CLIENT DISCLOSURE AGREEMENT
Hubavet Telehealth Services
This Client Disclosure Agreement ("Agreement") is entered into by and between the pet owner or legal guardian ("Client") and Hubavet Inc., a company providing telehealth services through the Hubavet app ("Hubavet"). This Agreement is designed to facilitate telehealth services provided by a licensed Veterinarian via Hubavet’s services. By making a Client account the Client hereby acknowledges and agrees to all of the following terms and conditions of the Hubavet Inc.
1. Purpose of Telehealth Services
Hubavet provides a platform for telehealth services that allows Clients to consult with licensed veterinarians remotely. These services are designed for informational purposes and are not a substitute for in-person veterinary care.
2. Definitions
2.1 “Telehealth” means the mode of delivering veterinary medicine via electronic communication technologies to facilitate the diagnosis, consultation, care management, or treatment of an animal patient, and includes, but is not limited to, real-time live video and audio communication; real-time live two-way audio communication; and electronic transmission of images, diagnostics, data, and medical information.1
2.2 “Veterinarian-client-patient relationship” (“VCPR”) means a relationship that exists if all of the following conditions are met:2
The veterinarian and client agree to the veterinarian assuming responsibility for making medical judgments regarding the health of the animal patient.
The veterinarian has sufficient knowledge of the animal patient to initiate at least a general or preliminary diagnosis of the medical condition of the animal through a recent observation and examination, either in person or using real-time video communication, of the animal or of a group of animals of which the patient is a part, or through medically appropriate and timely visits to the premises where the animal, or the group of animals of which the patient is a part, is kept.
The veterinarian assumes responsibility for providing medical assessments regarding the health of the animal patient and shall communicate with the patient owner, a medical diagnosis, a treatment plan, and any diagnostic or therapeutic plan appropriate for the animal patient.
A VCPR may not be established solely through audio-only communication or by a questionnaire.
2.3 “Confidential Veterinarian Information” is defined as information concerning: (1) an animal receiving veterinary services; (2) the client responsible for the animal; and (3)
1 Business & Professions Code Secon 4825.1(g). 2 Business & Professions Code Secon 4826.6 (a).
the veterinary care provided to the animal. This information is protected from disclosure by California law.3
2.4 “Synchronous” is defined as a real-time interaction between a client and animal patient with a veterinarian who is licensed in this state and located at a distant site.
3. Veterinarian's Professional Responsibilities
3.1 The Client acknowledges that the veterinarian providing telehealth services through Hubavet is responsible for determining whether immediate in-person veterinary attention is required, based on the information provided during the telehealth consultation.
3.2 The Client understands that the Veterinarian is obligated to follow the regulations outlined in Business and Professions Code section 4826.6, including any amendments or modifications.
3.3 By signing this consent form, Client understands and agrees to the Veterinarian assuming responsibility for making medical judgments regarding the health of the animal patient.
3.4 The Client understands that they have the option to choose an in-person visit from a veterinarian at any time.
3.5. The client understands and has been advised by the Veterinarian of the Veterinarian’s identity, location, licensure status, and privacy and security measures used in accessing veterinary services through telehealth.
3.6 The Client understands that any legal liability, responsibility and accountability of the practicing tele-health veterinarian should be in relation to the state where the patient is located and the state in which the veterinarian is providing the services.
3.7 The Client understands that
4. Limitations of Telehealth Services and Prescribing
4.1 The Client acknowledges that telehealth consultations have limitations, and the inability to physically examine the patient may impact the accuracy and completeness of the diagnosis and treatment recommendations.
4.2 Telehealth services provided through Hubavet are not a replacement for a physical examination performed by a veterinarian at an animal hospital.
4.3 The legal requirements and disclosures outlined in this agreement are representations of California law and are intended only to be utilized in the
3 Business & Professions Code secon 4857.
4 Business & Professions Code secon 4826.6(k).
the Veterinarian is permitted to use telehealth without
establishing VCRP in order to provide advice in an emergency situation only, as defined
in Section 4840.5.4
circumstances of veterinary treatment provided by a Veterinarian licensed in and located in California providing telehealth services to a Client located in California.5
4.4 Client acknowledges the limitations on Veterinarian prescribing drugs and medications via telehealth including:
Veterinarian who establishes the VCPR through synchronous audio-video communication may not prescribe a drug6 for a period longer than six months from the date of the examination. V
Veterinarian who establishes the VCPR through synchronous audio-video communication may not prescribe antimicrobial drug (including antibiotics) to the animal patient for a period longer than 14 days of treatment. Veterinarian may not issue any further antimicrobial drug or any refills without an in-person physical examination of the patient.
