine after-hours refills are not guaranteed. If a medication is unexpectedly unavailable or missed doses could cause harm, promptly contact PAH through its urgent channel or obtain appropriate local urgent care if a timely response is unavailable. Do not stop, ration, double, or otherwise change prescribed doses without appropriate clinical guidance. For a medical emergency or potentially life-threatening symptoms, CALL 911 or seek immediate care at the nearest emergency department; outside the United States, call the local emergency number. Do not wait for a refill request or message response. This responsibility does not relieve PAH of applicable professional duties or the need to assess a potentially dangerous interruption in treatment.

6.3 Controlled substances and hormone therapy

Controlled dangerous substances are generally not offered or routinely prescribed by Pure Access Health unless otherwise clinically indicated. After an appropriate medical history, review of available records, assessment, and clinical evaluation, a PAH healthcare provider may, in the provider's sole clinical discretion, prescribe a controlled substance when the provider determines that it is medically necessary, clinically appropriate, within the scope of PAH's services, and permitted by applicable federal and Maryland law.

Membership in PAH does not create any entitlement or guarantee to receive a controlled substance, a particular medication, dosage, quantity, refill, or duration of therapy, regardless of whether the medication was previously prescribed by another healthcare provider. PAH may require an in-person evaluation, diagnostic testing, review of prescription-monitoring information, medical records, a controlled-substance agreement, or referral to an appropriate specialist before prescribing or continuing such medication.

Testosterone and other controlled medications may be prescribed when clinically appropriate and legally permissible, but are not guaranteed as a benefit of membership. PAH retains sole clinical discretion to initiate, continue, modify, taper, decline, or discontinue any controlled-substance therapy consistent with applicable professional standards and law.

6.4 Dispensing and supplements

Any medication dispensed, supplied, prescribed, or otherwise made available through Pure Access Health is intended solely for the enrolled Member for whom it was clinically evaluated and authorized. Medications, prescriptions, discounted medication benefits, and other medication-related services are personal to the Member and may not be transferred, shared, resold, distributed, or obtained for any family member, friend, acquaintance, or other nonmember.

All prescribing and dispensing remain subject to the independent clinical judgment of the PAH healthcare provider and applicable federal and Maryland law. Membership does not guarantee the availability, prescribing, dispensing, refill, quantity, strength, price, or continued use of any particular medication. PAH may decline to prescribe or dispense a medication when clinically inappropriate, unsafe, outside PAH's scope, or inconsistent with law or professional standards.

When PAH offers medications at a reduced or discounted cost, availability and pricing may vary based upon medication, strength, quantity, supply, acquisition cost, and other applicable circumstances. No particular medication or price is guaranteed solely by membership. Members remain free to use an outside pharmacy.

Any office dispensing will comply with applicable licensing, permitting, labeling, storage, security, documentation, counseling, inventory-control, and recall requirements. Supplements and nonprescription products are voluntary, are not substitutes for medically indicated treatment, and remain subject to appropriate consideration of risks, benefits, contraindications, and interactions. Members must promptly report suspected dispensing errors, significant adverse reactions, medication-related safety concerns, or known recalls. Nothing in this section limits a right or protection that cannot lawfully be waived.

6.5 Testing and results

PAH will maintain a reasonable process for tracking diagnostic tests and studies ordered by PAH and for reviewing results actually received by the practice. The Member is responsible for completing recommended laboratory testing, imaging, diagnostic studies, and other evaluations within the timeframe recommended by the treating healthcare provider.

The Member should promptly notify PAH if recommended testing has not been completed, cannot be scheduled, or if an expected result has not been communicated within a reasonable period. The absence of communication from PAH must not be interpreted as confirmation that a result is normal or that no further evaluation or treatment is necessary.

Results may become available through a laboratory, imaging facility, patient portal, electronic health record, or other electronic system before review or interpretation by a PAH healthcare provider. Portal appearance does not constitute clinical interpretation, diagnosis, or confirmation of PAH review.

PAH cannot reasonably be expected to review or act upon a test, study, or result that PAH did not order and has not received or otherwise been made aware of. Members are responsible for informing PAH of clinically relevant testing performed by outside providers and, when appropriate, assisting in obtaining those records or results.

Critical, unexpected, or clinically significant findings may require additional testing, specialist evaluation, urgent care, or emergency treatment. For potentially life-threatening symptoms or circumstances, the Member must call 911 or seek immediate emergency care and must not wait for PAH to review a result or respond to a message.

Specimen collection and laboratory analysis are separate services. Testing performed directly by PAH will be conducted only within applicable federal and Maryland requirements, including applicable CLIA requirements. Collection by PAH does not necessarily mean outside laboratory analysis, imaging, pathology, or other third-party services are included. Home measurements, wearable information, automated flags, reference ranges, and patient-generated data may assist evaluation but do not independently establish or exclude a diagnosis.

6.6 Referrals and unfinished care

When PAH determines that consultation, testing, treatment, or services outside PAH's scope are clinically appropriate, PAH may recommend or refer the Member to a specialist, laboratory, imaging facility, hospital, urgent care center, emergency department, or other healthcare provider or facility.

A referral or recommendation does not guarantee appointment availability, acceptance by an outside provider, insurance authorization or coverage, a particular cost, or a specific clinical outcome. Outside providers and facilities are independent of PAH unless expressly stated otherwise and are responsible for their own clinical decisions, scheduling, billing, policies, and services.

The Member is responsible for making reasonable efforts to schedule, attend, and complete recommended referrals, consultations, diagnostic studies, and follow-up care and for informing PAH when unable or unwilling to obtain recommended outside care. Barriers involving cost, insurance, scheduling, transportation, or other circumstances should be reported so clinically reasonable alternatives may be considered when available.

PAH may provide appropriate supporting information consistent with privacy requirements. PAH does not control and is not responsible for an outside provider's scheduling, availability, billing, insurance participation, prior-authorization decisions, treatment decisions, or independent acts or omissions. Referral or coordination does not make PAH financially responsible for outside services.

If recommended care is declined, delayed, or not completed, PAH may document the recommendation, the Member's decision or known circumstances, foreseeable clinical concerns, and an appropriate follow-up plan. A referral does not automatically end PAH's involvement or eliminate professional responsibilities that remain applicable to PAH. PAH will address results and information actually received and undertake clinically appropriate follow-up within its scope. Material unresolved issues, pending results, outstanding referrals, and significant unfinished care should be identified and addressed when reasonably practicable during transfer or termination.

6.7 Limits of medical predictions

Medicine inherently involves clinical uncertainty, and no diagnosis, treatment, medication, procedure, test result, referral, or clinical outcome can be guaranteed. Individual responses vary, conditions may evolve, and diagnoses or recommendations may appropriately change as symptoms develop, additional information becomes available, or new findings are identified.

Screening, laboratory, imaging, and other diagnostic studies have inherent limitations and may produce false-positive, false-negative, indeterminate, incidental, incomplete, or unexpected findings. A normal result does not necessarily exclude disease, and an abnormal result does not necessarily establish a diagnosis.

