Telehealth Informed Consent

What this document is

This is the informed-consent document for receiving telehealth services from Practiclear PLLC ("Practiclear," "we," "our"). By using our service, you agree that you have read it and understand it.

Telehealth services in Virginia are governed by the bona fide practitioner-patient relationship requirements set out in Va. Code § 54.1-3303, with the telehealth-specific framework in Va. Code § 32.1-122.03:1. Where a section of this document tracks a specific statutory requirement, the citation is shown next to it.

Who your provider is

Your provider is Andrew Joseph Overbey, FNP-BC, ENP-C — a Family and Emergency Nurse Practitioner licensed in Virginia (License #0024172132, Individual NPI 1104220367), board-certified by ANCC (FNP-BC, #2014020454) and AANPCB (ENP-C, #E12190009). All four credentials are independently verifiable through public registries; links are listed on the Provider page. Your provider practices through Practiclear PLLC (Organization NPI 1972448322).

Your provider practices as an APRN with autonomous practice authority in Virginia under Va. Code § 54.1-2957(I) and 18 VAC 90-30-86. Eligibility for autonomous practice in Virginia requires at least three years (5,400 hours) of full-time post-graduate clinical experience in the practice category in which the APRN is certified and licensed, per 2024 Va. Acts ch. 305 (HB 971), effective July 1, 2024. The provider has been licensed as an APRN in Virginia since October 2014 and holds the autonomous-practice designation issued by the Joint Boards of Nursing and Medicine.

Autonomous practice means the provider does not require a practice agreement with a physician but is individually responsible, under 18 VAC 90-30-86(G), for:

1. Practicing only within the scope of the APRN's clinical and professional training, knowledge, experience, and applicable standards of care;
2. Consulting and collaborating with other health care providers based on the patient's clinical condition; and
3. Maintaining a plan for referral of complex medical cases and emergencies to physicians or other appropriate providers.

What "telehealth" means here

The routine Practiclear encounter does not automatically include a live video visit. Your provider establishes the practitioner-patient relationship by reviewing your written medical intake, your government-issued photo ID, and (where applicable) your lab result — a store-and-forward workflow. Synchronous contact occurs when the provider determines it is clinically indicated.

Live follow-up by encrypted email, telephone, or video may occur only if your provider determines it is clinically necessary — for example, to discuss an unexpected result — and is at the provider's discretion. It is not part of the routine flow.

Practiclear's services are delivered through a combination of:

• Asynchronous (store-and-forward) review — you complete a written medical intake through Paubox Forms, Practiclear's secure patient intake and file-upload channel under a Business Associate Agreement; your provider reviews it and decides whether to order the requested test. Jotform is not part of the MVP PHI intake workflow.
• Lab order routing and result review — Practiclear may use Evexia Diagnostics to route lab orders to Labcorp after clinician review. No lab order is placed automatically, and no requisition is sent until after manual Evexia order placement. Once your result returns through the lab-ordering workflow, your provider reviews it and issues written screening documentation when appropriate.
• Real-time follow-up when needed — if your case is not appropriate for asynchronous review, or if a result requires live discussion, your provider will reach you by encrypted email (through Paubox, our Business Associate for outbound encrypted communication), telephone, or video as the situation requires.

Va. Code § 54.1-3303 permits establishing a bona fide practitioner-patient relationship via telehealth when the standard of care does not require an in-person examination. Practiclear limits its services to screening requests where the reviewing clinician determines, based on the submitted intake and current standard of care, that in-person examination is not required before ordering or documentation.

How the practitioner-patient relationship is established

The practitioner-patient relationship is not established by paying for a service or by submitting the eligibility form at /start/. The relationship is established when, and only when, all of the following occur:

1. You verify your identity to your provider by uploading a clear image of a current government-issued photo ID and confirming your legal name, date of birth, and Virginia mailing address. Identity verification happens through Paubox Forms (under our Business Associate Agreement) and is a precondition to ordering laboratory testing under your name. This is consistent with the Va. Code § 32.1-122.03:1 Statewide Telehealth Plan expectation that the provider know the patient.
2. You complete a medical intake in our intake form after payment, and we obtain your medical history (§ 54.1-3303(A)(i)).
3. Your provider reviews your identity, intake, and the requested service, and determines that the service is clinically appropriate, within scope, and consistent with the standard of care (§ 54.1-3303(A)(ii)–(iii); 18 VAC 90-30-86(G)(1)).
4. Your provider signs a lab requisition through the intended Evexia/Labcorp workflow, or, in the case of a records-review service, accepts your existing documentation for interpretation.

Until that lab requisition is signed (or, for records-review, your documentation is accepted), the practitioner-patient relationship has not been established and you are not yet a Practiclear patient.

