TeleVital
Informed Consent to Perform Health Screenings

Please read this information carefully. The purpose of TeleVital is to help the community by remotely conducting COVID-19 assessment which includes checking vitals and analysing X-rays. This Informed Consent gives TeleVital permission to collect information about my health and conduct the health screenings listed below. This consent form serves two purposes: > First, it provides information on the procedures and risks involved, so that you can decide if you want to take part in the study. > Second, this form will ask for your permission to use the medical information that we will get from you during this study. Please take your time to make decision about taking part. You may discuss your decision with your friends and family. The following information will be collected from you if and only if you agree to proceed further: (1) Heart rate (2) Respiratory rate (3) SpO2 (4) Chest X-Ray (only for X-Ray Analyser) I consent to have TeleVital. administer each of the above-mentioned screenings online. I understand that: • I am entitled to receive a copy of this Informed Consent, my health screening results, and any other protected health information that is collected by TeleVital in connection with my health screenings. • The X-Ray analyser used for COVID-19 assessment may not be as accurate and it is always advised to visit nearby doctors or hospitals for accurate information. • The test results collected here by TeleVital will be held securely and confidentially by TeleVital. • Non test results information such as Phone Number, Email will not be shared with anyone.It is only being collected to notify you regarding your test results. • My test results (but not my identifying information) will be included as part of aggregated data in a summary report ,so that company can design health programs to meet employees’ needs. • TeleVital does not practice medicine and is not a substitute for the doctor’s care. • I am responsible for consulting the doctor for questions about any specific medical needs that may be indicated by these screenings. I will not hold TeleVital responsible for providing information, diagnosis or treatment as a substitute for the care I receive from my physician or other qualified healthcare provider. • I am responsible for consulting the doctor online through platform provided by TeleVital regarding questions about any specific medical needs that may be indicated by these screenings. I will not hold TeleVital responsible for providing information, diagnosis or treatment as a substitute for the care I receive from my physician or other qualified healthcare provider. • If I have an abnormal screening result, I am responsible for following-up with my primary care physician. I recognize that if I do not sign this Informed Consent, TeleVital cannot administer the screenings, and I will not have completed the first step to take the assessment. By choosing to continue, you acknowledge your understanding of instructions for accessing the portal and the risk involved. You will be solely responsible for the security and privacy of your email account and any device you use to access portal. I have had full opportunity to read and consider the contents of this form. I Disagree I Agree