Protocol flows
These diagrams are generated directly from the live questionnaire data. Change a rule in the protocol and the flow changes with it. A separate pre-payment safety gate runs before this — it is not shown here.
Patient begins intake
Eligibility — age, sex at birth, program fit
Q1How did your erection problems start?
Sudden-onset ED — assess for psychological trigger, medication effect, or acute pathology.
Q2Do you use nitrates in any form — nitroglycerin, isosorbide, or "poppers" — or riociguat (Adempas®) or another pulmonary-hypertension medication?
Nitrate or soluble guanylate cyclase stimulator (riociguat) use — absolute contraindication to PDE5 inhibitors, profound hypotension risk; refer for in-person cardiovascular management.
Q3In the past 6 months, have you had a heart attack, stroke, or chest pain with exertion or sex?
Recent cardiac event or exertional chest pain — sexual activity safety must be assessed in person before ED pharmacotherapy.
Q4Have you ever had an erection lasting over 4 hours, or do you have sickle cell disease, leukemia, or multiple myeloma?
Priapism history or predisposing hematologic condition — PDE5 inhibitors contraindicated; requires in-person urology assessment.
Q5Do you take an alpha-blocker (e.g., tamsulosin, doxazosin)?
Alpha-blocker co-prescription — PDE5 dosing must be staggered; hypotension counselling required.
Q6Do you take a strong CYP3A4 inhibitor — ritonavir, ketoconazole, or itraconazole?
CYP3A4 inhibitor use (ritonavir/ketoconazole/itraconazole) — markedly raises PDE5 inhibitor blood levels; dose-limiting interaction. Physician must select a reduced starting dose or an alternative before approving.
Labs — No labs required
This treatment does not require blood work.
Medical history
Medications · allergies · conditions
Consents
Telehealth · async review · PHIPA · accuracy attestation (+ informed refusal if labs declined)
Physician review
Clear or flagged charts — reviewed and decided by the physician
Priority review
8 amber flags surface at the top of your queue
Auto-referral
4 hard stops — patient redirected with urgency + next steps, chart documented
Pre-payment stops end the intake before any charge — no chart is created. Post-payment exclusions are filed as "referred" with the triggering answer and protocol reason — visible in your physician portal.