DocHelp offers services, such as helping you to find and learn about nearby healthcare providers, booking appointments with the healthcare provider(s) of your choice (each, “Your Healthcare Provider”) and managing and forwarding your health history forms and other health-related information to share with Your Healthcare Providers and managing your wellness (“DocHelp Services”). As part of providing the DocHelp Services, DocHelp may collect, use, share, and exchange your health history forms and other health-related information with Your Healthcare Providers and other individuals and or entities as you authorize to share. 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 and other entities.
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 DocHelp, 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 DocHelp Authorization (“Authorization”) is to request your written permission to allow DocHelp to use and disclose your PHI in the same way as we use and disclose your Non-PHI. If DocHelp is a Business Associate of Your Healthcare Providers, DocHelp needs your Authorization to be able to use and disclose your PHI in the same way it can currently use and disclose your Non-PHI when DocHelp is not working on behalf of Your Healthcare Providers, but is instead working on its own behalf. Therefore, when DocHelp relies on this Authorization, and uses and discloses PHI as described in this Authorization, it is not working as a Business Associate and the HIPAA requirements that apply to Business Associates will not apply to such uses and disclosures.
If you e-sign this Authorization, you give your permission to DocHelp to retain your PHI and to use and/or disclose your PHI in the same way that you have agreed that your Non-PHI can be used and disclosed.
Specifically, you agree that DocHelp can use your PHI to:
You also agree that DocHelp can disclose your PHI to:
If DocHelp discloses your PHI, DocHelp 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 DocHelp or for the permitted purpose of the disclosure (as described above). DocHelp cannot, however, guarantee that any such person or entity to which DocHelp 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 DocHelp.
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 DocHelp 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 DocHelp Services. A Revocation of Authorization is effective after you submit it to DocHelp, but it does not have any effect on DocHelp’s prior actions taken in reliance on the Authorization before revoked.
Once DocHelp receives your Revocation of Authorization, DocHelp can only use and disclose your PHI as permitted in DocHelp’s agreements with Your Healthcare Provider(s). Your Revocation of Authorization does not affect DocHelp’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.