Medintra Telehealth, Privacy, Financial, and Shipping Consent

Last Updated: 4/11/2026

Important Emergency Notice

Medintra is not a replacement for emergency medical services.

If you are experiencing a medical emergency, call 911 or seek immediate in-person emergency medical care.

1. Introduction

This Telehealth, Privacy, Financial, and Shipping Consent (“Consent”) describes important terms that may apply when you use the Medintra platform and any related services.

In this Consent, “Medintra,” “we,” “us,” and “our” refer to Medintra and, where applicable, related entities supporting the Platform. “You” and “your” refer to the user of the Platform.

Medintra is a platform and administrative support business. Medintra does not itself practice medicine or pharmacy. Medical services may be provided by independent licensed healthcare professionals and affiliated professional entities. Medication fulfillment may be provided by independent pharmacies and related vendors. This platform-versus-provider split is also reflected in the source document you uploaded.

By using the Platform, requesting services, or continuing through the intake and consultation process, you acknowledge and agree to the terms of this Consent.

2. Telehealth Consent

What Telehealth Is

Telehealth is a type of healthcare delivery that allows patients to access health-related services using audio, video, electronic communications, digital intake systems, messaging tools, and other remote technologies.

Depending on the workflow, telehealth services may include:

collection and review of intake information,

communication with a licensed healthcare professional,

assessment, consultation, and follow-up,

care coordination,

prescription-related review where appropriate.

HHS notes that telehealth informed-consent requirements vary by state, but providers should explain what the patient can expect from the telehealth visit and what the patient’s rights are.

Expected Benefits

Potential benefits of telehealth may include:

improved access to healthcare services across distance,

greater convenience,

more efficient evaluation and follow-up,

access to providers who may not be located near you,

streamlined communication and care coordination.

Possible Risks

As with any healthcare interaction, telehealth has potential limitations and risks, including but not limited to:

technical failures, delays, or interruptions,

incomplete or poor-quality audio, video, or transmitted information,

limitations caused by remote review,

delays in care caused by equipment or connectivity problems,

privacy or security failures, though safeguards are used,

lack of access to complete medical records,

the possibility that telehealth may not be appropriate for every person or every condition.

The source document you uploaded lists the same general telehealth risk categories: transmission limits, equipment failures, privacy/security issues, and incomplete records leading to errors.

Telehealth Acknowledgments

By consenting to telehealth, you understand and agree that:

Telehealth may involve the use of electronic communications, digital intake tools, remote review, and other technologies.

The people providing healthcare services may be located in a different location from you.

Reasonable privacy and security safeguards are used, but no system is completely free from risk.

You may withhold or withdraw your consent to telehealth at any time, subject to applicable law and the practical effect that doing so may limit or end your ability to receive services through the Platform.

You may seek alternative methods of care, including in-person care, at any time.

No specific outcome, result, approval, or prescription can be guaranteed.

Telehealth may not be appropriate for every situation.

HHS also notes that telehealth platforms should meet HIPAA requirements and that informed consent may be required before telehealth treatment.

Telehealth Consent Statement

I have read and understood the information above regarding telehealth. I understand the potential benefits, risks, and limitations of telehealth. I consent to the use of telehealth technologies and remote communication methods in connection with my care, where applicable.

3. Privacy and HIPAA Acknowledgment

Medintra and its partners may collect, use, and disclose information as described in the applicable Privacy Policy, Notice of Privacy Practices, and related documents.

You understand and agree that:

information you provide may be shared with independent licensed medical providers and affiliated professional entities for review and care-related purposes,

information may also be shared with pharmacies, laboratories, and other vendors where necessary to support requested services,

service providers and vendors may have limited access to information where needed to operate the Platform and related business functions,

information may be used and disclosed as permitted or required by applicable law.

HHS explains that individuals generally have HIPAA rights to:

see and get copies of their health records,

request corrections,

receive a notice explaining how information may be used and shared,

request certain restrictions,

and decide whether to authorize certain marketing uses of their PHI.

Privacy Acknowledgments

You acknowledge that:

Your information may be used and disclosed to support treatment, payment, healthcare operations, and related administrative functions, where applicable.

Medintra may use vendors and service providers in the ordinary course of business, and those vendors may have access to information as needed to perform services.

You may receive communications related to appointments, support, billing, process updates, policy changes, and related matters.

Medintra and applicable providers may maintain records in electronic systems and related workflows.