Clinical recommendations are based upon information reasonably available at the time of evaluation. Members are responsible for providing complete and accurate information and promptly reporting material changes in symptoms, medications, diagnoses, hospitalizations, testing, or treatment received elsewhere.

Membership provides access to described services but does not purchase or guarantee any particular diagnosis, prescription, medication, controlled substance, laboratory or imaging order, referral, certification, medical opinion, disability determination, work or school excuse, treatment plan, or desired outcome. Such decisions remain subject to independent professional judgment and applicable law. PAH will not knowingly provide inaccurate or misleading records, unsupported diagnoses or certifications, medically inappropriate prescriptions, or other clinical documentation merely because a Member requests it or pays a membership fee. Nothing in this section reduces the applicable standard of care, excuses professional negligence, or waives a right that cannot lawfully be waived.

7.1 Separate telehealth consent

PAH may provide clinically appropriate healthcare services through telehealth, including synchronous audio/video encounters and, when clinically and legally appropriate, telephone or asynchronous electronic communications. Availability is determined by the treating healthcare provider based upon the Member's condition, location, technology, applicable licensing requirements, and independent clinical judgment.

Membership does not guarantee that any particular condition, symptom, medication request, diagnosis, or treatment can be evaluated or managed through telehealth. PAH may require an in-person examination, diagnostic testing, emergency evaluation, specialist consultation, or another appropriate level of care whenever telehealth is insufficient or inappropriate.

Before providing telehealth care when consent is required, PAH will take reasonable steps to verify identity, identify the treating provider and applicable credentials, obtain information necessary for safe care, and obtain and document consent required by law. Acceptance of these general Terms does not by itself constitute consent to every future telehealth encounter or replace a separate telehealth consent required by law or PAH policy.

The Member may withdraw telehealth consent prospectively as permitted by law. Withdrawal does not invalidate prior care or documentation and does not require PAH to provide remotely a service that requires in-person evaluation. When telehealth is declined, unavailable, clinically inappropriate, or legally impermissible, PAH may recommend in-person PAH care or another appropriate provider or level of care.

7.2 Location and licensure

At the beginning of each telehealth or other remote clinical encounter, the Member must accurately disclose the Member's current physical location, an appropriate callback number, and information reasonably necessary for PAH to determine applicable licensure requirements and arrange emergency assistance if necessary.

Healthcare services are generally considered to occur where the patient is physically located at the time care is provided. PAH may provide diagnosis, treatment, prescribing, or other clinical services only when the treating provider is legally authorized to provide those services in that jurisdiction and the proposed service is otherwise lawful.

PAH membership, Maryland residency, an established physician-patient relationship, or prior PAH treatment does not authorize PAH to practice medicine in another state, territory, or country where the treating provider lacks necessary legal authority. Traveling Members should disclose location before requesting clinical care. PAH may provide only legally permissible communication, general health information, coordination, review, or other assistance when full clinical care is not authorized.

PAH may decline, limit, discontinue, or redirect a remote encounter when location cannot be verified or licensing, prescribing, telehealth, professional-practice, or other legal requirements prevent safe and lawful care. When PAH cannot provide requested care because of location, the Member may be directed to an appropriately licensed local provider, urgent care center, emergency department, or other suitable resource. For an emergency or potentially life-threatening condition, the Member must contact emergency services available at the Member's actual location and must not wait for PAH.

7.3 Remote evaluation limitations

Telehealth and other remote communications have inherent clinical limitations. A remote encounter may limit or prevent a complete physical examination, independently obtained vital signs, direct observation of certain findings, diagnostic testing, or recognition of changes that could be identified during an in-person evaluation.

The treating PAH healthcare provider retains sole clinical discretion to determine whether telehealth or another remote method is appropriate and sufficient. A Member's preference for telephone, video, messaging, photographs, or another remote method does not require PAH to evaluate or treat through that method.

Information submitted remotely - including photographs, videos, home blood-pressure readings, pulse measurements, wearable-device information, glucose readings, temperature measurements, patient-generated data, or other electronically transmitted information - may assist evaluation but does not necessarily substitute for history, physical examination, diagnostic testing, or in-person assessment.

PAH may decline, stop, defer, or convert a remote encounter to in-person evaluation whenever technology, inadequate information, communication difficulty, privacy concerns, the Member's condition, inability to obtain an adequate examination, or another safety concern prevents appropriate remote care. PAH may require in-person care, laboratory testing, imaging, specialist consultation, urgent care, emergency-department evaluation, or another level of care before diagnosis, treatment changes, prescriptions, refills, forms, or certifications.

Membership does not entitle a Member to remote prescribing or any particular prescription solely because the medication was previously received, the Member was previously evaluated in person, or another provider prescribed it. Prescribing remains subject to adequate evaluation, professional judgment, applicable requirements, and law. Worsening or concerning symptoms require appropriate urgent or emergency care without relying on an unanswered message or pending telehealth encounter. Nothing in this section reduces PAH's professional obligations or standard of care.

7.4 Technology and privacy

Telehealth and electronic communications involve inherent technological and privacy limitations. PAH will use reasonable administrative, technical, and physical safeguards appropriate to the communication method and applicable law; however, no electronic communication system can guarantee uninterrupted availability or absolute security.

The Member should participate from a reasonably private and safe location, use an appropriate device and secure connection when reasonably available, and disclose any other individual participating in or able to hear the encounter. The Member should promptly inform PAH if privacy cannot reasonably be maintained. Unauthorized individuals may overhear communications, devices may display notifications, connections may fail, and electronic information may be misdirected or accessed through shared or compromised devices. Acknowledgment of these risks does not relieve PAH of applicable privacy, confidentiality, or security obligations.

A family member, friend, interpreter, caregiver, or support person may participate when appropriate and authorized, but participation does not independently authorize access to the Member's medical record, future communication on the Member's behalf, or exercise of membership rights. Members must not participate in telehealth while driving, operating machinery, or engaging in an activity or environment that materially interferes with safe evaluation and communication. PAH may terminate or reschedule an encounter when circumstances prevent safe or clinically appropriate care.

7.5 Failed connection and emergencies

A failed telephone, video, portal, internet, or other electronic connection does not mean that a clinical concern has been evaluated or resolved. If a remote encounter is interrupted, PAH may attempt to reconnect or use the callback information provided and may determine whether the encounter should continue remotely, be rescheduled, be converted to in-person evaluation, or be referred to another appropriate level of care.

The Member remains responsible for obtaining appropriate medical attention when a connection cannot be restored and the clinical situation cannot safely wait. Electronic communications with PAH are not continuously monitored emergency services. A sent, delivered, opened, or read notification does not establish that a PAH healthcare provider has clinically reviewed or acted upon the Member's message.

For an emergency or potentially life-threatening condition, the Member must call 911 or the emergency service applicable to the Member's actual location or proceed to an appropriate emergency department and must not wait for PAH to answer a telephone call, text, portal message, email, or telehealth request. When legally permitted and clinically appropriate, PAH may contact emergency medical services, another healthcare provider, or an appropriate emergency contact when reasonably necessary to address an immediate safety concern.

