Patient documents

I understand that Direct Line Medical provides rapid-access medical evaluation through telehealth and, when specifically arranged, other outpatient services. Telehealth may use video, telephone, secure messaging, photographs, questionnaires, or other electronic communications. The clinician will decide whether my concern can be evaluated safely through the available method.

I understand that the clinician may require an in-person examination, diagnostic testing, urgent-care or emergency-department evaluation, specialist evaluation, or follow-up with another treating clinician. Direct Line does not guarantee that my condition can be diagnosed or treated remotely.

Potential benefits and limitations

Potential benefits include improved access, reduced travel, earlier assessment, medication review, treatment recommendations, testing orders, and referral guidance. Limitations may include an incomplete physical examination, poor image or audio quality, unavailable records, technology failure, delayed results, and the possibility that a condition is more serious than it appears remotely.

I understand that an encounter does not guarantee a diagnosis, prescription, antibiotic, controlled substance, refill, test, work note, procedure, or any requested treatment.

Emergency conditions

Direct Line is not an emergency service and does not continuously monitor submitted requests, messages, or callback requests. If I have a medical or psychiatric emergency, severe chest pain, significant breathing difficulty, stroke symptoms, uncontrolled bleeding, severe allergic reaction, suicidal intent, major trauma, or another condition requiring immediate attention, I will call 911 or seek emergency-department care.

If a clinician determines that higher-acuity care is required, I authorize the clinician to recommend or direct emergency or in-person evaluation and, when reasonably necessary for immediate safety and permitted by law, to contact emergency services or an emergency contact.

Identity, location, and eligibility

I will provide accurate identifying information and, when requested, appropriate identity verification. At each telehealth encounter I will provide my current physical location and a working callback number. I understand that the clinician must be legally authorized to treat me where I am physically located and may decline or stop an encounter when that requirement or the applicable standard of care cannot be satisfied.

Information and records

I certify that the history, medication list, allergy information, photographs, identification, and other information I submit are accurate to the best of my knowledge and belong to me or to a patient whom I am legally authorized to represent. I authorize clinically relevant submitted photographs and documents to become part of the medical record when appropriate.

I understand that photographs and questionnaires may assist evaluation but do not replace an examination when an examination is clinically necessary.

Treatment and follow-up

I consent to medically appropriate evaluation and treatment within the rendering clinician’s lawful scope of practice. I understand that I am responsible for completing recommended testing, follow-up, referral, or emergency evaluation and for providing accurate pharmacy and medication information.

Consent to telehealth billing

I understand the disclosed self-pay charge applicable to the service. I consent to billing for a telehealth service after a billable clinical evaluation is rendered. Submitting a request, entering a queue, or requesting a callback does not by itself constitute a billable clinical evaluation.

Refund policy

Refunds will be issued for services that were not rendered or could not be completed, as determined through documented review. A patient requesting a refund must submit a description of the service concern and supporting information reasonably available to the patient. The provider responsible for the service will review the request in conjunction with the Direct Line Medical owner/operator or the owner/operator’s designated representative. The review and final determination, including the basis for any refund or denial, must be documented. Any refund due under applicable law will be provided regardless of the outcome of an internal discretionary review. A completed, clinically meaningful evaluation is not automatically refundable solely because a requested prescription, treatment, or outcome was not provided.

Voluntary consent

I have had an opportunity to review this consent and ask questions. I voluntarily consent to telehealth and related Direct Line services. I may withdraw consent prospectively, but withdrawal does not affect services already rendered or lawful charges already incurred.

During the current launch, patients may choose self-pay when uninsured or when they do not wish to use insurance. Insurance billing may be offered for future encounters after activation and patient election. Direct Line will not submit this self-pay encounter to an insurer unless a separate future arrangement is made and permitted.

Price disclosure

The price presented to me before the billable service begins is the expected Direct Line professional charge for the selected service. Outside laboratories, imaging centers, pharmacies, specialists, urgent-care centers, emergency departments, hospitals, pathology services, or other third parties may charge separately.

