Telemedicine & Treatment Informed Consent

Apsara Integrative Women’s Health  |  Seema Shah, MD

This consent describes how care is delivered by Apsara Integrative Women’s Health (the “Practice”), the benefits and limitations of receiving care by telemedicine, and the risks of the treatments the Practice may recommend. Please read it in full before signing. You may ask questions at any time and may withdraw this consent at any point.

1. Who is providing your care

Your care is provided personally by Seema Shah, MD, a physician licensed in the State of California and board certified in obstetrics and gynecology. Dr. Shah is a solo practitioner. No other clinician will provide care to you under this consent unless you are separately informed. You may verify Dr. Shah’s license at any time through the Medical Board of California at mbc.ca.gov.

2. What telemedicine means here

2.1 The care is remote. At this time, the Practice provides care exclusively by telemedicine. Care is delivered through live two-way video visits, telephone visits where appropriate, and secure asynchronous messaging through the Practice’s patient portal. There is no physical office and no in-person visits are available at this time.

2.2 Technology used. Visits and messages are conducted through the Practice’s HIPAA-compliant telehealth and patient portal platform, currently Hint Health. Records are maintained in the Practice’s electronic health record. Faxes are sent and received through a secure, HIPAA-compliant fax service. If the Practice changes platforms, the replacement will meet the same standards and you will be told before your information is moved.

2.3 Your location. You must be physically located in the State of California at the time of each visit. You will be asked to confirm your location at the start of every visit. Dr. Shah is not licensed to provide care to you while you are located in another state, and a visit will be rescheduled if you are outside California.

2.4 Your environment. You are responsible for arranging a private, quiet location with a reliable internet connection for your visit. Discussing sensitive health information in a shared or public space carries privacy risk that the Practice cannot control.

3. Benefits and limitations of telemedicine

3.1 Benefits. Telemedicine allows longer visits, access without travel, greater scheduling flexibility, and continuity of care with the same physician over time.

3.2 Limitations. You should understand that:

• No physical examination is performed. This is a meaningful limitation. Conditions that would be detected on physical examination, including pelvic and breast examination, may be missed; because of this, Dr. Shah requires that you have had a physical exam, including a pelvic exam, within the last two years.
• Dr. Shah relies on the accuracy and completeness of the information you provide, on outside records, and on laboratory results you obtain.
• Some conditions cannot be diagnosed or managed by telemedicine and will require in-person evaluation, testing, imaging, or referral. Dr. Shah will tell you when that is the case, and it is your responsibility to obtain that care outside of Apsara until a time when Dr. Shah is able to secure a brick and mortar location.
• Technology may fail, transmission may be delayed or degraded, and in rare circumstances electronic information may be lost, delayed, or accessed by unauthorized persons despite reasonable safeguards.
• There is no guarantee that telemedicine care will produce any particular outcome.

3.3 You may decline. You may withdraw this consent and decline telemedicine at any time without affecting your right to seek care elsewhere. Because the Practice provides care only by telemedicine, withdrawing consent ends the Practice’s ability to provide you care. You may also ask that a particular visit be conducted by telephone rather than video where that is clinically appropriate.

4. Scope of care and what is not provided

4.1 Areas of care. The Practice focuses on perimenopause and menopause, menopausal hormone therapy and non-hormonal alternatives, sexual health, genitourinary symptoms of menopause, cancer survivorship as it relates to menopausal health, and midlife preventive and wellness counseling. Her goal is to provide a central medical hub to help not only with her areas of expertise, but also with coordination of your broader care.

4.2 No obstetric care. Dr. Shah is a board-certified obstetrician-gynecologist but does not provide obstetric care of any kind. The Practice does not provide prenatal care, care during labor or delivery, or management of pregnancy or its complications. The Practice does not provide postpartum care within the first six (6) weeks after delivery; postpartum care may be provided after the six-week postpartum window. If you become or may be pregnant, you must tell Dr. Shah immediately and establish care with an obstetric provider.

4.3 No emergency or urgent care. The Practice does not provide emergency or urgent care and does not monitor communications continuously. In an emergency, call 911 or go to the nearest emergency department. If you are having thoughts of harming yourself, call or text 988.

4.4 Primary care. The Practice is not a substitute for a primary care physician, especially if you have multiple medical conditions. You are expected to maintain a primary care relationship for general medical care, screening, and management of conditions outside the Practice’s focus. Dr. Shah’s goal is to have easy communication and coordination of care with all of your healthcare providers.

5. Treatments the Practice may recommend

5.1 General. Any treatment carries potential benefits, risks, side effects, and alternatives, including the alternative of no treatment. Dr. Shah will discuss the specific risks, benefits, and alternatives that apply to your situation before initiating any therapy, and you may ask questions and decline any recommendation.

5.2 Menopausal hormone therapy. Menopausal hormone therapy, including estrogen with or without progesterone, and testosterone may relieve vasomotor symptoms, genitourinary symptoms, and other consequences of estrogen loss, and may affect bone health. Depending on your age, time since menopause, formulation, dose, and route, hormone therapy carries potential risks that may include venous thromboembolism, stroke, gallbladder disease, and, with certain regimens and durations, breast cancer. Your individual risk depends on your personal and family history, and Dr. Shah will discuss your individual risk profile with you.

5.3 Off-label prescribing. Some medications used in menopause and sexual health care are prescribed for uses not approved by the U.S. Food and Drug Administration. Off-label prescribing is lawful and common, and may be supported by clinical evidence and professional guidelines. Dr. Shah will tell you when a recommendation is off-label.

5.4 Compounded medications. Compounded medications are prepared by a compounding pharmacy for an individual patient and are not FDA-approved. They are not reviewed by the FDA for safety, effectiveness, or manufacturing quality, and potency may vary between pharmacies and between batches. Dr. Shah always prefers to use FDA approved medications and will tell you when a recommendation involves a compounded product and why.