7.6 Documentation and recording

PAH will document telehealth and other remote clinical encounters in the medical record as clinically appropriate and as required by applicable law and professional standards.

Neither membership in PAH nor consent to telehealth constitutes blanket consent to audio recording, video recording, transcription, ambient listening, or AI-assisted documentation. When PAH proposes to use recording, transcription, ambient documentation, or an AI-assisted documentation system, PAH will provide applicable disclosures and obtain consent required by law and PAH policy before use. Article XVIII also applies.

A Member may decline optional recording or ambient transcription without losing ordinary access to clinically appropriate care. When declined, PAH may use conventional documentation methods. AI-assisted or automated documentation output is a documentation aid and does not independently diagnose, prescribe, establish a treatment plan, or replace professional judgment. Clinical documentation generated or assisted by such technology remains subject to appropriate provider review.

Members and other participants may not assume that they are authorized to record a private clinical encounter merely because it occurs electronically. Recording by any participant remains subject to applicable consent and privacy law.

8.1 Governing privacy duties

PAH will protect Member health information in accordance with applicable Maryland confidentiality requirements and applicable federal privacy, security, and breach-notification requirements. Where HIPAA applies, PAH's Notice of Privacy Practices describes applicable uses, disclosures, responsibilities, and patient rights. PAH's direct-pay or membership model does not, by itself, determine whether a particular federal privacy requirement applies.

Payment of a membership fee, enrollment in PAH, or acceptance of these Terms does not constitute blanket authorization for PAH to disclose health information to an employer, sponsor, spouse, family member, friend, marketer, or unrelated third party. Information will be used and disclosed only for lawful purposes and subject to applicable limitations, including the minimum-necessary standard where applicable. Nothing in these Terms reduces privacy or confidentiality protections that cannot lawfully be waived.

8.2 Care operations and special disclosures

PAH may use or disclose Member information as legally permitted for treatment, membership and payment administration, healthcare or practice operations, and other legally permitted or required purposes. A specific authorization will be obtained whenever applicable law requires one.

Public-health reporting, mandatory reporting, health oversight, judicial or administrative process, law-enforcement requests, emergency or safety disclosures, and other legally compelled disclosures will be evaluated according to the requirements applicable to the particular circumstances. The existence of a request for information does not automatically establish that disclosure is legally permitted or required.

Information receiving heightened legal protection - including qualifying substance-use-disorder records and other specially protected categories - will receive the additional protections required by applicable law. General membership acceptance does not replace a specialized authorization when one is required.

8.3 Sponsors relatives and representatives

Payment for another adult's membership does not provide the payer with access to that Member's medical information or authority to make healthcare decisions. PAH will reasonably verify the identity, legal authority, and scope of authority of guardians, healthcare agents, personal representatives, proxies, or other persons seeking access to Member information.

A Member may authorize PAH to communicate with another person subject to the scope and limitations of that authorization and may prospectively modify or withdraw permission as permitted by law. Designation as an emergency contact, payer, spouse, relative, employer, or sponsor does not independently create proxy access or healthcare decision-making authority.

Members should identify safe communication channels and any disclosure restrictions. PAH may decline or limit a requested disclosure when identity or authority cannot reasonably be verified or when disclosure would violate applicable law.

8.4 Access and transfer

Members retain applicable rights to inspect, obtain copies of, and request lawful transfer of their medical information during membership and after membership terminates. PAH may reasonably verify identity and clarify the scope or format of a request but will not impose unnecessary barriers to lawful access.

Requests will be processed within applicable Maryland and federal time requirements, including any applicable Maryland requirement to provide records within 21 working days and applicable federal requirements where they govern. Permitted extensions may be used only when legally authorized and accompanied by required notice. Any fee for records must comply with the law governing the request. PAH will not withhold records solely because a Member owes money for healthcare or membership services.

A lawful denial or partial denial will include required explanations and applicable review rights. Requesting transfer of records to another healthcare provider does not, by itself, terminate PAH membership, and termination of membership does not terminate lawful record-access rights.

8.5 Amendment retention and integrity

Members may request correction or amendment of information they believe is inaccurate or incomplete and may exercise applicable disagreement or review rights. PAH will preserve the integrity of the medical record. Accurate historical information will not ordinarily be deleted merely because it is disputed; an accepted correction or amendment may supplement the existing record in accordance with applicable requirements.

Closing an account, terminating membership, withdrawing a consent, or requesting deletion does not require PAH to destroy information PAH is legally or professionally required to retain. PAH's adult medical-record policy is retention for at least seven years after creation of the applicable record or report, and longer when required by law, legal hold, rules applicable to minors, or another lawful obligation.

Secure disposal, transfer, practice closure, retirement, death, incapacity, and custodian arrangements will follow applicable notice, access, custody, retention, and security requirements. Practice changes or termination of membership do not eliminate applicable record-custody and patient-access obligations.

8.6 Vendors and security events

PAH may use third-party vendors for electronic medical records, patient portals, telehealth, messaging, scheduling, payment processing, storage, documentation, AI-assisted documentation, and other legitimate practice functions. Vendor access to Member information will be limited to legitimate functions and subject to contractual, privacy, security, and other safeguards required by applicable law.

No electronic system can guarantee absolute security or uninterrupted availability. That inherent limitation does not excuse PAH from implementing safeguards required by applicable law. PAH will appropriately investigate suspected security incidents and provide notifications when legally required.

Members are responsible for taking reasonable measures to protect their own login credentials and devices and should promptly report suspected unauthorized access, compromised credentials, lost devices containing PAH information, or misdirected communications. PAH may temporarily restrict or secure an account when reasonably necessary to protect information or systems while preserving an appropriate means for necessary clinical communication and lawful access to records.

8.7 Privacy choices and complaints

Members may exercise applicable rights concerning access, amendment, confidential communications, restrictions, disclosure accounting, and other privacy matters. Acknowledgment of the Notice of Privacy Practices does not waive those rights. Members may raise privacy concerns with PAH or contact an appropriate governmental or regulatory authority as permitted by law. PAH will not retaliate against a Member for making a good-faith privacy complaint or exercising a lawful privacy right.

PAH will not unlawfully interfere with legally permitted access, exchange, or use of electronic health information. Applicable information-blocking requirements and exceptions will be evaluated separately from HIPAA requirements. If PAH participates in a health-information exchange, PAH will provide applicable notices and explain available choices when required; these Terms do not promise participation in any particular exchange.

When a Member directs information to an independent third-party application, that application's own privacy and security practices may apply after lawful transmission. PAH remains responsible for its own actions and for responsibilities that applicable law places upon PAH.

