Scope and Refusal Policy

Purpose: Define supported use cases, out-of-scope requests, and refusal behavior for Bounded Health.

Supported Use Cases

Bounded Health is designed and validated for the following specific use cases:

B2B (US Employers): GLP-1 Medication Tapering Management

Scope:

• GLP-1 receptor agonist medication management (semaglutide, tirzepatide, liraglutide)
• Tapering protocol simulation and guidance
• Weight regain risk assessment
• Side effect monitoring and mitigation
• Employer health plan cost savings analysis

Target Population:

• Adults (18+) with obesity (BMI ≥ 30) or overweight (BMI ≥ 27) with comorbidities
• Currently prescribed GLP-1 medications
• Referred by employer health plans
• Located in United States

Supported Decisions:

• When to reduce GLP-1 dosage
• Optimal tapering schedule
• Lifestyle intervention recommendations
• Re-escalation criteria
• Risk assessment for tapering outcomes

B2C (Emerging Markets): Weight Management and Metabolic Health

Scope:

• Weight management tracking
• Meal analysis and nutrition guidance
• Glucose response predictions
• Lifestyle intervention recommendations
• Regional food recognition (Ghana, Nigeria, Kenya, Uganda, South Africa)

Target Population:

• Adults (18+) seeking weight management
• Located in supported emerging markets
• No active eating disorders
• Not requiring emergency medical care

Supported Decisions:

• Meal planning and portion control
• Exercise recommendations
• Behavioral change strategies
• Progress tracking

Out-of-Scope Requests

Bounded Health is not designed for and will refuse the following:

Medical Diagnosis

Not Supported:

• Diagnosing any medical condition
• Identifying diseases from symptoms
• Interpreting medical test results for diagnosis
• Providing differential diagnoses

Refusal Message:

"I cannot provide medical diagnoses. Please consult a licensed healthcare provider for proper diagnosis and treatment. If you're experiencing symptoms, contact your doctor or seek medical attention."

Reason Code: OUT_OF_SCOPE_DIAGNOSIS

Emergency Medical Situations

Not Supported:

• Emergency medical advice
• Urgent care decision-making
• Life-threatening condition management
• Acute medical events

Refusal Message:

"This appears to be an emergency medical situation. Please call emergency services immediately (911 in the US, 999 in the UK, or your local emergency number) or go to the nearest emergency room. Do not rely on this platform for emergency medical care."

Reason Code: EMERGENCY_REDIRECT

Trigger Keywords: chest pain, difficulty breathing, severe bleeding, loss of consciousness, stroke symptoms, heart attack, suicide, severe allergic reaction

Medications Outside GLP-1 Class (B2B)

Not Supported:

• Non-GLP-1 weight loss medications
• Insulin management (except as context for GLP-1)
• Other medication classes
• Medication interactions (beyond GLP-1-specific)

Refusal Message:

"Bounded Health's B2B service is specifically designed for GLP-1 medication (semaglutide, tirzepatide, liraglutide) tapering management. For questions about other medications, please consult your healthcare provider or pharmacist."

Reason Code: OUT_OF_SCOPE_MEDICATION

Pediatric Use

Not Supported:

• Individuals under 18 years of age
• Pediatric medication dosing
• Child-specific nutrition advice

Refusal Message:

"Bounded Health is designed for adults 18 years and older. For pediatric care, please consult a pediatrician or pediatric specialist."

Reason Code: OUT_OF_SCOPE_AGE

Eating Disorders

Not Supported:

• Active anorexia nervosa
• Active bulimia nervosa
• Binge eating disorder (acute phase)
• Other eating disorders requiring clinical treatment

Refusal Message:

"Bounded Health is not appropriate for individuals with active eating disorders. Please seek care from a qualified mental health professional or eating disorder specialist. Resources: National Eating Disorders Association (NEDA) Helpline: 1-800-931-2237"

Reason Code: OUT_OF_SCOPE_EATING_DISORDER

Screening: Platform should include screening questions during onboarding

Unsupported Regions

B2B: Currently limited to United States employer health plans

B2C: Currently limited to Ghana, Nigeria, Kenya, Uganda, South Africa

Refusal Message:

"Bounded Health is not currently available in your region. Supported regions: [list]. For updates on regional expansion, please visit our website."

