End User Agreement

Remote Patient Monitoring Program – Patient Acknowledgement and Consent
Thank you for choosing to use this Remote Patient Monitoring Program for your care. This document explains certain items that you, as the patient, should be aware of when using the remote monitoring device.

Your Remote Monitoring Readings:
• Remote patient monitoring is a collaborative process between you and your health care team. If you have any concerns related to your readings or your health, it is your responsibility to contact your health care provider directly or contact emergency services.
• Your readings will not be reviewed immediately after they are sent. Readings will be available to your health care team Monday through Friday from 8am–5pm and will only be reviewed periodically during those times.
• You agree that the remote monitoring device is for your own use and cannot be shared with others. Sharing the device could adversely impact your health care team’s care plan for you as the true patient.
• The length of time for your remote monitoring is at the discretion of your health care provider and may change as your plan progresses. o Your health care team will discontinue monitoring your recordings at the end of the monitoring period discussed with you by your health care provider.

You understand that your health care team needs to receive remote monitoring readings on an
accurate and consistent basis and if this does not occur, it may limit their ability to monitor you and may impact your care.
• You agree to notify your health care team if you have any concerns about the data or its transmission.
• This remote monitoring service is considered a new technology. Some insurance plans may not cover this service and the associated charges, which may include, but may not be limited to, a monthly charge for your health care team to monitor your home health readings every 30 days. It is advised that you
contact your insurance carrier to ensure coverage. Otherwise, the remote monitoring cost may be an out-of-pocket expense for you.
• If you are provided with a PT Genie branded tablet/kit and that tablet/kit is lost, damaged, or stolen, you may be responsible for the estimated cost of the entire kit, which is valued at $999. If you are using your own personal device (mobile phone or tablet), that potential fee would not relate to you.

Privacy and Security:
• The remote monitoring device sends your readings to the outside remote monitoring device company. If you decide to use your own device (mobile phone or tablet), you are responsible for installing the company’s application on your personal mobile phone, tablet, or other device. You may become subject
to this company’s terms of use, privacy and other policies and agreements. We encourage you to review these agreements, terms of use and/or policies of the company before use of the company’s remote monitoring device and application.
• Your readings will not be accessible to your health care team until you approve their access by signing this consent.
• You may be responsible for data or other charges from your Internet service provider or cellular carrier.
• When your reading is sent by your remote monitoring device to the company’s application or to your health care team over the Internet, there is a potential risk that the sent data could be read by a third party.
• Your Health Care Provider does not own, control, manage, supervise, direct, or have any involvement in the business affairs of the outside remote monitoring device company. Your Health Care Provider is not responsible for the privacy practices, security, nor the content of the company’s application or device, and it cannot guarantee the privacy or security of your data that is stored on or sent by this device or application. For more information, please contact the outside company directly.

Physical therapy care provided via telehealth is the utilization of technology by licensed physical therapy providers to provide physical therapy services including evaluation and treatment to through online audio/video consultation. Genie Health is the video call platform performed online through encrypted,
private meetings between the physical therapist and patient to protect patient privacy. This online video service meets current regulations for HIPAA compliance. I understand that the evaluation and treatment of current medical condition(s) using synchronous audio/video consultation is under the Physical
Therapy scope of practice like a clinic visit and will be carried out by a licensed practitioner. Potential benefits: Benefits of telehealth include increased accessibility to physical therapy services. As a result of this session, I may experience an improvement in my symptoms and an increase in my ability to perform daily activities. I may experience an increase in strength, awareness, flexibility, and endurance in my movements. I should gain greater knowledge about actively maintaining my health and the resources available to me.

Potential risks: I may experience an increase in my current symptoms, or an aggravation of my existing injury or condition. This discomfort is usually temporary; if it does not subside in a reasonable time period, I agree to contact my physical therapist. I understand there are potential risks to this technology, including interruptions, unauthorized access and technical difficulties. I understand that my healthcare provider or I can discontinue the telehealth visit if it is felt that the videoconferencing connections are not adequate for the situation.
Alternatives: If I do not wish to participate in this telehealth session, I will discuss the alternatives with my physical therapist. I understand that the Telehealth sessions differ from direct patient/health care provider visit since I will not be in the same room as my health care provider. This hands-off session(s) will consist of detailed discussion regarding my condition and may include a visual assessment of my movement patterns, balance, and range of motion. I agree to the Therapist’s plan of care which may be modified for telehealth. I understand that I will be given a home exercise program and recommendations to allow me
to progress towards my goals. I understand that during my telehealth services, my healthcare provider may determine that telehealth services are not the most appropriate means for my physical therapy care, at which point the healthcare provider will then discuss with me the next appropriate action for
my care. I understand that it is my responsibility to ensure that I am in a private space during my telehealth session in order to maintain the privacy of my health information. I understand the Physical Therapist will also conduct the session in a space that is conducive for keeping health information private and
maintaining professional guidelines. I should use my own private wi-fi or data plan and not a public wi-fi for ultimate privacy.