9.1 Approved clinical channels

Use PAH's designated secure portal or approved clinical channel for health information whenever feasible. Messages sent to social media, website comment forms, personal accounts, or other unapproved locations may not reach the clinical team and should not be used for patient care. PAH will identify the appropriate channel and expected routine handling practices. Automated acknowledgments are not clinical advice. An automated intake, chatbot, or scheduling assistant will be identified as automated and is not an emergency clinician or an independent source of individualized diagnosis or treatment.

9.2 SMS and ordinary email

Ordinary texting and email can create privacy risks, including shared-device access, forwarding, lock-screen display, incorrect addresses, and interception. Article XVI explains how the Member can choose permitted content and channels through the communication-preference process after being informed of those risks. PAH may restrict especially sensitive information or move a discussion to a secure channel. Consent can be withdrawn prospectively. Withdrawal of optional texting does not terminate membership or remove access to another reasonable communication method.

9.3 Automated messages and marketing

Appointment reminders, operational notices, and clinical communications are distinct from advertising. Any consent required for automated calls or texts will be obtained for the actual system and message category used. Marketing consent is optional and separately selected; treatment or purchase will not be conditioned on optional advertising consent. Applicable opt-out requests will be honored. Message frequency varies and carrier charges may apply. A request to stop messages does not by itself cancel membership.

9.4 Account and device security

Protect login credentials and do not share a personal clinical account. Use available security features and notify PAH of unauthorized access. Proxy access should be configured through an approved process. PAH will not require the Member to waive privacy rights as a condition of using the portal. A Member without a suitable device may request an available alternative for essential communication. Account restrictions will preserve a reasonable alternative for necessary care and lawful access to records. Restrictions on misuse do not prohibit lawful accessibility tools, authorized interoperability, or access to the Member's own information.

9.5 Photographs uploads and home measurements

Members should send only information relevant to their own care or information they are authorized to provide. Photographs may omit clinically important detail and cannot always substitute for an examination. Home readings, wearable data, and uploaded files are reviewed only under an agreed clinical workflow; transmission does not create continuous monitoring. PAH will specify any monitoring service separately rather than imply it from the ability to upload data.

9.6 AI and clinical responsibility

PAH may use appropriately governed software to assist documentation or administrative work. A clinician remains responsible for reviewing clinical documentation and decisions; software output may contain errors. No autonomous diagnosis or treatment is promised. Optional recording or ambient transcription requires the separate process in Article XVIII. Identifiable clinical information will not be supplied for unrelated model training or advertising merely because the Member accepts these general terms.

10.1 Accurate information and participation

Provide complete and accurate information about symptoms, diagnoses, hospitalizations, medications, supplements, allergies, pregnancy when relevant, and other clinicians. Report changes and adverse effects promptly. Follow agreed plans or explain barriers so alternatives can be considered. PAH recognizes that cost, disability, language, transportation, and personal circumstances may affect follow-through; raising those concerns is part of shared decision-making. Keep an accurate count of pills and other prescribed supplies, monitor remaining refills, and request routine renewals in advance during normal business hours as described in Article VI. After-hours contact is reserved for urgent concerns that cannot safely wait. For emergencies, call 911 or the local emergency number, or seek immediate emergency department care; do not wait for PAH.

10.2 Choice and respectful treatment

You may ask about benefits, risks, alternatives, fees, and clinician qualifications; decline recommended treatment; seek another opinion; and request transfer of records. You are entitled to respectful care and an explanation of clinically necessary limitations. Membership does not authorize coercion, discrimination, or retaliation. PAH may decline unsafe or inappropriate requests while offering an explanation and reasonable alternatives within its scope.

10.3 Conduct and safety

Members and accompanying persons must treat clinicians, staff, and other patients respectfully. Threats, violence, discriminatory harassment, deliberate exposure of another patient's private information, and misuse of credentials are prohibited. PAH may establish reasonable safety rules and arrange a different communication format when needed. Good-faith complaints, disagreement with treatment, requests for accommodation, and truthful criticism are not themselves abusive conduct.

10.4 Accessibility and communication assistance

Tell PAH about disability-related access needs, hearing or vision limitations, language needs, or other communication barriers. PAH will provide accommodations and communication assistance as required by applicable law. The practice will assess whether a proposed aid or interpreter is suitable and protect confidentiality. A financial sponsor or family member will not automatically be treated as the Member's interpreter or decision-maker. Legally required communication aids and accommodations will be provided without an impermissible surcharge. A minor will not be required to interpret except under a narrow lawful exception. Service animals, support persons, accessible documents, and physical-access needs will receive appropriate consideration. PAH's membership model does not itself create an exemption from applicable civil-rights requirements.

10.5 Representatives and advance directives

Provide applicable health care powers of attorney, guardianship orders, advance directives, or other relevant documents. PAH will consider their validity and scope under applicable law. A change in capacity may require a legally authorized representative or additional assessment. Designating an emergency contact is not the same as granting unlimited decision-making authority. An advance directive is not automatically a portable emergency medical order. PAH will review relevant documents and coordinate appropriate care within its role. A Member may ask to speak privately even when a sponsor or family member attends. Clinically appropriate chaperone requests and concerns about examination boundaries may be raised without retaliation.

10.6 Care of others and public statements

Do not request prescriptions or clinical decisions for a person using your membership. Each patient requires an appropriate relationship and assessment. Members may give honest reviews, report concerns, or communicate with regulators. PAH does not require nondisparagement, advance approval of reviews, or surrender of statutory consumer-review rights. Members should avoid disclosing other patients' private information in public communications.

11.1 Educational content

Public website content, newsletters, general videos, and social media posts provide education and practice information. They are not individualized evaluation or emergency advice. A person should not delay urgent care because of website content. Individual recommendations arise through an accepted clinical interaction, not merely from viewing a page or receiving a general announcement.

11.2 Permitted use

You may use PAH digital services for lawful personal purposes and authorized communication with the practice. Do not impersonate another person, submit malicious code, bypass access controls, interfere with system availability, collect other users' information without authority, or use the system to obtain prescriptions through deception. PAH may restrict abusive or compromised accounts while preserving reasonable alternative routes for necessary clinical communication and record access.

11.3 Ownership and patient information

PAH and its licensors retain rights in their own website materials and software, subject to applicable law. The Member retains rights in material the Member supplies. By sending clinical information, the Member permits PAH to use and maintain it for the relevant care and lawful operations; this is not a transfer of unrestricted publicity or commercial exploitation rights. PAH will obtain separate permission where legally required for photographs, testimonials, or other public-facing uses.

11.4 External links and integrations

Links to pharmacies, laboratories, insurers, educational resources, or software providers do not make those entities part of PAH. Their terms may apply to their own services. PAH remains responsible for its own choices and duties and does not use this clause to disclaim responsibility for a vendor function for which the law holds PAH accountable. Members may ask for clarification before sending sensitive information through an unfamiliar link. PAH will provide a separate, accurate digital privacy disclosure for its actual website and application practices, including collection, cookies, analytics, purposes, recipients, retention, and available choices. Advertising pixels or similar tracking in patient workflows require an applicable lawful basis and safeguards. Acceptance of this agreement does not authorize sale of health information or targeted advertising based on confidential clinical information. Maryland consumer-data and breach requirements are assessed independently of HIPAA; a vendor's claim of HIPAA compatibility is not proof that every configuration or feature is compliant.

