I, the undersigned, voluntarily consent to participate in the Deborah Heart and Lung Center Home Visit Program. The Services are provided through Rapid Reliable Care by DocGo, LLC and its affiliated medical practices, including Mobile Medical Healthcare, P.C. (collectively, "DocGo"). Rapid Reliable Care by DocGo, LLC provides the administrative and operational support for the program, while all medical care is provided by Mobile Medical Healthcare, P.C. or another affiliated medical practice through its licensed and/or certified healthcare providers.

Consent to Home Visit: I, the undersigned, give my informed consent to Deborah Heart and Lung Center, through its contracted provider DocGo (which includes DocGo physicians, advanced practice nurses, nurses and other New Jersey-licensed and/or certified personnel), to provide screening and/or medical care to me in my home (the “Home Visits”). I understand that there is no cost to me for this service. I also understand the following:

1. Home Visit Program Authorization and Payment. I understand that the costs of the medical services provided by Deborah through DocGo during the Home Visits are covered through a Rural Health Transformation Grant issued by the New Jersey Department of Health. Neither Deborah nor DocGo will charge me any costs or expenses for these services. My insurance will not be billed. I understand that if I have any questions or concerns regarding payment, I may call the New Jersey Department of Health at 800-367-6543.

2. Scope of Care. DocGo will provide screening and medical care during the Home Visits as appropriate based on my current health needs. These services may include physical examinations, diagnostic tests, treatment recommendations, vaccinations and any necessary follow-up care.

3. Voluntary Participation. I understand that my participation in the Home Visits is voluntary, and I have the right to withdraw my consent at any time.

4. Confidentiality. All personal health information shared during the home visit will be maintained in accordance with HIPAA regulations and other applicable privacy laws. I understand that I will be provided a HIPAA Notice of Privacy Practices outlining my rights to health information privacy.

5. Risks and Benefits. I will be informed by DocGo at the time of each Home Visit of the screening and/or medical services they will provide, the potential risks and benefits associated with those services and my option to refuse any of the services.

6. Emergency Care. In the event DocGo determines that I am in need of immediate medical attention that they cannot provide, I will be referred to the nearest medical facility or emergency services. I understand that I should call 9-1-1 if I experience a medical emergency at any time.

7. Accessibility and Transportation. I am responsible for ensuring that my home environment is accessible and safe for DocGo to provide the Medical Services. If I require transportation to a healthcare facility, I understand that it will be my responsibility to arrange for such transportation.

By signing this consent form, I confirm that I have read and understood the information provided above. I have had the opportunity to ask questions regarding the home visit, and all my questions have been answered to my satisfaction.