I consent for ongoing Telehealth PT.

End-User License Agreement (“Agreement”)
Last updated: June 23, 2021
Please read this End-User License Agreement carefully before clicking the “I Agree” button, downloading
or using Genie Health.
Interpretation and Definitions
The words of which the initial letter is capitalized have meanings defined under the following conditions.
The following definitions shall have the same meaning regardless of whether they appear in singular or in plural.

For the purposes of this End-User License Agreement:
• “Agreement” means this End-User License Agreement that forms the entire agreement between You and the Company regarding the use of the Application.
• “Application” means the software program provided by the Company downloaded by You through an Application Store’s account to a Device, named PT Genie
• “Application Store” means the digital distribution service operated and developed by Apple Inc. (Apple App Store) or Google Inc. (Google Play Store) by which the Application has been downloaded to your Device.
• “Company” (referred to as either “the Company”, “We”, “Us” or “Our” in this Agreement) refers to PT Genie LLC, 6555 Sanger Rd. Suite 100 Orlando, FL 32827.
• “Content” refers to content such as text, images, or other information that can be posted, uploaded, linked to or otherwise made available by You, regardless of the form of that content.
• “Country” refers to: Florida, United States
• “Device” means any device that can access the Application such as a computer, a cellphone or a digital tablet.
• “Family Sharing / Family Group” permits You to share applications downloaded through the Application Store with other family members by allowing them to view and download each others’ eligible Applications to their associated Devices.
• “Third-Party Services” means any services or content (including data, information, applications and other products services) provided by a third-party that may be displayed, included or made available by the Application.
• “You” means the individual accessing or using the Application or the company, or other legal entity on behalf of which such individual is accessing or using the Application, as applicable.
By clicking the “I Agree” button, downloading or using the Application, You are agreeing to be bound by the terms and conditions of this Agreement. If You do not agree to the terms of this Agreement, do not click on the “I Agree” button, do not download or do not use the Application.
This Agreement is a legal document between You and the Company and it governs your use of the
Application made available to You by the Company.
This Agreement is between You and the Company only and not with the Application Store. Therefore, the Company is solely responsible for the Application and its content. Although the Application Store is not a party to this Agreement, it has the right to enforce it against You as a third party beneficiary
relating to your use of the Application.
Since the Application can be accessed and used by other users via, for example, Family Sharing / Family
Group or volume purchasing, the use of the Application by those users is expressly subject to this
The Application is licensed, not sold, to You by the Company for use strictly in accordance with the terms of this Agreement.
Scope of License
The Company grants You a revocable, non-exclusive, non-transferable, limited license to download, install and use the Application strictly in accordance with the terms of this Agreement.