Your provider's right to decline

Your provider may, at sole clinical discretion, decline to order a test or issue a clearance letter when, in the provider's judgment, doing so would be outside scope of training, contrary to the standard of care, or not in your clinical best interest (18 VAC 90-30-86(G)(1)).

If your provider declines to proceed, you will receive:

• A written explanation of the decline and a recommended next step (typically: see your primary care provider, urgent care, or — for an emergency — go to the nearest emergency department).
• A refund of your full payment, as described in our Refund Policy.

Scope of services — what we do and do not do

Practiclear is a focused screening-lab ordering and documentation-support service. We:

• Review and, when appropriate, order a defined MVP set of routine screening labs (TB IGRA, MMR / Varicella / Hep B Surface Antibody titers) for asymptomatic adults located in Virginia.
• Review existing lab documentation and provide clinician-signed screening documentation when appropriate only after a dedicated secure records-upload workflow is approved ("Screening Documentation Review").
• Provide Practiclear-letterhead screening documentation signed by your provider with NPI and license number when review criteria are met.
• Refer to a primary care provider, specialist, urgent care, or emergency department when a result or symptom is outside our scope.

We do not:

• Diagnose or treat acute medical conditions, infections, or chronic disease.
• Manage positive screening results long-term — we coordinate the handoff to your primary care or local health department but do not replace ongoing care.
• Prescribe medications as part of a documentation-support encounter. (Your provider retains prescribing authority in Virginia but does not exercise it as part of this limited-scope service.)
• Provide care to patients located outside the Commonwealth of Virginia at the time of the encounter.
• Provide Evexia/Labcorp ordering for patients who reside in New York, New Jersey, or Rhode Island.
• Provide Evexia/Labcorp ordering for patients who intend to use insurance, Medicare, Medicaid, another government health care program, or third-party reimbursement for the order.
• Provide minor ordering in MVP. Evexia minor ordering would require a signed Minor Consent Agreement for each requisition, but Practiclear's MVP is adults-only.

Limits of documentation

Practiclear screening documentation addresses only the specific screening test or titer result reviewed, the laboratory that performed the test, the draw date, and the provider's clinical interpretation of that result.

Practiclear screening documentation is not:

• A broad medical evaluation.
• A history and physical examination.
• An occupational readiness determination.

Practiclear cannot guarantee that any third party — including your school, clinical-rotation site, employer, or any other receiving institution — will accept Practiclear documentation for their requirement. Whether the documentation satisfies a third party's documentation requirement is determined by that institution at its discretion.

If a third party rejects the documentation for reasons attributable to a clerical error by Practiclear — for example, a misspelled name, a missing line item, or a date typo — the documentation will be corrected and re-issued at no additional charge, consistent with our Refund Policy.

Limits of asynchronous telehealth

Asynchronous review is appropriate for routine, low-acuity screening of asymptomatic adults. It is not appropriate for:

• Active symptoms (cough, fever, night sweats, weight loss, etc.)
• Suspected active or untreated infection
• Pregnancy-related concerns
• Anyone under 18 (Practiclear does not currently serve patients under 18)
• Any clinical question that requires a physical examination
• Emergencies — call 911 or go to your nearest emergency department

If, during intake or result review, your provider determines that your case falls into any of these categories, the order will be declined per the section above and you will be referred to the appropriate level of care.

Risks and benefits of telehealth

Benefits of receiving care this way include:

• No in-person clinic visit for routine screening.
• Single blood draw at a Labcorp Patient Service Center, subject to Labcorp location, hours, appointment, and service availability.
• Signed screening documentation your school, employer, or program can review — not just a lab printout.
• Clear pricing without insurance billing.

Risks and limitations of asynchronous telehealth include:

• No physical examination is performed. A condition that would have been detected on physical exam may not be identified.
• Information you provide on intake is the basis for your provider's clinical decision. Inaccurate or incomplete information can lead to an inappropriate order.
• Lab errors, mislabeling, or specimen integrity issues at the draw site can produce inaccurate results. We rely on the laboratory's quality processes.
• Asynchronous communication can have delays. If you have an urgent concern, do not wait — go to urgent care or the emergency department.
• Despite reasonable security measures, electronic transmission of health information carries a small risk of unauthorized access.

Continuity of care and follow-up

For positive or unexpected results, your provider will:

• Contact you by encrypted email (via Paubox) to explain the result and the recommended next step.
• For positive TB IGRA results: explain that the screening result does not by itself diagnose active TB, and refer you to your primary care provider, the Virginia Department of Health, or an infectious-disease clinician for any needed follow-up evaluation. Additional evaluation, such as symptom review and/or chest imaging, may be required depending on your situation and program. Practiclear does not provide emergency care or active TB treatment.
• For non-immune titer results: explain what the result means and document that vaccination, booster documentation, or outside follow-up may be required according to your school, employer, or program requirements. We do not administer vaccines.
• For results that may indicate active infection or other clinical concern: refer to the appropriate level of care promptly, including emergency care if warranted (18 VAC 90-30-86(G)(2)).