11.5 Maintenance and account closure

Digital tools may be temporarily unavailable for maintenance, outages, or security response. PAH will identify another appropriate contact route when practicable. Downloading the app does not guarantee compatibility with every device. After membership ends, interactive clinical access may close, but lawful record-access rights survive. Essential documents and billing information will be available through an appropriate alternative process.

11.6 No hidden changes to clinical terms

An app update, revised screen, or continued website use does not silently increase the membership fee or create a new consent to recording, marketing, or disclosure. Material contract changes follow Article XII and the applicable notice and assent requirements. The Member will receive a copy of accepted terms and may request an accessible format.

12.1 Questions and complaints

Members may raise clinical, billing, accessibility, privacy, or service concerns with the contacts at enrollment. PAH will review complaints and communicate an appropriate response. Internal review is voluntary and does not prevent timely complaints to the Maryland Board of Physicians, other licensing authorities, the Maryland Attorney General, HHS Office for Civil Rights where applicable, or another agency with jurisdiction. No provision requires a Member to miss a legal filing deadline while awaiting PAH's reply.

12.2 Governing law and preserved remedies

Maryland law governs this agreement to the extent not superseded by applicable federal law. Mandatory rules of another jurisdiction may apply to an encounter occurring there. Nothing in this agreement releases malpractice liability, excuses fraud or intentional misconduct, imposes a membership-fee cap on recoverable damages, shortens a statutory limitations period, or waives nonwaivable rights. This agreement does not impose mandatory arbitration or a class-action waiver. No provision imposes a jury-trial waiver, makes the Member responsible for all PAH attorney fees, requires indemnification of PAH for its own acts or omissions, or excludes an otherwise available personal-injury remedy. Responsibility for vendors depends on the actual relationship and governing law. These Terms do not release liability for breach of an express promise or professional negligence.

12.3 Changes to the agreement

PAH may propose prospective changes by delivering understandable written notice identifying the change and effective date. Changes to fees or a material reduction in services follow Article III. A new consent will be obtained when required; general continued use is not substituted for a legally required affirmative authorization. If a change is needed immediately to comply with law or protect safety, PAH will explain the affected service and available alternatives and make an appropriate financial adjustment when warranted.

12.4 Notices and electronic signatures

Contract notices may be delivered through the designated portal, verified email, or written delivery address, consistent with the Member's communication choices and applicable law. Members should update contact details. A cancellation notice received through an accepted channel is effective according to Article IV even if PAH's acknowledgment is delayed. Electronic signatures and records may be used when legally valid and properly attributable to the signer. Members may request a copy of the completed agreement. PAH will retain the accepted document version and evidence of assent and provide a copy capable of being retained. If electronic-delivery consent is required, PAH will disclose its scope, paper alternatives, withdrawal method, and actual technology requirements before consent. Preselected boxes and hidden terms are not substitutes for meaningful acceptance. Withdrawal of electronic delivery is prospective and does not itself cancel care. A known failed delivery of a significant notice will prompt reasonable alternative steps.

12.5 Assignment and practice changes

A sale, reorganization, retirement, or closure will be handled with appropriate notice, privacy safeguards, record-custody arrangements, and care-transition measures. PAH will not treat assignment of an administrative contract as automatic consent to treatment by a new clinician. The Member retains applicable cancellation and record-access rights. No assignment may strip mandatory patient protections or authorize otherwise unlawful disclosure. PAH will identify responsibility for outstanding services, refunds, credits, and records after a transfer or closure. A successor does not receive unlimited permission to use medical information for unrelated purposes. Material changes remain subject to required notice and assent.

12.6 Severability and waiver

If a term is unenforceable, the remaining terms continue only to the extent they can operate lawfully and fairly. No invalid term will be rewritten to enlarge the Member's financial obligations. PAH's decision to waive a charge or accommodate one situation does not require the same result in every future situation. A waiver of a specific contractual right should be documented; no informal waiver overrides mandatory law.

12.7 Entire agreement and continuing obligations

The completed documents identified in Article I contain the parties' agreement about membership. No unsigned promotional statement changes them. Provisions that by their nature must continue, including lawful record retention, confidentiality, final accounting, and preserved legal rights, survive termination. Continuing professional or regulatory obligations do not extend the recurring membership charge beyond the termination date.

13.1 Core acknowledgments

By selecting the acceptance checkbox at the end of this document, I acknowledge that PAH is not health insurance and does not bill health insurance at all. I understand the included services and separate charges shown in my completed enrollment schedule. I understand that emergency care, hospital care, specialists, and other outside services may require separate payment or insurance. Member initials: [ ]

13.2 Cancellation acknowledgment

I understand that there is no minimum membership term and that I may give written cancellation notice at any time. Unless an applicable exception or written waiver applies, I must pay for the additional 30 calendar days following PAH's receipt of notice. Benefits remain active during that period. PAH will credit amounts already paid, prorate the final period, refund unearned prepaid amounts as stated, and stop recurring membership charges at termination. Member initials: [ ]

13.3 Access and clinical acknowledgment

I understand that immediate responses and same-day or next-day appointments are not guaranteed. Routine matters should be handled during business hours. After-hours contact is for urgent concerns that cannot reasonably wait. I will call 911 or seek emergency care for emergencies rather than wait for a message response. Treatment and prescribing depend on professional judgment, scope of practice, and law. I am responsible for monitoring my medication supply and remaining refills and requesting routine renewals early enough for processing during normal business hours, allowing for weekends, holidays, and required clinical review. Member initials: [ ]

13.4 Separate choices

I understand that telehealth, optional SMS or email, recurring electronic payments, recording or AI transcription, and marketing may require separate disclosures and choices. Accepting these Terms and Conditions does not automatically grant optional or separately required permissions. I may ask questions and obtain a copy before accepting. I do not waive statutory rights, professional standards, or lawful complaint rights. Member initials: [ ]

13.5 Acceptance of these terms

I acknowledge the key provisions in this Article by placing my initials in the boxes provided. At the end of this document, I confirm that I have read and agree to these Terms and Conditions by selecting the acknowledgment checkbox, entering my full legal name, and providing one full signature. An electronic signature is intended to have the same effect as a handwritten signature to the extent permitted by law. Membership remains subject to PAH's enrollment acceptance under Article I, the cancellation provisions in Article IV, and applicable law.

14.1 Practice identity and contacts

PAH records or supplies the following information through the applicable enrollment, account, consent, or clinical process: Legal practice entity and entity type; Doing business as Pure Access Health; Practice address and mailing address; Routine telephone and secure portal address; Routine office days and hours; Urgent after-hours method and backup instructions; Cancellation email and direct online cancellation route; Privacy official name or title and telephone; Privacy and records request email or mailing route; Billing and complaint contact; Accessibility and language-assistance contact; Routine response targets and refill request lead time; Terms effective date and adopted version; Prior agreement replaced and replacement date if applicable.