You may only use the Application on a Device that You own or control and as permitted by the
Application Store’s terms and conditions.
The license that is granted to You by the Company is solely for your personal, non-commercial purposes
strictly in accordance with the terms of this Agreement.
License Restrictions
You agree not to, and You will not permit others to:
• License, sell, rent, lease, assign, distribute, transmit, host, outsource, disclose, or otherwise commercially exploit the Application or make the Application available to any third party.
• Copy or use the Application for any purpose other than as permitted under the above section ‘License’.
• Modify, make derivative works of, disassemble, decrypt, reverse compile, or reverse engineer any part of the Application.
• Remove, alter, or obscure any proprietary notice (including any notice of copyright or trademark) of the Company or its affiliates, partners, suppliers, or the licensors of the Application.
Content Restrictions
The Company is not responsible for the entries, information, or content of the Application’s users. You expressly understand and agree that You are solely responsible for the Content and for all activity that occurs under your account, whether done so by You or any third person using your account.
You may not transmit any Content that is unlawful, offensive, upsetting, intended to disgust, threatening, libelous, defamatory, obscene, or otherwise objectionable. Examples of such objectionable
Content include, but are not limited to, the following:
• Unlawful or promoting unlawful activity.
• Defamatory, discriminatory, or mean-spirited content, including references or commentary about religion, race, sexual orientation, gender, national/ethnic origin, or other targeted groups.
· Spam, machine generated content or randomly generated content, constituting unauthorized or unsolicited advertising, chain letters, any other form of unauthorized solicitation, or any form of lottery or gambling.
• Containing or installing any viruses, worms, malware, trojan horses, or other content that is designed or intended to disrupt, damage, or limit the functioning of any software, hardware or telecommunications equipment or to damage or obtain unauthorized access to any data or
other information of a third person.
• Infringing on any proprietary rights of any party, including patent, trademark, trade secret, copyright, right of publicity or other rights.
• Impersonating any person or entity including the Company and its employees or representatives.
• Violating the privacy of any third person.
•False information and features.
The Company reserves the right, but not the obligation, to, in its sole discretion, determine whether any Content is appropriate and complies with this Agreement, refuse, or remove any Content. The Company further reserves the right to make formatting and edits and change the manner any Content. The
Company can also limit or revoke the use of the Application if You post such objectionable Content. As the Company cannot control all content posted by users and/or third parties on the Application, you
agree to use the Application at your own risk. You understand that by using the Application You may be exposed to content that You may find offensive, indecent, incorrect, or objectionable, and You agree that under no circumstances will the Company be liable in any way for any content, including any errors
or omissions in any content, or any loss or damage of any kind incurred because of your use of any content.
Intellectual Property
The Application, including without limitation all copyrights, patents, trademarks, trade secrets and other intellectual property rights are, and shall remain, the sole and exclusive property of the Company.
The Company shall not be obligated to indemnify or defend You with respect to any third-party claim arising out of or relating to the Application. To the extend the Company is required to provide indemnification by applicable law, the Company, not the Application Store, shall be solely responsible for the investigation, defense, settlement, and discharge of any claim that the Application or your use of it infringes any third-party intellectual property rights.
Your Suggestions
Any feedback, comments, ideas, improvements, or suggestions provided by You to the Company with respect to the Application shall remain the sole and exclusive property of the Company.
The Company shall be free to use, copy, modify, publish, or redistribute the Suggestions for any purpose and in any way without any credit or any compensation to You.
Modifications to the Application
The Company reserves the right to modify, suspend or discontinue, temporarily or permanently, the Application or any service to which it connects, with or without notice and without liability to You.
Updates to the Application
The Company may from time to time provide enhancements or improvements to the
features/functionality of the Application, which may include patches, bug fixes, updates, upgrades, and other modifications.
Updates may modify or delete certain features and/or functionalities of the Application. You agree that the Company has no obligation to (i) provide any Updates, or (ii) continue to provide or enable any features and/or functionalities of the Application to You. You further agree that all updates or any other modifications will be (i) deemed to constitute an integral part of the Application, and (ii) subject to the terms and conditions of this Agreement.
Maintenance and Support
The Company does not provide any maintenance or support for the download and use of the Application. To the extent that any maintenance or support is required by applicable law, the Company, not the Application Store, shall be obligated to furnish any such maintenance or support.
Third-Party Services
The Application may display, include, or make available third-party content (including data, information, applications and other products services) or provide links to third-party websites or services. You acknowledge and agree that the Company shall not be responsible for any Third-party Services,
including their accuracy, completeness, timeliness, validity, copyright compliance, legality, decency, quality or any other aspect thereof. The Company does not assume and shall not have any liability or responsibility to You or any other person or entity for any Third-party Services.