No charge for request submission

I understand that I will not be charged merely for submitting a request, entering an administrative queue, or requesting a callback. A callback request does not guarantee that a clinician will accept the request or respond within a particular time.

Payment authorization

I authorize Direct Line’s approved payment processor to securely store or tokenize my payment method when I choose that option. I authorize Direct Line to charge the disclosed amount only after a billable service has been rendered or when another charge was clearly disclosed to and authorized by me in advance.

No-treatment outcome

A clinical evaluation may still be billable when the clinician determines that no prescription or requested treatment is appropriate, or recommends in-person, urgent, or emergency evaluation, provided a meaningful billable evaluation was performed and the charge was disclosed.

Technology failure

If a technical failure prevents a meaningful clinical evaluation, Direct Line may reschedule the encounter, use another legally permissible method, refer me to in-person care, or issue an appropriate refund or credit under the final written refund policy.

Good Faith Estimate

If I am uninsured or choose not to use insurance, I may request a Good Faith Estimate of expected charges. When federal timing rules require an estimate, Direct Line will provide one within the applicable timeframe. I understand that federal law may permit a patient-provider dispute if a provider’s billed charge is at least $400 more than that provider’s Good Faith Estimate, subject to the applicable federal requirements.

Cancellation terms

Refund policy

Refunds will be issued for services that were not rendered or could not be completed, as determined through documented review. A patient requesting a refund must submit a description of the service concern and supporting information reasonably available to the patient. The provider responsible for the service will review the request in conjunction with the Direct Line Medical owner/operator or the owner/operator’s designated representative. The review and final determination, including the basis for any refund or denial, must be documented. Any refund due under applicable law will be provided regardless of the outcome of an internal discretionary review. A completed, clinically meaningful evaluation is not automatically refundable solely because a requested prescription, treatment, or outcome was not provided.

Covered entity/practice: Direct Line Medical

HIPAA Privacy, Compliance, and Safety Officer: Meghan Tripodi, RHIA

Document revision date: October 12, 2026

Effective date: October 12, 2026

Our responsibilities

We are required by applicable law to maintain the privacy and security of protected health information, provide this notice when required, follow the privacy practices described in the notice currently in effect, and notify affected individuals when a breach requires notification.

How we may use and disclose health information

Subject to applicable law, we may use or disclose health information for treatment, payment, and health-care operations; to coordinate care with other treating professionals; for public-health and safety activities; when required by law; for health oversight; in response to lawful judicial or administrative processes; and for other purposes permitted by HIPAA and applicable Ohio law.

We will obtain written authorization when an authorization is legally required. An authorization may generally be revoked in writing prospectively, subject to actions already taken in reliance on it.

Your rights

Subject to applicable law, you may request access to or a copy of your health information; request correction or amendment; request confidential communications; ask for certain restrictions; request an accounting of certain disclosures; obtain a paper or electronic copy of this notice; designate an authorized personal representative; and file a privacy complaint without retaliation.

If you pay in full out of pocket for an item or service, you may have a right to request that information about that item or service not be disclosed to a health plan for payment or health-care operations, except where disclosure is required by law.

Electronic systems and vendors

Direct Line may use contracted technology, communications, cloud, payment, or other service providers. When a vendor is a business associate under HIPAA, the appropriate Business Associate Agreement and safeguards must be in place before the vendor handles protected health information in that capacity.

Sensitive information

Certain information, including mental-health, substance-use-disorder, reproductive-health, and minors’ records, may receive additional protection under applicable federal or Ohio law. Direct Line Medical follows those additional requirements when applicable.

Complaints

Patients may submit privacy complaints to the practice privacy contact and may also complain to the U.S. Department of Health and Human Services Office for Civil Rights. Direct Line will not retaliate against a patient for filing a privacy complaint.

Changes to this notice

The practice may change this notice as permitted by law. The current notice will be made available through the practice website and upon request.

Policy ownership and oversight

Meghan Tripodi, RHIA, is designated as Direct Line Medical’s HIPAA Compliance Officer and Safety Officer, responsible for coordinating privacy and security policy oversight, reviews, and corrective actions in collaboration with practice leadership.

