Relatient offers services, such as helping you book appointments with the healthcare provider(s) of your choice (“Your Healthcare Provider”) and notifying you of your appointment details (“Relatient Services”). As part of providing the Relatient Services, Relatient may collect, use, share, and exchange your health-related information with Your Healthcare Providers. Under a federal law called the Health Insurance Portability and Accountability Act (“HIPAA”), some of this health and health-related information may be considered “protected health information” or “PHI” if such information is received from or on behalf of Your Healthcare Providers.
HIPAA protects the privacy and security of your PHI by limiting the uses and disclosures of PHI by most healthcare providers and by health plans (called “Covered Entities”) as well as companies, like Relatient, that provide certain types of assistance to Covered Entities (called “Business Associates”). Under certain circumstances described in HIPAA, an individual needs to sign an Authorization form before a Covered Entity, like Your Healthcare Provider(s), can disclose protected health information to a third party.
The purpose of this Relatient Authorization (“Authorization”) is to request your written permission to allow Relatient to use and disclose your PHI. If Relatient is a Business Associate of Your Healthcare Providers, Relatient needs your Authorization to be able to use and disclose your PHI.
Specifically, you agree that Relatient can use your PHI to:
You also agree that Relatient can disclose your PHI to:
If Relatient discloses your PHI, Relatient will require that the person or entity receiving your PHI agrees to only use and disclose your PHI to carry out its specific business obligations to Relatient or for the permitted purpose of the disclosure (as described above). Relatient cannot, however, guarantee that any such person or entity to which Relatient discloses your PHI or other information will not re-disclose it in ways that you or we did not intend or permit.
Your Authorization remains in effect until you provide written notice of revocation to Relatient.
YOU CAN CHANGE YOUR MIND AND REVOKE THIS AUTHORIZATION AT ANY TIME AND FOR ANY (OR NO) REASON.
If you wish to revoke this Authorization, you must notify Relatient by submitting a revocation through your account settings page. Your decision not to execute this Authorization or to revoke it at any time will not affect your ability to use certain of the Relatient Services. A Revocation of Authorization is effective after you submit it to Relatient, but it does not have any effect on Relatient’s prior actions taken in reliance on the Authorization before revoked.
Once Relatient receives your Revocation of Authorization, Relatient can only use and disclose your PHI as permitted in Relatient’s agreements with Your Healthcare Provider(s). Your Revocation of Authorization does not affect Relatient’s use of your Non-PHI.
We will make available to Your Healthcare Provider(s), current and past, your agreement to or revocation of this Authorization.