1. Purpose of This Authorization

This Authorization and Consent permits ReAssure Med to:

• collect medical information;
• receive medical records;
• organize medical documentation;
• facilitate specialist review;
• coordinate care navigation activities;
• support provider introductions;
• enable administrative communications.

2. Authorization to Collect Records

I authorize ReAssure Med to collect and receive medical records that I provide directly or authorize third parties to provide. Records may include:

• physician records;
• consultation notes;
• diagnostic reports;
• pathology reports;
• laboratory results;
• imaging;
• prescriptions;
• discharge summaries;
• treatment plans;
• related health information.

I confirm that any information submitted is accurate to the best of my knowledge.

3. Authorization to Share Records

I authorize ReAssure Med to disclose relevant medical records solely as necessary to:

• independent healthcare professionals;
• hospitals;
• treatment centers;
• authorized service providers;
• administrative support vendors.

Sharing shall occur only to support services requested by me.

4. Independent Specialist Review

I acknowledge that:

• specialists participate independently;
• specialists exercise independent judgment;
• ReAssure Med does not supervise specialists;
• ReAssure Med does not provide clinical opinions.

Any second opinion is informational only.

5. Cross-Border Transfer Consent

I understand and consent that:

• records may be transferred internationally;
• specialists may review records outside my jurisdiction;
• privacy protections may differ by country;
• records may be processed using international infrastructure.

ReAssure Med will implement reasonable safeguards designed to protect information.

6. No Healthcare Relationship

I acknowledge that:

• ReAssure Med is not my healthcare provider;
• ReAssure Med does not diagnose or treat;
• use of the Platform does not create a physician–patient relationship with ReAssure Med.

Any treatment relationship exists solely with the applicable provider.

7. No Medical Advice

I understand:

• second opinions are informational;
• emergency care must not be delayed;
• healthcare decisions remain my responsibility.

I agree to consult qualified healthcare professionals before acting on information received.

8. Care Navigation Consent

Where requested, I authorize ReAssure Med to:

• assist with provider introductions;
• coordinate appointments;
• facilitate communications;
• organize administrative logistics.

Care navigation does not constitute medical advice.

9. Data Use and Retention

I understand that my information may be:

• stored;
• processed;
• transmitted;
• retained;

as described in the Privacy Policy.

De-identified information may be used for:

• analytics;
• platform improvement;
• operational purposes;
• lawful internal activities.

10. Withdrawal of Consent

I may withdraw this authorization at any time by written request. Withdrawal shall not affect:

• processing already completed;
• legal retention requirements;
• contractual obligations.

Withdrawal requests may be submitted to: privacy@reassuremed.com

11. Electronic Consent

I agree that:

• electronic signatures are valid;
• electronic records satisfy written requirements;
• acceptance through website actions constitutes consent.

12. Patient Representations

By accepting, I represent that:

• I am at least eighteen (18) years old or legally authorized;
• I understand this authorization;
• information submitted is truthful;
• I have authority to submit records.

13. Acknowledgement

By creating an account, uploading records, or continuing to use the Platform, I confirm that I have read and understood this Authorization, consent to processing of health information, consent to international transfer of records, understand ReAssure Med is not my healthcare provider, and authorize coordination with independent providers.

Patients may also print and sign this document and submit it together with their patient intake forms.