You must comply with applicable Third parties’ Terms of agreement when using the Application. Thirdparty Services and links thereto are provided solely as a convenience to You, and You access and use them entirely at your own risk and subject to such third parties’ Terms and conditions.
Privacy Policy
The Company collects, stores, maintains, and shares information about You in accordance with Our
Privacy Policy: www.ptgenie.com/privacypolicy By accepting this Agreement, You acknowledge that You hereby agree and consent to the terms and
conditions of Our Privacy Policy.
Term and Termination
This Agreement shall remain in effect until terminated by You or the Company. The Company may, in its
sole discretion, at any time and for any or no reason, suspend or terminate this Agreement with or
without prior notice. This Agreement will terminate immediately, without prior notice from the Company, if you fail to
comply with any provision of this Agreement. You may also terminate this Agreement by deleting the
Application and all copies thereof from your Device or from your computer. Upon termination of this Agreement, You shall cease all use of the Application and delete all copies of the Application from your Device.
Termination of this Agreement will not limit any of the Company’s rights or remedies at law or in equity
in case of breach by You (during the term of this Agreement) of any of your obligations under the
present Agreement.
You agree to indemnify and hold the Company and its parents, subsidiaries, affiliates, officers, employees, agents, partners and licensors (if any) harmless from any claim or demand, including reasonable attorneys’ fees, due to or arising out of your: (a) use of the Application; (b) violation of this
Agreement or any law or regulation; or (c) violation of any right of a third party.
No Warranties
The Application is provided to You “AS IS” and “AS AVAILABLE” and with all faults and defects without warranty of any kind. To the maximum extent permitted under applicable law, the Company, on its own behalf and on behalf of its affiliates and its and their respective licensors and service providers, expressly
disclaims all warranties, whether express, implied, statutory or otherwise, with respect to the Application, including all implied warranties of merchantability, fitness for a particular purpose, title and non-infringement, and warranties that may arise out of course of dealing, course of performance, usage
or trade practice. Without limitation to the foregoing, the Company provides no warranty or undertaking, and makes no representation of any kind that the Application will meet your requirements, achieve any intended results, be compatible or work with any other software, applications, systems or
services, operate without interruption, meet any performance or reliability standards or be error free or that any errors or defects can or will be corrected. Without limiting the foregoing, neither the Company nor any of the company’s provider makes any representation or warranty of any kind, express or implied: (i) as to the operation or availability of the Application, or the information, content, and materials or products included thereon; (ii) that the Application will be uninterrupted or error-free; (iii) as to the accuracy, reliability, or currency of any information or content provided through the Application; or (iv) that the Application, its servers, the content, or e-mails sent from or on behalf of the Company are free of viruses, scripts, trojan horses, worms, malware, timebombs or other harmful components. Some jurisdictions do not allow the exclusion of certain types of warranties or limitations on applicable statutory rights of a consumer, so some or all of the above exclusions and limitations may not apply to You. But in such a case the exclusions and limitations set forth in this section shall be applied to the greatest extent enforceable under applicable law. To the extent any warranty exists under law that cannot be disclaimed, the Company, not the Application Store, shall be solely responsible for such warranty.
Limitation of Liability
Notwithstanding any damages that You might incur, the entire liability of the Company and any of its suppliers under any provision of this Agreement and your exclusive remedy for all of the foregoing shall be limited to the amount actually paid by You for the Application or through the Application or 100 USD
if You haven’t purchased anything through the Application. To the maximum extent permitted by applicable law, in no event shall the Company or its suppliers be liable for any special, incidental, indirect, or consequential damages whatsoever (including, but not limited to, damages for loss of profits, loss of data or other information, for business interruption, for personal injury, loss of privacy arising out of or in any way related to the use of or inability to use the Application, third-party software and/or third-party hardware used with the Application, or otherwise in connection with any provision of this Agreement), even if the Company or any supplier has been advised of the possibility of such damages and even if the remedy fails of its essential purpose. Some states/jurisdictions do not allow the exclusion or limitation of incidental or consequential damages, so the above limitation or exclusion may not apply to You. You expressly understand and agree that the Application Store, its subsidiaries and affiliates, and its licensors shall not be liable to You under any theory of liability for any direct, indirect, incidental, special consequential or exemplary damages that may be incurred by You, including any loss of data, whether or not the Application Store or its representatives have been advised of or should have been aware of the possibility of any such losses arising.
Severability and Waiver
If any provision of this Agreement is held to be unenforceable or invalid, such provision will be changed and interpreted to accomplish the objectives of such provision to the greatest extent possible under applicable law and the remaining provisions will continue in full force and effect.
Except as provided herein, the failure to exercise a right or to require performance of an obligation under this Agreement shall not affect a party’s ability to exercise such right or require such performance at any time thereafter nor shall be the waiver of a breach constitute a waiver of any subsequent breach.