14.2 Member and membership selection

PAH records or supplies the following information through the applicable enrollment, account, consent, or clinical process: Member legal name; Date of birth; Address; Telephone and verified email; Sponsor or payer if different; Representative name and verified authority if applicable; Membership start date and first payment date; Billing day and interval; Annual coverage start and end dates if selected; Student verification and recheck date; Sponsor contribution and Member share; Attached electronic enrollment schedule identifier if used. The available choices are documented separately when applicable: Individual monthly membership at $99 per month; Student monthly membership at $79 per month with valid student identification; Individual annual prepayment of $1,089 for 12 months at the price of 11; Employer or individually negotiated plan under the identified attached schedule. No optional choice is selected merely by accepting these Terms. Monthly membership continues until ended under Article IV. Annual prepayment does not renew automatically; a new annual election or separate monthly election and payment authorization is required. No minimum membership term applies. The additional 30-day paid cancellation period remains subject to overriding legal rights, credits, daily proration, and applicable refunds.

14.3 Reduced cost services and discounted medications

Reduced cost laboratory work and imaging services are available to members, along with discounted medications available for $5 and $10.

14.4 Enrollment documentation

PAH records or supplies the following information through the applicable enrollment, account, consent, or clinical process: Public-program review when applicable and separate contract reference; PAH acceptance recorded by and date; Copy supplied by paper / electronic / accessible format and date. Staff acceptance documents PAH's enrollment decision; it does not replace any separately required clinician signature or public-program contract.

15.1 Nature and limits

Before telehealth care begins, PAH obtains and documents any required service-specific consent. Available methods may include video, audio only when appropriate, and secure asynchronous messaging. Remote care can limit examination and may require in-person evaluation. Technology may fail or create privacy risks. The Member may ask questions, request an alternative, or withdraw telehealth consent for future care. PAH may decline remote care when unsafe or not legally permitted.

15.2 Identity and location

The Member provides a current physical location and callback number for each encounter and identifies anyone else present. PAH identifies the treating clinician and discloses the clinician's contact information and license type. PAH cannot promise services in every state or country. Both parties cooperate with appropriate privacy and emergency plans.

15.3 Emergencies and interrupted connections

For a medical emergency, CALL 911 or seek immediate care at the nearest emergency department; outside the United States, call the local emergency number. Do not wait for PAH. If a connection fails, PAH uses the callback information confirmed for that encounter or recommends appropriate local care. Telehealth consent does not authorize recording, ambient transcription, or marketing.

15.4 Documenting consent

PAH records the permitted methods, required disclosures, the Member's consent, and any withdrawal or later change through its clinical consent workflow. Acceptance of these general terms alone does not establish that a separate telehealth consent has been obtained. Do not participate while driving or operating machinery. Telehealth can be declined or stopped; PAH will discuss available in-person care or referral. Consent may be withdrawn prospectively by telling the clinician or contacting PAH through Article XIV. PAH documents a lawful oral consent when used; general acceptance alone is insufficient.

15.5 Consent and encounter documentation

PAH records or supplies the following information through the applicable enrollment, account, consent, or clinical process: Patient name and date; Clinician name license type and contact. The available choices are documented separately when applicable: I consent to clinically appropriate telehealth after receiving these disclosures; I decline telehealth and request discussion of available alternatives. No optional choice is selected merely by accepting these Terms. PAH records or supplies the following information through the applicable enrollment, account, consent, or clinical process: Permitted methods video / audio / secure asynchronous exchange; Staff recording oral consent if used and date and time. For each encounter, PAH confirms and records identity, actual location, callback information, participants, and the emergency or disconnection plan. The following details are recorded in the clinical record.

PAH records or supplies the following information through the applicable enrollment, account, consent, or clinical process: Encounter date and patient physical location; Callback number and persons present; Emergency contact or local emergency resource; Connection failure plan; Withdrawal or change and date.

16.1 Privacy and channel choices

Ordinary email and SMS may expose information through shared devices, misdirected messages, forwarding, or carrier systems. Secure messaging is preferred for clinical information. The Member may change preferences prospectively, and PAH may use a safer method for sensitive information. Communication preferences do not authorize unrelated disclosures, replace a required authorization, or make a channel suitable for emergencies. For a medical emergency, call 911 or the local emergency number, or seek immediate emergency department care.

16.2 Permitted communications

PAH verifies contact details and records the Member's preferences through enrollment or the secure portal. Options may include secure clinical messaging, SMS or email for administrative notices, limited clinical content after discussion of privacy risks, callback-only voicemail, or voicemail containing appointment details. Other restrictions may be recorded. Acceptance of these terms alone does not opt the Member into unsecure clinical messages or marketing.

16.3 Automated notices and optional marketing

Before seeking any required automated-messaging consent, PAH identifies the sender, system category, permitted message categories, and contact destination. Frequency varies; message and data rates may apply. Optional messaging consent may be revoked through the stated opt-out route, including STOP where supported, or by contacting PAH. PAH provides another reasonable route for essential communications. Marketing is an optional, separately obtained permission and is not a condition of membership, treatment, or purchase.

16.4 Communication preferences

After PAH explains the risks of ordinary SMS, email, voicemail, shared devices, and misdirected messages, the Member may select desired communication options through enrollment or account preferences. No unanswered option is consent. Preferences may be changed prospectively through the published PAH contacts. Secure messaging remains preferred for sensitive health information. PAH records or supplies the following information through the applicable enrollment, account, consent, or clinical process: Verified mobile number; Verified email; Information not to include and safe contact restrictions; Alternative channel if electronic contact is unsuitable. The available choices are documented separately when applicable: Secure portal for clinical messages; Ordinary SMS for administrative notices; Ordinary email for administrative notices; Limited clinical SMS after discussion of privacy risks; Limited clinical email after discussion of privacy risks; Voicemail with callback request only; Voicemail with appointment details. No optional choice is selected merely by accepting these Terms. Required consent for a particular automated calling or messaging system will identify the sender, system, message categories, destination, and opt-out method before activation. These preferences do not supply missing statutory disclosures or unlimited permission for automated contact.

16.5 Optional marketing

The available choices are documented separately when applicable: No promotional email or texts; I request optional promotional email to the verified address above. No optional choice is selected merely by accepting these Terms. Promotional texts or calls require a separate campaign-specific consent with all applicable disclosures before activation. No promotional-text authorization is created by this agreement. Marketing is not a condition of membership, treatment, or purchase, and opting out does not cancel care.

16.6 Optional proxy access

PAH records or supplies the following information through the applicable enrollment, account, consent, or clinical process: Proxy name relationship and verified identity; Authorized functions scheduling / billing / messages / records; Information or functions excluded; Effective date and expiration date or event; How revocation may be submitted; Staff verifying authority and technical limits. The available choices are documented separately when applicable: I request proxy access limited as described below; I do not request proxy access. No optional choice is selected merely by accepting these Terms. A proxy-access election requests defined portal access and is not a healthcare power of attorney or an unrestricted disclosure authorization. PAH will explain any technical inability to honor restrictions before activation. A payer or emergency contact has no proxy authority solely because of that status. Obtain a separate legally compliant authorization when the proposed disclosure requires one, including special record categories. Do not share passwords.