Practiclear is not a primary care provider and does not replace one.

Critical-result protocol

Consistent with 18 VAC 90-30-86(G)(2), your provider maintains a written plan for handling abnormal, unexpected, or critical results. In summary:

Evexia Diagnostics does not diagnose or treat and does not replace Practiclear clinical review/escalation. Before launch, Practiclear must verify how Evexia notifies Practiclear of critical results, including portal, email, phone, after-hours, voicemail, and backup-contact pathways.

• Your provider personally reviews every result before any Practiclear letter is issued.
• For results flagged by the laboratory as critical (for example, a result the laboratory reports requires immediate clinical attention), your provider will use the abnormal-result follow-up process during monitored business operations, including phone or encrypted email outreach as clinically appropriate.
• For results that suggest an active infection, the need for in-person evaluation, or are otherwise outside the scope of asynchronous Practiclear care, your provider will refer you to an appropriate clinician (your primary care provider, an infectious-disease specialist, the local health department, or an emergency department, depending on severity) and document the referral in your chart.
• Practiclear does not provide ongoing management for active disease and does not prescribe medication. Where you require treatment, you will need to be seen by a clinician who provides that level of care.

If you believe you are experiencing a medical emergency at any point, call 911 or go to the nearest emergency department. Do not wait for a Practiclear message.

Reportable diseases

Some test results trigger mandatory reporting to the Virginia Department of Health under Virginia's reportable-disease regulation (12 VAC 5-90-80) and the underlying statutory authority (Va. Code § 32.1-35 et seq.). Active tuberculosis is a reportable condition. A positive TB IGRA does not by itself diagnose active TB disease and is generally not directly reportable, but if your clinical picture or follow-up evaluation suggests active TB disease, your provider — or a downstream clinician you are referred to — is required by law to report. By consenting to telehealth services with Practiclear, you acknowledge this legal duty.

Privacy and protected health information

The handling of your protected health information is governed by HIPAA (45 CFR Parts 160 and 164) and described in detail in our Notice of Privacy Practices. In brief:

• The eligibility form at /start/ intentionally collects no medical information. It is not subject to HIPAA because no protected health information is exchanged.
• All medical intake (including your photo ID, vaccination history, and any clinical detail) is collected through Paubox Forms, Practiclear's secure patient intake and file-upload channel under a Business Associate Agreement. Jotform is not part of the MVP PHI intake workflow.
• The intended MVP lab path is Evexia Diagnostics for lab ordering/result workflow and Labcorp for performing laboratory and Patient Service Center draw path. This workflow must not be used for live ordering unless current vendor evidence and counsel-reviewed agreement constraints support that use.
• All outbound encrypted email — including screening documentation — is delivered through Paubox Email Suite, operating under a Business Associate Agreement.
• Your provider's intended inbox, calendar, and chart-storage Drive folders are within Google Workspace. PHI use requires current HIPAA configuration and Business Associate Agreement evidence before launch.
• Stripe handles payment information only; Practiclear does not store your card details, and Stripe does not receive your medical history, lab results, or screening documentation. Stripe is used as a payment processor for non-clinical payment information in the public checkout flow.
• Practiclear does not use a centralized record system or web portal. Your record set is composed of the items each named active PHI workflow maintains, plus locally generated screening documentation and audit logs Practiclear keeps on a secured workstation.

Your rights as a patient

• You have the right to refuse or withdraw consent for telehealth at any time without losing access to other care. If you have paid but the lab has not been drawn, you may withdraw and request a refund per the Refund Policy.
• You have the right to a copy of your records, including your screening documentation and lab results, on request, in accordance with Va. Code § 32.1-127.1:03 and HIPAA.
• You have the right to file a complaint about the care you received with the Virginia Board of Nursing or the U.S. Department of Health and Human Services Office for Civil Rights without retaliation.
• You have the right to request an in-person referral if you would prefer not to receive care via telehealth. Practiclear does not provide in-person care; we can recommend appropriate local options.

Emergencies

This service is not for emergencies. If you are experiencing a medical emergency — including chest pain, shortness of breath, severe symptoms, or any condition you believe is life-threatening — call 911 or go to the nearest emergency department. Do not wait for a provider response.

How you give consent

You give your informed consent to telehealth services by checking the "telehealth consent" box on the eligibility form at /start/. Your consent is recorded as part of the submission. You may withdraw consent at any time before the lab is drawn by emailing andrew@practiclear.com.

Questions

Questions about this consent — or any aspect of how Practiclear delivers care — can be sent to andrew@practiclear.com. Compliance and privacy questions are routed to the provider directly.