Policy review and maintenance

This policy shall be reviewed at least semiannually (every six months). Revisions and corrective actions shall be made at these reviews as appropriate and promptly whenever inadequacies, deficiencies, incidents, or material changes in operations or risks are identified; corrective action shall not be delayed until the next scheduled review.

Direct Line Medical will monitor applicable federal and Ohio laws, regulations, and official guidance affecting privacy, security, and patient information and will revise this policy as necessary to maintain alignment with current legal requirements. Reviews, deficiencies, corrective actions, and policy revisions shall be documented, including dates and responsible personnel.

The Direct Line website and application provide a pathway to request medical services and related administrative functions. General website content is informational and is not individualized medical advice.

No emergency service

The platform is not designed for emergencies and is not continuously monitored as an emergency communication system. Users experiencing an emergency should call 911 or seek emergency care.

Request is not acceptance

Submitting a request, joining a queue, uploading information, or requesting a callback does not guarantee acceptance by a clinician, a response within a particular time, diagnosis, treatment, prescription, or establishment of an ongoing clinician-patient relationship. A clinical relationship begins only as determined by applicable law and the actual clinical interaction.

Availability modes

“Available now” indicates that the service is accepting requests but does not guarantee immediate evaluation.

“Delayed service/callback” allows a user to request later contact. It is not continuous clinical monitoring and should not be used for urgent or worsening symptoms.

“Unavailable/off” means Direct Line is not accepting clinical requests through the platform at that time.

Eligibility and location

Users must provide accurate identity, contact, and location information. Clinical services may be limited based on patient location, clinician licensure, scope of practice, age, condition, or clinical appropriateness.

User responsibilities

Users must provide accurate information, protect account credentials, avoid submitting information about another person without legal authority, follow urgent or emergency instructions, and use the platform lawfully.

Clinical judgment

Clinicians retain independent professional judgment. Direct Line does not guarantee any particular medication, prescription, test, referral, diagnosis, work note, or outcome.

Payments

Current relaunch services are self-pay unless Direct Line expressly states otherwise. Charges, refunds, payment authorization, and Good Faith Estimate rights are governed by the patient financial agreement and applicable law.

Privacy

Medical and identifying information is handled under the applicable Notice of Privacy Practices and privacy/security policies. We maintain privacy and security safeguards designed to protect medical information in accordance with applicable law. No electronic system can guarantee absolute security.

Third-party services

The platform may rely on third-party cloud, communications, payment, laboratory, imaging, pharmacy, or other services. Separate third-party terms and charges may apply.

Intellectual property

Direct Line names, logos, software, workflows, and original website content are protected to the extent provided by law. Users receive only the limited right to use the service for its intended purpose.

Disclaimers and limitation of liability

Nothing in these terms is intended to waive or limit rights or remedies that cannot lawfully be waived, including applicable patient and consumer-protection rights.

Governing law/dispute terms

Direct Line Medical operates in Ohio. Applicable law determines patients’ rights and the resolution of disputes; these terms do not impose arbitration or a class-action waiver.

I consent to receive administrative communications from Direct Line using the mobile number and email address I provide. Communications may include request-status updates, callback notices, scheduling information, payment receipts, account-security messages, and limited follow-up reminders.

I understand that ordinary text messaging and email may have privacy risks. Direct Line will limit sensitive clinical information in ordinary messages and may direct me to a secure method for clinical content.

I understand that communication consent is not permission to use SMS or email as an emergency channel. Direct Line does not continuously monitor ordinary messages for emergencies.

I may change my communication preferences or opt out of nonessential messages using the method provided by Direct Line, subject to messages that are necessary for an active transaction, security, or care process and are permitted by law.

Marketing or promotional messaging, if ever used, must be separately evaluated and consented to when required. This consent is intended for operational and care-related communications and should not be treated as blanket marketing consent.

Patient preferences

Patients may contact Direct Line Medical through the contact methods provided on the website to update communication preferences. Emergency care should be sought through 911 or the nearest emergency department.

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