Product Claims
The Company does not make any warranties concerning the Application. To the extent You have any claim arising from or relating to your use of the Application, the Company, not the Application Store, is responsible for addressing any such claims, which may include, but not limited to: (i) any product liability
claims; (ii) any claim that the Application fails to conform to any applicable legal or regulatory requirement; and (iii) any claim arising under consumer protection, or similar legislation.
United States Legal Compliance
You represent and warrant that (i) You are not located in a country that is subject to the United States government embargo, or that has been designated by the United States government as a “terrorist supporting” country, and (ii) You are not listed on any United States government list of prohibited or restricted parties.
Changes to this Agreement
The Company reserves the right, at its sole discretion, to modify or replace this Agreement at any time.
If a revision is material, we will provide at least 30 days’ notice prior to any new terms taking effect.
What constitutes a material change will be determined at the sole discretion of the Company.
By continuing to access or use the Application after any revisions become effective, you agree to be
bound by the revised terms. If You do not agree to the new terms, you are no longer authorized to use
the Application.
Governing Law
The laws of the Country, excluding its conflicts of law rules, shall govern this Agreement and your use of
the Application. Your use of the Application may also be subject to other local, state, national, or
international laws.
Entire Agreement
The Agreement constitutes the entire agreement between You and the Company regarding your use of
the Application and supersedes all prior and contemporaneous written or oral agreements between You
and the Company.
You may be subject to additional terms and conditions that apply when You use or purchase other
Company’s services, which the Company will provide to You at the time of such use or purchase.
PT Genie Notice of Privacy Practices
PT Genie, Inc. (“PT Genie”) is committed to protecting the privacy and security of our customers’ data.
To that end, we operate in compliance with all applicable privacy and data protection laws including the
Health Insurance Portability and Accountability Act of 1996, as amended by the Health Information
Technology for Economic and Clinical Health Act of 2009 (“HITECH”) and implementing regulations
This Notice of Privacy Practices describes the practices that we will follow with respect to the privacy of
the health information of users of this site and our mobile applications and related services (“Services”).
What Health Information We Collect
PT Genie takes the confidentiality of your health information seriously. In providing our Services, some
of the information we collect may constitute protected health information (“PHI”) under HIPAA. PHI is
personal (individually identifiable) information about you that relates to (a) your past, present or future
physical or mental health or condition, (b) the provision of health care to you, or (c) your past, present,
or future payment for the provision of health care, which is created, received, transmitted, or
maintained by PT Genie. This Notice of Privacy Practices describes how we protect the privacy of your
protected health information as a user of our Services. As a provider of health services, PT Genie has
certain obligations under HIPAA for maintaining the privacy and security of your PHI collected while
performing our Services.
What Information We Disclose
When you use our Services, PT Genie may use and disclose your PHI for the purposes described below.
These uses and disclosures do not require your prior authorization. You may revoke your authorization
for us to use or share your health information at any time, except for uses or disclosures we have
already made. PT Genie may use and disclose your health information for the following purposes:
We can use and share your health information with healthcare professionals to treat you. For example,
we can disclose your information to your PT Genie Coach to personalize your experience.
We may use and share your health information to obtain payment for our services. For example, we
may disclose your PHI to your health plan to determine whether you are enrolled with the payer or
eligible for health benefits or to get payment for our services.
Health Care Operations:
We may use and share your health information for our operations related to health care. For example,
we may use your health information to administer your account, including your assignment and
Business Associates:
From time to time, we work with other companies and individuals who help us deliver our services,
known as “business associates.” These entities are required to keep any PHI confidential and store it
securely. For example, we may use business associates to help store the data that we collect.
De-identifiable and Aggregated Data:
We may use and disclose your PHI in a de-identified and aggregated manner to analyze our users’
experiences and help improve our services.
We can use or share your information for health research as authorized by law.
As Required by Law:
We may use or disclose your PHI if state or federal laws require it.
Public Health and Safety
We may use and disclose your PHI to prevent or minimize a serious threat to your health and safety or
that of another person, or as requested by an authorized public health authority for any other public
safety reason. We may also disclose PHI to those assisting in disaster relief efforts so that others can be
notified about your condition, status, and location.
Law Enforcement Activities
We may also provide PHI to law enforcement officials, for example, in response to a warrant,
investigative demand or similar legal process, or for officials to identify or locate a suspect, fugitive,
material witness, or missing person. We may also disclose PHI to appropriate agencies if we reasonably
believe an individual to be a victim of abuse, neglect or domestic violence, and for any other reason
required by applicable law.
Legal Proceedings
We may disclose PHI to respond to a court or administrative order, or in response to a warrant,
