Authorization for Use and Disclosure of Health Information

Last modified: May 25, 2017, Version 1.0

A federal law known as the Health Insurance Portability and Accountability Act (HIPAA) protects how your health information is used. HIPAA does not allow your information to be used or released for certain purposes without your written permission.

By signing this form, you are allowing your 98point6 healthcare providers to use and release your health information for the purposes described herein. For purposes of this authorization 98point6 refers to both 98point6 Inc. and 98point6 Physicians PC collectively.

You will be able to access a copy of this authorization after signing on the 98point6 website.

How health information will be used
Marketing
This authorization permits 98point6 staff (which, for purposes of this authorization includes contractors and vendors used by 98point6) to use your information, such as demographic and contact information, and information about your health care, including sensitive diagnoses, to identify programs, initiatives and information that are likely to interest you and contact you about those programs, initiatives or information.

98point6 does not receive any payment for sharing that information. 98point6 will not provide this information to unrelated parties for their own marketing and will not use this information for telephone solicitations. 98point6 will not sell patient lists to third parties for their own marketing activities.

Research and Product Development
This authorization also permits 98point6 staff to use your information, such as your demographic information (gender, age, email and physical address, race, etc.); health and social history; and health care information for research and product development. Such research and product development includes:

• exploring ways to improve our patient and provider portals
• exploring ways to make health care delivery more user-friendly, efficient, and effective, including development of artificial intelligence using data provided in your health history and your health care encounters
• development of new software products, such as medical records and other software products related to healthcare, and other products designed to facilitate communication over different mediums
• development of software that may be considered a medical device, as defined by the Federal Food Drug, and Cosmetic Act.

Length of Authorization
This authorization will remain in effect for fifty (50) years from the date that you agree. Once your authorization expires, we will request a new authorization, if required by law, for any uses described in this form.

Revoking Authorization
By agreeing to this authorization, you confirm that you knowingly and voluntarily agree to 98point6 to use your information for the purposes described above.