Reason Code: OUT_OF_SCOPE_REGION

Prescription or Medication Changes

Not Supported:

• Prescribing medications
• Changing prescribed dosages without provider approval
• Recommending specific medications
• Over-the-counter medication recommendations

Refusal Message:

"I cannot prescribe medications or recommend changes to your current prescriptions. Any medication changes must be made by your licensed healthcare provider. Please consult your doctor before making any changes."

Reason Code: OUT_OF_SCOPE_PRESCRIPTION

Legal/Regulatory Advice

Not Supported:

• HIPAA compliance advice
• Legal interpretation
• Regulatory guidance
• Employment law questions

Refusal Message:

"I cannot provide legal or regulatory advice. Please consult appropriate legal counsel or compliance professionals for these questions."

Reason Code: OUT_OF_SCOPE_LEGAL

Regional Support Boundaries

B2B (United States)

Supported States: All 50 states

Limitations:

• Must have employer partnership agreement
• Must be referred through employer health plan
• Provider telehealth restrictions apply per state law

B2C (Emerging Markets)

Supported Countries:

• 🇬🇭 Ghana
• 🇳🇬 Nigeria
• 🇰🇪 Kenya
• 🇺🇬 Uganda
• 🇿🇦 South Africa

Regional Considerations:

• Local food recognition specific to region
• Currency and pricing localized
• Cultural context in recommendations
• Language support (English primary)

Unsupported: Other African countries, Europe, Asia, Australia, Americas (except USA B2B)

Emergency Redirection Behavior

Emergency Detection

Automated Detection: System scans user input for emergency keywords:

• chest pain, heart attack, stroke, seizure
• difficulty breathing, can't breathe
• severe bleeding, heavy bleeding
• suicidal thoughts, suicide
• severe allergic reaction, anaphylaxis
• unconscious, unresponsive, passed out

Immediate Response:

1. Display prominent emergency banner
2. Provide emergency contact numbers
3. Disable normal chat/simulation features
4. Log incident for review
5. Optionally notify care team (if configured)

Emergency Contact Display:

Post-Emergency Follow-Up

After emergency detection:

• Account flagged for care team review
• User receives follow-up email with resources
• Next login shows safety check-in
• Optional connection to crisis resources

Implementation

Refusal Detection Service

Core Function:

Reason Codes:

API Integration

Endpoints Using Refusal Policy:

• /api/ai/simulate
• /api/ai/predict-outcome
• /api/ai/coaching/generate
• Any advice-like endpoints

Standard Response Format:

Emergency Response Format:

UX Integration

Refusal Policy Link:

• Footer link: "Scope & Refusal Policy"
• Legal page section
• Onboarding acknowledgment

In-App Messaging:

• Clear error state when request refused
• Link to full policy
• Alternative action suggestions where appropriate

Example UI:

Continuous Improvement

Refusal Logging

Track All Refusals:

• User ID (if authenticated)
• Request content (sanitized)
• Reason code
• Timestamp
• User's subsequent action

Analytics:

• Refusal frequency by reason code
• Common patterns in refused requests
• User satisfaction after refusal
• Conversion to appropriate action

Policy Updates

Review Triggers:

• New medical evidence
• Regulatory changes
• Incident reports
• User feedback patterns
• Expansion to new use cases

Update Process:

1. Engineering and medical team review
2. Legal counsel review
3. Update documentation and code
4. Deploy with testing
5. Communicate to users if material change

User Education

Onboarding

Explicit Scope Communication:

• During signup: "Bounded Health is designed for..."
• Acknowledge supported use cases
• Confirm eligibility criteria

What We Don't Do:

• Clear list of out-of-scope activities
• Alternative resources provided
• Emergency contact information

In-App Reminders

Periodic Reminders:

• "Remember: Always consult your doctor for medical decisions"
• "Bounded Health provides guidance, not medical advice"
• "In emergencies, call 911 or your local emergency number"

Context-Specific:

• Before simulations: "This is educational, not medical advice"
• Before meal analysis: "For informational purposes only"
• Before tapering recommendations: "Discuss with your provider before changes"

Legal Disclaimers

General Disclaimer:

Bounded Health is a decision support tool and health tracking platform. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or experienced on Bounded Health.

Emergency Disclaimer:

If you think you may have a medical emergency, call your doctor, go to the emergency department, or call emergency services (911 in the US) immediately.