5.5 Supplements and non-prescription products. The Practice may discuss supplements or over-the-counter products. Such products are not FDA-approved for the treatment of disease, and quality varies by manufacturer. The Practice does not sell supplements or products and has no financial interest in any product recommended.

5.6 Controlled substances. The Practice does prescribe controlled substances as medically necessary and with the required laboratory tests. All treatment plans that include controlled substances require different types of follow up and will be relayed to you.

5.7 Laboratory testing. When possible Dr. Shah will use recent laboratory testing completed to drive clinical decision making and to provide recommendations. This also is to provide value and convenience for the patient. Some online platforms order testing that may or may not have clinical utility in your care. Those companies are responsible for informing you the results of those tests, clinical utility, and their interpretation regarding some of those results (i.e., Function Health). For genetic testing, many companies are testing for genetic markers that currently are not known to have clinical utility. It is the responsibility of the ordering provider and the company to update you on any new findings regarding the genetic markers. Dr. Shah may order laboratory testing. You are financially responsible for the cost of testing, which is billed directly by an independent laboratory and is not marked up by the Practice. Results are released to you automatically and may appear in your portal before Dr. Shah has reviewed them. Please wait for her interpretation before drawing conclusions.

6. Communication and response expectations

6.1 All clinical communication takes place through the patient portal or during a scheduled visit. Dr. Shah will make reasonable efforts to respond to non-urgent messages within one (1) business day. Messages are not actively monitored after hours, on weekends, or during announced closures. She asks that medication refill requests occur before 4 pm on Friday. All communication with Dr. Shah outside of business hours are done at her sole discretion.

6.2 Some questions cannot be answered safely by message. If Dr. Shah determines that your question requires a visit, she will tell you and you will be asked to schedule one. This is a clinical safety judgment, not a billing decision.

6.3 Most ongoing medication management requires a visit at least once every three (3) months. Prescriptions will not be continued or refilled without a visit within that interval.

7. Privacy, records, and artificial intelligence

7.1 Confidentiality. Your health information is protected under HIPAA and the California Confidentiality of Medical Information Act. The Practice’s Notice of Privacy Practices describes how your information may be used and disclosed and what rights you have.

7.2 No sale of your information. The Practice does not sell your personal or health information, and does not share, license, or otherwise make it available to data brokers, advertisers, or any other third party for marketing, advertising, or research. Your information is used to provide and administer your care, and is disclosed only as you direct or as the law requires.

7.3 Documentation. Clinical notes are written by Dr. Shah. The Practice does not use artificial intelligence scribes. The EHR does automatically make some clinical practice suggestions, however, this is not used by Dr. Shah for clinical decision making. She may utilize a dictation type system to help with retaining vital information.

7.4 Vendor artificial intelligence. The Practice’s electronic health record and other vendors may incorporate artificial intelligence features within their platforms. The Practice cannot fully control or audit how a vendor processes data within its own system. Vendors that handle your protected health information do so under written business associate agreements that restrict their use and disclosure of that information. Where a vendor uses information for product improvement, the Practice requires that such use be limited to de-identified data as permitted by law.

7.5 Generative artificial intelligence in patient communications. The Practice does not use generative artificial intelligence to write communications to you about your clinical information. If that ever changes, the Practice will label those communications as required by California law and will tell you how to reach a human clinician.

7.6 Recording. Visits are not recorded by the Practice except for dictation. You may not record a visit without Dr. Shah’s advance consent. California law requires the consent of all parties to record a confidential communication.

7.7 Communication risk. No electronic system is perfectly secure. By consenting to telemedicine and portal communication, you accept the residual risk of interception, technical failure, or misdirected delivery despite reasonable safeguards.

8. Financial acknowledgment

8.1 The Practice does not accept insurance, does not bill insurance, and does not participate in any health plan or government program. Dr. Shah has opted out of Medicare; no claim for services under this consent may be submitted to Medicare by you or by the Practice.

8.2 You are responsible for all fees as set out in the Membership Agreement and the Practice’s Financial Policy and Fee Schedule, and for all third-party charges including laboratory, pharmacy, imaging, and specialist charges.

8.3 As a self-pay patient you have the right to a good faith estimate of Dr. Shah’s expected charges before scheduled services, and you may request a written quote for any service at any time. She is unable to give an estimate of services that are being paid for by the insurance or how much they reimburse.

9. Your rights

You have the right to:

• Ask questions and receive answers you understand before agreeing to any treatment;
• Refuse or discontinue any treatment;
• Request that a visit be conducted by telephone rather than video where clinically appropriate;
• Withhold or withdraw this consent at any time;
• Obtain a copy of your medical record; and
• Receive a copy of this signed consent.

10. Acknowledgment and consent

By signing below, I acknowledge and agree that:

• I have read and understand this consent and have had the opportunity to ask questions;
• I understand that all care will be provided by telemedicine and that no physical examination will be performed;
• I understand the benefits, risks, and limitations of telemedicine described above;
• I understand that the Practice does not provide obstetric care, emergency care, or urgent care;
• I understand that I must be physically located in California at the time of each visit;
• I understand that ongoing medication management requires a visit at least every three months;
• I understand that the Practice does not accept or bill insurance and that I am financially responsible for the Practice’s fees and for third-party charges;
• I consent to receive medical care from Seema Shah, MD by telemedicine, and I consent to the treatments described above being discussed and, where I separately agree, prescribed.

Clinician attestation: I have discussed the nature of telemedicine care, its benefits and limitations, and the risks, benefits, and alternatives of proposed treatment with the patient, and have answered the patient’s questions.