Nolia Consent for Provided Services

Please note that professional services associated with Nolia are provided by Brain and Memory Health Group, PLLC or other affiliated professional entities.

Introduction:

Thank you for choosing Nolia. Before we begin, we want to clearly outline what you can expect from us and what our services will include. This will ensure that you have a comprehensive understanding of the support we provide and make informed decisions about your care.

Our Philosophy of Care:

Nolia is an extension of your healthcare team, working in close partnership with your providers and others in your community to ensure that everyone involved in your care receives the comprehensive and holistic support necessary for managing chronic and complex conditions. We believe that these diagnoses impact not only the individual living with symptoms but also those who provide care, including spouses, adult children, other relatives, friends and neighbors. Our mission is to fundamentally change how caregiving is seen and valued within our healthcare systems; ensuring that family caregivers are equipped with the tools, expertise and support they need so no one has to walk this path alone.

You will have access to a dedicated transdisciplinary care team that will support you throughout your diagnosis. This team will be available to you, your primary caregiver, and others involved in your care network. Your Care Navigator will serve as your main point of contact, providing ongoing assistance to ensure you feel supported every step of the way.

Our promise to our clients, and their families/chosen families, is to provide accessible and culturally responsive care based on the recognition that you are the expert on your own journey. While we strive to provide the best care possible, we recognize that our own identities as clinicians hold privileges and power dynamics that will inevitably affect our interactions with you. We will always welcome conversation that ground us in collaboration, healing and lived experiences.

Services Provided:

We are committed to offering the following services to support you and your family:

• Disease Education: Providing detailed information and education about your specific condition to help you understand and manage it better.
• Emotional and Practical Support: Offering both emotional support and practical advice to help you navigate the challenges associated with chronic conditions.
• Family Facilitation: Assisting with family communication and decision-making to ensure that everyone is on the same page and working together.
• Future Care-Planning: Helping you plan for future care needs to ensure that you are prepared for any changes that may arise.
• Transition Guidance: Offering support and guidance during transitions between different levels of care or living situations.
• Referring to Resources/Programs in the Community: Connecting you with relevant community resources and programs that can offer additional support.
• Coordinating Home and Community-Based Care: Assisting in the coordination of care services that you may receive at home or within the community.
• Home-Safety Support: Providing assessments and recommendations to ensure that your home environment is safe and conducive to your needs.
• Person-Centered Assessment and planning: Conducting thorough assessments to ensure that our services are tailored to meet your specific needs.
• Caregiver Training and Workshops: Led by our licensed clinicians, our caregiver training sessions are designed to help you feel confident and well-equipped in your caregiving role. Each month, we cover a new topic tailored to support you on this journey.

For all services provided, we will bill the patient's insurance, and a co-pay or deductible may apply.

Services Not Provided:

Please note that the Care Navigators are not required to be licensed providers, and, thus, they will not provide any care that requires a professional license, including, without limitation, medical, nursing, psychotherapy, or mental health care, or therapy, counseling or social work. If you are having an emergency, you should call 911.

Telehealth Services:

I understand that my provider at Nolia wishes me to have a telehealth consultation.

This means that through an interactive video connection, I will be able to consult with my provider about my health and wellness concerns. Nolia has explained to me how telehealth will be used to do such consultation and how else we will use telehealth to connect while working together, using the Healthie telehealth platform

I understand there are potential risks with this technology:

• The video connection may not work or it may stop working during the consultation.
• The video picture or information transmitted may not be clear enough to be useful for the consultation.

The benefits of a telehealth consultation are:

• I do not need to travel to the consult location.
• I have access to a specialist through this consultation.

I also understand other individuals may need to use the Healthie telehealth platform and that they will take reasonable steps to maintain confidentiality of the information obtained. I have read this document and understand the risk and benefits of the telehealth consultation and have had my questions regarding the procedure explained and I hereby consent to participate in telehealth sessions under the conditions described in this document.

Communication and Contact Consent:

By providing your contact information and agreeing to these terms, you expressly consent to receive communications from Nolia and its care team through various channels to support your care journey. This includes:

Communication Methods:

• Phone calls and voicemails to the phone number(s) you provide
• Text messages (SMS) to your mobile phone number, including appointment reminders, care coordination updates, and health tips
• Emails to the email address(es) you provide, including care summaries, educational materials, and service updates
• Secure messages through our patient portal (Healthie platform)
• Video calls for telehealth appointments and consultations

Types of Communications:

• Appointment scheduling, reminders, and follow-ups
• Care coordination updates and care team messages
• Health education materials and resources
• Caregiver support group invitations and workshop announcements
• Service updates and important notifications about your care
• Surveys and feedback requests to improve our services
• Billing and insurance-related communications

Important Notes:

• Message and data rates may apply for text messages depending on your mobile phone plan
• You may opt out of non-essential communications at any time by contacting your Care Navigator
• Essential communications related to your care, appointments, and billing cannot be opted out of while you remain an active client
• We will never share your contact information with third parties for marketing purposes
• All communications will comply with HIPAA privacy regulations

To update your communication preferences or contact information, please reach out to your Care Navigator or contact our support team at support@noliahealth.com or (855) 621-0466.