investigation demand or other legal process.
We may also use and disclose your PHI for other purposes as permitted by HIPAA.
Note Regarding State Law
Where state law is more restrictive of disclosure than federal law, we are required to follow the more
restrictive state law.
Notice Regarding Technology
We may use electronic software, services, and equipment, including without limitation email, video
conferencing technology, cloud storage and servers, internet communication, cellular network,
voicemail, facsimile, electronic health record, and related technology to share PHI with you or thirdparties subject to the rights and restrictions contained herein. In any event, certain unencrypted
storage, forwarding, communications and transfers may not be confidential. We will take measures to
safeguard the data transmitted, as well as ensure its integrity against intentional or unintentional breach
or corruption. However, in very rare circumstances security protocols could fail, causing a breach of
privacy or PHI. In the unlikely event that happens, we will take immediate steps to stop further breach
of information and promptly notify you if your information is impacted.
Your Rights
As a user of PT Genie’s services, you have rights with respect to your health information:
• Right to Inspect and Obtain a copy of PHI: You have a right to inspect and obtain a copy of your
protected health information we maintain.
• Right to Request Restrictions: You may request that we limit what information we use or share. We
will notify you within 60 days whether we can agree to your request. If you pay for a service or health
care item out of-pocket in full, you can ask us not to share that information for the purpose of payment
or our operations with your health insurer. We will say “yes” unless a law requires us to share.
• Right to Request Alternative Means of Confidential Communication: You have the right to request
that copies of your medical information be provided by alternative means.
• Right to Request Corrections: You have a right to request that we correct your protected health
information that you think is incorrect or incomplete.
• Right to Receive an Accounting of Disclosures: You can ask for a list (accounting) of the times we’ve
shared your health information for six years prior to the date you ask, who we shared it with, and why.
We will include all the disclosures except for those about treatment, payment, and health care
operations, and certain other disclosures (such as any you asked us to make). We’ll provide one
accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within
12 months.
• Right to Obtain a Paper Copy of this Notice: You have the right to obtain a paper copy of this notice
upon request at the address below.
• Right to File a Complaint: You may file a complaint with us if you believe your Privacy Rights have
been violated. To file a complaint, or to ask any questions about this Notice of Privacy Practices, send an
email to us at security@PT Geniehealth.com, or write to us at the following address: 6555 Sanger Road,
Suite 100. Orlando, FL 32827
• You also have the right to file a complaint with the Secretary of the U.S. Department of Health and
Human Services, Office for Civil Rights. We will not retaliate against any individual for filing a complaint.
Our Responsibilities
• We are required by law to maintain the privacy and security of your protected health information.
• We will not use or disclose your PHI for marketing purposes or to sell your PHI, unless you have agreed
to this use or disclosure, although we may use your PHI to keep you informed of services we offer.
• We must follow the duties and privacy practices described in this notice and provide you with a copy
of it.
• We will not use or share your information other than as described here unless you tell us we can in
writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you
change your mind.
We will let you know promptly if a breach occurs that may have compromised the privacy or security of
your information.
Benefits and Possible Costs
This program is not a free program. While I am getting concierge level care for about the cost of a
premium coffee per day; and though it is routinely covered by Medicare and most major insurance plans
under Remote Monitoring benefits and PT telehealth benefits; it is ultimately up to me to understand
my health insurance plan. Even though my benefits have been explained to me regarding coverage, it is
very difficult to be 100% accurate in eligibility checking and this is ultimately up to me to be aware of my
benefits and possible costs associated with this program. RPM codes are 99453, 99454, 99457 and
99458. RTM codes are 98975, 98977,98980, and 98981 respectively. I will be enrolled only under one of
these remote monitoring programs, though both usually have the same coverage. PT Telehealth is billed
under CPT code 97161 for the evaluation and typically 97110 on the evaluation day and each visit
thereafter. If my plan needs prior authorization or referrals, the team will work on getting these prior to
treatment, if known. If I change insurance plans or carriers or lose my coverage, it is my responsibility to
let the practice and team know ASAP as it will impact potential charges that I may become liable for.
There is a private pay cash option that I may be entitled to if this is not covered by my benefits. I enroll
having had the ability to discuss my benefits with someone with the program if needed to my
satisfaction of understanding my potential costs.
Changes to the Terms of this Notice
From time to time, we may change this privacy statement, which is applicable to all PHI we maintain
about you. For example, as we update and improve our services, new features may require
modifications to the privacy statement. The new notice will be available on our website. Accordingly,
please check back periodically.
Last updated on August 15th, 2023
I have read and understand the information described above, and I acknowledge and consent to the
above statements and terms of the Remote Patient Monitoring Program.
Contact Us
If you have any questions about this Agreement, you can contact Us:
• By email: support@genie.health
• By visiting this page on our website: https://genie.health/
• By phone number: 321-558-6855
• By mail: 6555 Sanger Rd. Suite 100 Orlando, FL 32827

End User Agreement