You may request access to records or exercise other applicable rights through the appropriate party, depending on who maintains the records.

Privacy / HIPAA Consent Statement

I acknowledge that I have been informed that privacy and confidentiality protections apply to my information. I understand that my information may be used and disclosed as described in the applicable privacy documents and as necessary to support the requested services.

4. Financial Consent

You understand and agree that Medintra may collect payments or facilitate payments in connection with the Platform and requested services.

You acknowledge and agree that:

Payment may be required before or during the service process.

Payment does not guarantee approval, prescribing, or dispensing of any medication.

Fees may include platform, administrative, consultation, clinical, fulfillment, or related charges, depending on the structure of the program.

You are responsible for charges associated with the services you request, except to the extent otherwise stated in writing.

A payment method may be kept on file where permitted and disclosed in applicable billing terms.

Medintra and/or its payment processors may charge your payment method for authorized transactions, recurring program fees, unpaid balances, or other amounts you agree to pay.

If a program is structured as recurring or auto-renewing, you may be charged automatically unless you cancel in accordance with the applicable program terms before the next billing event.

Refunds, exchanges, credits, and cancellation rights are governed by the terms applicable to the specific product or service.

The uploaded medical-consent template includes similar financial concepts: card on file, responsibility for balances, recurring charges, no refunds/exchanges language, and authorization to charge for services rendered.

Financial Consent Statement

I understand that payment may be required in connection with the services I request. I authorize Medintra and/or its payment processors to charge my payment method for authorized amounts in accordance with the applicable billing and program terms. I understand that payment does not guarantee approval, prescribing, or dispensing.

5. Shipping and Fulfillment Authorization

If medication or related products are prescribed and approved for fulfillment, you understand that fulfillment and shipping may be handled by an independent pharmacy or other authorized vendor in accordance with applicable law.

You acknowledge and agree that:

Medication fulfillment is subject to provider review, pharmacy approval, operational availability, and applicable law.

Shipping times are estimates and may be affected by processing delays, carrier delays, inventory issues, weather, address problems, or other factors outside Medintra’s control.

Medintra is not the shipping carrier and does not guarantee exact delivery timing.

You authorize shipment to the address you provide, or to another address you validly provide to the company in accordance with its procedures.

Once medication has been dispensed and released into the shipping process, certain return, refund, or exchange limitations may apply.

You are responsible for providing an accurate shipping address and promptly notifying support of any errors.

The uploaded form includes similar fulfillment concepts, including pharmacy approval, shipping-delay disclaimers, and authorization to ship medication to the address provided.

Shipping Authorization Statement

If prescribed and approved for fulfillment, I authorize medication or related products to be shipped to the address I provide, subject to applicable law, pharmacy procedures, and the program terms.

6. Consent to Electronic Communications

You consent to receive communications from Medintra and, where applicable, related providers or vendors by:

email,

text message,

phone,

portal message,

or other electronic means.

These communications may include:

account notifications,

support updates,

reminders,

billing notices,

service updates,

process-related communications,

and other operational messages.

You understand that standard message and data rates may apply depending on your carrier or service plan.

7. No Guarantee of Services or Results

You understand and agree that:

meeting basic eligibility requirements does not guarantee services,

a provider may determine that treatment is not appropriate,

no diagnosis, prescription, treatment, medication, or outcome is guaranteed,

telehealth may not be suitable for every person or situation,

and no specific results can be promised or assured.

This tracks both your uploaded source and broader telehealth consent principles requiring clear expectation-setting.

8. Withdrawal of Consent

You may withdraw your consent to telehealth and related remote communications at any time by contacting the appropriate party, but doing so may affect your ability to continue receiving services through the Platform.

Certain completed transactions, records, prior uses or disclosures, and obligations that arose before withdrawal may still remain in effect as allowed by law.

9. Acknowledgment and Agreement

By continuing to use the Platform, checking an electronic consent box, signing electronically, or otherwise proceeding with services, you acknowledge and agree that:

you have read and understood this Consent,

you have had the opportunity to ask questions,

you understand the telehealth process and its risks and limitations,

you understand that Medintra is a platform and not the medical provider or pharmacy,

you understand the privacy, financial, and shipping terms described above,

and you consent to proceed on that basis.

10. Contact Information

If you have questions about this Consent, please contact:

Medintra

Medintra Inc

1529 6th st s Fargo ND 58103

pat@medintra.org