17.1 Specific payment authorization

Recurring charges require separate authorization through PAH's secure payment process. The account holder is shown the payment method, processor, recurring amount, frequency, first charge, billing date, and renewal schedule and receives a copy of the authorization. Acceptance of these Terms and Conditions alone does not authorize an unspecified debit or establish a separately required payment authorization. Full card or bank details must be provided only through the approved secure payment system. An authorization does not permit undisclosed optional services, arbitrary increases, or charges beyond the termination date. Separately purchased items require their own agreed basis for payment.

17.2 Changes revocation and cancellation

PAH provides applicable advance notice and obtains additional authorization when required for changes or variable transfers. The account holder may revoke recurring payment authorization through the designated billing contact. PAH stops future debits as required by law and explains alternative arrangements for any valid balance. Banks and card issuers may provide additional stop-payment and dispute rights. Revoking payment authorization differs from cancelling membership; written membership cancellation follows Article IV. PAH acknowledges either request without an unnecessary call or retention discussion.

17.3 Final billing

Member-initiated cancellation normally leaves 30 calendar days of membership, with credit for amounts already paid, prorated final billing, and any required refund. No authorization permits a full additional billing cycle when only part is owed.

17.4 Payment instructions and authorization record

Before any recurring debit, PAH obtains the account holder's separate secure payment authorization with the details described below. The final general signature does not alone authorize recurring transfers. If someone else pays, that account holder must provide their own authorization. Full card and bank numbers are collected only through the approved secure payment system, not ordinary email, text, or this agreement. PAH records or supplies the following information through the applicable enrollment, account, consent, or clinical process: Account holder name and member covered; Secure payment processor; Payment method and token or last four digits only; Recurring amount and interval; First charge date and recurring billing date; Coverage period; Separately agreed variable amount calculation and limit; Revocation contact and method; Secure authorization reference and date; Retainable authorization copy provided by and date. The separate authorization must identify the authorized amount or calculation, timing, frequency, and revocation method. It does not authorize undisclosed services, unlimited variable charges, a change of payment instrument, or debits after revocation. Applicable advance notice for varying electronic transfers or a lawful agreed-range arrangement must be implemented. A bank's stop-payment and dispute rights remain available. No account will be charged because an optional choice is unanswered.

17.5 Optional electronic delivery

An electronic-delivery election concerns delivery of agreements and legally required notices, not marketing or consent to treatment. PAH first supplies its actual delivery format and technology requirements. The Member must be able to access and retain the documents. If a required electronic-consent process needs an additional demonstration of access, PAH completes that process before relying on electronic delivery. PAH records or supplies the following information through the applicable enrollment, account, consent, or clinical process: Documents covered by electronic delivery; Email or portal delivery destination; Required software format and device access; Paper-copy request route and any lawful disclosed charge; Electronic-delivery withdrawal and contact update method. The available choices are documented separately when applicable: I can open and retain the disclosed format and elect electronic delivery; I request paper copies or an accessible alternative. No optional choice is selected merely by accepting these Terms. Withdrawal applies to future delivery and does not invalidate an earlier signature or automatically terminate membership. PAH provides an appropriate alternative for required communications. Keep a copy of this agreement and any separately authenticated payment authorization.

18.1 Specific disclosures before consent

Before seeking permission for recording or ambient AI documentation, PAH identifies the actual tool and vendor, purpose, data captured, persons or vendor roles with access, storage service, retention and deletion policies for raw recordings, retention of reviewed clinical documentation, and applicable subprocessors or a source describing them. These disclosures and permissions are documented separately when the tool is proposed.

18.2 Voluntary choice

A tool may produce a draft note or transcript and may make errors. A clinician reviews clinical documentation. The Member may decline optional recording or transcription and receive ordinary documentation, or ask that recording stop during an encounter. Withdrawal operates prospectively and does not require deletion of records PAH must lawfully retain. PAH explains whether an existing recording can be deleted under the disclosed policy.

18.3 Limits on permission

Any permission is limited to the specifically disclosed clinical documentation purpose. It does not authorize public posting, marketing, unrelated research, or unrelated AI model training. A separate valid authorization or other lawful basis is required for a different use. All participants whose consent is legally required must agree before recording begins. A Member cannot consent for another adult participant. PAH reconfirms recording status at the encounter and documents consent, refusal, or withdrawal. Accepting these terms does not itself authorize recording or AI transcription.

18.4 Encounter specific disclosure and decision

Before capture begins, PAH supplies and records the encounter-specific disclosures described below. Permission applies only to the identified encounter and tool unless a separate lawful ongoing consent is obtained. An unanswered request or general acceptance does not authorize recording or ambient transcription. Every participant whose consent is required must affirmatively agree before capture. PAH records or supplies the following information through the applicable enrollment, account, consent, or clinical process: Patient name and encounter date; Clinician and other participants; Tool and vendor name; Function audio / video / live transcription / AI scribe; Clinical documentation purpose; Data captured and whether raw recordings are stored; Raw recording and draft transcript retention and deletion; Reviewed clinical note retention; Persons or vendor roles with access and processing locations; Subprocessors or disclosure source; Restriction on unrelated model training and other uses; Alternative documentation without capture. The available choices are documented separately when applicable: I consent to the specific documentation tool and use disclosed above; I decline recording or ambient transcription and request ordinary documentation. No optional choice is selected merely by accepting these Terms. PAH records or supplies the following information through the applicable enrollment, account, consent, or clinical process: Patient decision recorded at date and time. A clinician, interpreter, support person, or other adult participant makes their own decision; the patient cannot consent for another adult. PAH documents the required permissions in the encounter record before starting. If permission is absent, do not capture. Additional written authorization is obtained if applicable law requires it. PAH records or supplies the following information through the applicable enrollment, account, consent, or clinical process: Clinician decision and time recorded; Other participant name decision and time recorded; Additional participant name decision and time recorded; Staff confirming all required permissions before capture; Stop or withdrawal request time and action taken. PAH reconfirms recording status at the encounter. Neither PAH nor a patient may assume the right to record private communications without the consent required by law, subject to an applicable exception or legally required accommodation. Consent does not replace vendor safeguards, security review, or a required business associate agreement.

19.1 Our responsibilities

We protect identifying health information that we create or receive in caring for you and administering the practice. We follow this notice while it is in effect, maintain safeguards required by law, and notify you when a breach of unsecured protected health information requires notice. When a more protective applicable rule limits a use or disclosure described here, we follow that rule. A membership fee or general signature is not blanket permission to disclose your information.