Veterinarian may not prescribe or order any controlled substances as defined by Business & Professions Code section 4021, or xylazine, unless Veterinarian has conducted an in-person physical examination of the patient or conducted an on-sight visit to the premises where the animal is kept.
Veterinarian shall notify Client that some drugs may be available at pharmacies and upon request shall submit a prescription to the pharmacy Client chooses.
Veterinarian may not prescribe any drug or medication via telehealth to a horse engaged in racing or training under the jurisdiction of the California Horse Racing Board,
4.5 Medical records for the telehealth visit will be created and maintained at the premises where the veterinarian is licensed to practice and stored in such a manner to protect the veterinary medical records from access by authorized individuals.
5. Protection of Confidential Veterinary Information
5.1 The laws that protect the privacy and confidentiality of health and care information also apply to telehealth/telemedicine. Information obtained during telehealth/telemedicine that identifies Client or their animal will not be given to anyone without Client’s consent except for the purposes of treatment, education, billing and veterinary care operations. By agreeing to use the telehealth/telemedicine services,
5 Business & Professions Code Secon 4826.6(f).
6 “Drug” as defined by Business & Professions Code (BPC) secon 4826.6(j) is any controlled substance as defined by BPC 4021, or any dangerous drug, as defined by BPC 4022.
eterinarian shall not issue
another prescription to the animal patient for the same drug unless they
have conducted another examination of the animal patient, either in
person or using telehealth.
Client is consenting to Hubavet and Veterinarian sharing of Client’s confidential veterinarian information with certain third parties. Client understands, agrees, and expressly consents to Hubavet and Veterinarian obtaining, using, storing, and disseminating to necessary third parties, information about Client, including their animal’s image, as necessary to provide the telehealth/telemedicine services.
5.2 As with any internet-based communication, Client understands that there is a risk of security breach. Electronic systems used will incorporate network and software security protocols to protect the confidentiality of patient identification and imaging data and will include measures to safeguard the data and to ensure its integrity against intentional or unintentional corruption. Individuals other than Veterinarian and their associated care team may also be present and have access to Client’s information for the telehealth session, in order to operate or repair the video or audio equipment used. These persons will adhere to applicable privacy protection laws and security policies.
5.3 Furthermore, Client understands that telehealth sessions may not always be possible. Disruptions of signals or problems with internet infrastructure may cause broadcast and reception problems (e.g., poor picture or sound quality, dropped connections, audio interference) that prevent effective interaction between Veterinarian and Client.
5.4 Client hereby releases and holds harmless Hubavet, and all other members of Client’s care team, from any loss of data or information due to technical failures associated with the telehealth/telemedicine service.
6. Client Responsibilities
6.1 The Client agrees to provide accurate and complete information about the patient's health during the telehealth consultation.
6.2 The Client acknowledges their responsibility to seek in-person veterinary attention promptly if advised by the veterinarian during the telehealth consultation.
6.3 The Client further understands that if they withdraw consent for any telehealth services, it will not affect any future services or care benefits to which they are entitled.
7. Liability Waiver
7.1 The Client hereby waives any claims, suits, or demands against Hubavet and its officers, directors, employees, agents, and representatives for any malpractice, negligence, or other professional misconduct related to telehealth services provided through Hubavet.
7.2 This waiver extends to any claims made by the Client or third parties arising from the veterinarian's actions or advice during telehealth consultations.
8. Governing Law
This Agreement shall be governed by and construed in accordance with the laws of the State of California. By signing below, the Client acknowledges that they have read, understood, and agree to abide by the terms and conditions outlined in this Client Disclosure Agreement.
I hereby consent to the use of telehealth in the provision of care for my animal(s) and the above terms and conditions.
By proceeding with the making of an account on the Hubavet platform, I certify that I am the legal owner of the animal to be treated via telehealth or are otherwise legally authorized to consent. I have carefully read and understand the above statements. I have had all my questions answered. I understand that this informed consent will become a part of my animal’s veterinary record.