TO RELEASE PROTECTED HEALTH INFORMATION
Authorization for Use or Disclosure of Protected Health Information is required by the Health Insurance Portability and Accountability Act (HIPAA), 45 C.F.R. Parts 160 and 164.
We are committed to protecting your privacy and we take great care with your personal information that we gather when using our application. This HIPAA Authorization and Release of Protected Health Information is meant to help those that use our services understand how we treat your personal health information. BY USING OR ACCESSING OUR SERVICES IN ANY MANNER, YOU ACKNOWLEDGE THAT YOU ACCEPT THE PRACTICES AND POLICIES OUTLINED IN THIS AUTHORIZATION; AND YOU HEREBY CONSENT TO THE COLLECTION, USE, AND DISCLOSURE OF YOUR PERSONAL HEALTH INFORMATION IN THE FOLLOWING WAYS. IF YOU USE THE SERVICES ON BEHALF OF SOMEONE ELSE (SUCH AS YOUR CHILD) OR AN ENTITY (SUCH AS YOUR EMPLOYER), YOU REPRESENT THAT YOU ARE AUTHORIZED BY SUCH INDIVIDUAL OR ENTITY TO SIGN SUCH RELEASE ON THE INDIVIDUAL’S OR ENTITY’S BEHALF.
Certain demographic, health, and/or health-related information that Access Health collects about Users as part of providing the Services offered may be considered “protected health information” or “PHI” under HIPAA. Specifically, when Access Health receives identifiable information about a User from or on behalf of a Healthcare Provider and such Healthcare Provider is a “Covered Entity” (as such term is defined in HIPAA), this information is considered PHI. Personal data that a User provides to Access Health outside of the foregoing context is not PHI.
HIPAA provides specific protections for the privacy and security of PHI and restricts how PHI is used and disclosed. Access Health may only use and disclose PHI in the ways permitted by HIPAA or as authorized below by the User.
By use of the App, you authorize the disclosure of your confidential health information to Access Health and its employees and agents to use and disclose your PHI according to the provisions below. The authorization may be revoked by your express revocation delivered to Access Health. This authorization will remain until expressly revoked by you in writing. You are entitled to a copy of the complete authorization upon request. If you are a person with a disability and require this authorization in an alternative format or require a special accommodation to complete this form, you may request assistance from the Access Health staff.
You understand that by use of the app, you are authorizing access to your health conditions, current medications, current treatments, and desired treatments. Further, you understand that Access Health will disclose such information to health care providers as necessary for the continued provision of quality health care.
You understand that you are not required to use the App in order to receive treatment or services from Access Health or its affiliates, associates, partners, and third parties. You understand that the information used or disclosed pursuant to this authorization may be subject to re-disclosure by Access Health.
We may disclose PHI or other personal information that we collect or that you provide to the following:
- To our subsidiaries and affiliates who are bound by contractual obligations to keep PHI and other personal information confidential and use it only for the purposes for which we disclose it to them.
- To contractors, service providers, and other third parties we use to support our business and who are bound by contractual obligations to keep PHI and other personal information confidential and use it only for the purposes for which we disclose it to them.
- To fulfill the purpose for which you provide it.
- For any other purpose disclosed by us when you provide the information.
- With your consent.
- To comply with any court order, law, or legal process, including to respond to any government or regulatory request.
- To enforce our rights arising from any contracts entered into between you and us, including the End User License Agreement, and for billing and collection.
- Subject to applicable laws, if we believe disclosure is necessary or appropriate to protect the rights, property, or safety of Access Health, our customers, or others. This includes exchanging information with other companies and organizations for the purposes of fraud protection.
You, or your personal representative as designated by state law, have a right to access your health information as described in 45 CFR § 164.524. Upon request, Access Health will provide you with access to the PHI in the “designated record sets” maintained by Access Health or on behalf of any of its subsidiaries, business associates, or partners. The “designated record sets” that Access Health provides access to upon request include:
- Medical records and billing records about the individual maintained by Access Health or for another covered entity;
- Enrollment, payment, claims adjudication, and case or medical management record systems maintained by or for a health plan; or
- Other records that are used, in whole or in part, by or for the covered entity to make decisions about individuals.
VIP StarNETWORK does not provide you access to information that is not part of a designated record set except as required by federal, state, or local law. This information may include quality assessment or improvement records, patient safety activity records, or business planning, development, and management records that are used for business decisions more generally rather than to make decisions about individuals.
Requests for access must be made in writing and addressed to:
4904 Alameda Boulevard Northeast, STE B
Albuquerque NM, 87113
ATTN: HIPPA Coordinator
Requests may also be made via email by sending an email to email@example.com. In accordance with federal law, Access Health must verify the identity of the person making a request for records. Following a request, Access Health will take steps to verify your identity and right to access the designated record sets prior to disclosure. Following verification of the identity of the person making a request, Access Health will disclose or provide access to the PHI in electronic format.
This HIPAA Policy was last updated May 21st, 2021.