19.2 Treatment payment and healthcare operations

For treatment, we may use and share information with clinicians, laboratories, pharmacies, and other providers involved in your care when permitted, such as sending relevant history to a specialist. For payment, we may use necessary information to administer membership, issue statements, or resolve an authorized charge. PAH does not bill health insurance at all; this description does not change that policy. For operations, we may use information for quality review, training, record management, compliance, and other permitted practice functions. Vendors performing authorized functions receive appropriate contractual safeguards and limited access.

19.3 People involved in care and personal representatives

You may tell us whom you want involved and what may be discussed. We may share relevant information with someone involved in your care or payment when you agree, have an appropriate opportunity to object and do not, or another lawful basis applies. If you cannot express a choice, we may use permitted professional judgment in your interests, including lawful emergency or disaster-relief communications. A sponsor, parent of an adult, or emergency contact does not automatically receive your full chart. We verify a representative's authority and apply lawful abuse, neglect, endangerment, or other exceptions when relevant.

19.4 Other legally permitted or required disclosures

Depending on the applicable legal conditions, we may disclose information for public health reporting, prevention or control of disease, reporting suspected abuse or neglect, health oversight, medication or device safety, workers' compensation, organ or tissue donation, medical examiners, coroners, funeral directors, or specified government functions. We may respond to a lawful court order, subpoena, or law-enforcement request only after evaluating the applicable requirements; a request alone is not always sufficient. We may disclose information to address a serious safety threat when permitted. Research requires your valid authorization or another lawful research pathway and safeguards; accepting membership does not enroll you in research.

19.5 Authorizations and particularly sensitive records

Uses or disclosures outside the permitted framework require your written authorization when the law requires it. These include most uses of separately maintained psychotherapy notes, marketing uses requiring authorization, and any sale of protected health information requiring authorization. PAH does not use general membership acceptance to authorize publicity, testimonials, sale of identifiable clinical information, or unrelated AI model training. You may revoke a specific authorization in writing prospectively, except to the extent action has already been taken in reliance on it or another lawful exception applies. Treatment is not conditioned on an optional authorization except where law permits a specific exception. Maryland rules may impose additional limits on mental-health, HIV-related, genetic, and other sensitive information. PAH applies the category-specific conditions, including required consent or a lawful exception, rather than treating a general treatment or payment permission as sufficient for every record. A specialized disclosure authorization is obtained when needed. Substance-use-disorder records covered by 42 CFR Part 2 receive the additional protections applicable to their source and use. Such records will not be used or disclosed in civil, criminal, administrative, or legislative proceedings against you without the specific written consent or court order and accompanying subpoena or other process required by Part 2. A general treatment, payment, and operations consent is not consent to those proceedings. A legally permitted redisclosure may sometimes be subject to different protections, but Part 2's restrictions on proceedings remain applicable as provided by law. PAH does not operate a fundraising program under this notice. If that practice changes, any required notice and opportunity to opt out will precede fundraising contact.

19.6 Access and copies

You may request inspection or an electronic or paper copy of information available under applicable access law, including information beyond what the portal displays. PAH verifies identity reasonably and supplies a readily producible requested format or an agreed alternative. A summary is used instead of a copy only when appropriately agreed. We act within applicable deadlines, ordinarily no later than 30 calendar days where HIPAA applies, with an earlier applicable Maryland deadline controlling. Only a legally permitted extension may be used, with required notice. Any fee must be permitted and reasonable under the governing rule. We do not withhold records for unpaid healthcare fees. A lawful denial includes the required explanation and any review opportunity.

19.7 Corrections and amendments

You may request correction or amendment of information you believe is inaccurate or incomplete. We respond within the applicable period, ordinarily within 60 days under HIPAA unless a permitted extension is used; any earlier applicable obligation controls. A refusal is explained in writing with available review or disagreement rights. An accepted correction supplements the record and preserves its integrity rather than silently deleting the original entry. A statement of disagreement may be included when the governing rule permits.

19.8 Restrictions and confidential communication

You may ask us to limit a use or disclosure for treatment, payment, or operations. We consider the request but need not agree to every restriction. Where HIPAA applies, we will honor a qualifying request not to disclose information to a health plan for payment or operations about an item or service paid in full out of pocket, unless disclosure is required by law. This does not prevent permitted treatment disclosures. Ask before transmission when possible. We accommodate reasonable requests for confidential communication, such as another telephone number or mailing address.

19.9 Accounting paper copies and complaints

Where applicable, you may request an accounting of disclosures within the preceding six years, or a shorter requested period. The accounting excludes categories exempted by law, commonly treatment, payment, operations, and authorized disclosures. One accounting in a 12-month period is free; a permitted fee for additional requests is disclosed before processing, with an opportunity to modify or withdraw the request. You may obtain a paper copy of this notice even if you accepted electronic delivery. Contact the privacy official identified above to ask questions, exercise rights, or complain. You may also contact the U.S. Department of Health and Human Services Office for Civil Rights at 200 Independence Avenue SW, Washington DC 20201, call 1-877-696-6775, or use https://www.hhs.gov/hipaa/filing-a-complaint/index.html. Appropriate Maryland agencies may also receive complaints. We will not retaliate. An internal complaint is not a condition of contacting an agency and does not extend an outside filing deadline.

19.10 Notice changes and record custody

We may change this notice when law permits and apply lawful revised practices to information already held. We will date the revision and make it available in the office, on the applicable practice website, and on request, with additional notice when required. A revised notice does not supply an authorization that must be obtained separately. Records remain subject to lawful retention, custody, access, and secure-disposal requirements after membership ends or the practice closes. Contact the practice's records route in Article XIV for access and custodian information.

19.11 Receipt of the privacy notice

PAH separately documents delivery and, where required, receipt of this notice through its enrollment or clinical process. A receipt acknowledgment is not consent to every use or disclosure. Refusal to acknowledge receipt does not itself authorize denial of treatment. If acknowledgment cannot be obtained, PAH records its good-faith effort and the reason. General acceptance does not convert receipt into a disclosure authorization.

20.1 Actual systems and data practices

PAH records or supplies the following information through the applicable enrollment, account, consent, or clinical process: Website and application covered and notice effective date; Separate digital privacy notice location and version; EMR portal and telehealth vendors; Scheduling messaging and payment providers; Information collected directly from users and its purposes; Technical logs cookies and analytics collected and purposes; Recipients service providers and categories of sharing; Retention periods or criteria for nonclinical data; Cookie controls and nonessential tracking choices; Consumer privacy request and appeal route where applicable; Health information exchange participation and choices if applicable; Independent apps selected by patients and applicable disclosures.

Clinical information is not sold or used for targeted advertising merely because a person visits a website or accepts membership. PAH will apply legally required consent, minimization, security, deletion, and consumer-choice obligations to the data and systems within their scope. A legally required medical-record retention duty can limit deletion of clinical records. A website cookie preference is not a consent for treatment or a HIPAA authorization.

20.2 Changes and alternatives

PAH explains material changes and obtains new permission when required. Patients may request an accessible copy of the applicable notice and an available alternative for essential communication. Declining optional tracking, advertising, or recording is not treated as cancellation of membership. General website content and automated tools are not emergency services.