Authorization to Use and Disclose Protected Health Information
The privacy of your health information is important to us. We call your health information that identifies you, your “protected health information” or “PHI.” To protect your PHI, we will follow federal and state privacy laws, including the Health Insurance Portability and Accountability Act and regulations (HIPAA). We refer to all of these laws as the “Privacy Rules.” Here we let you know how we will use and disclose your PHI.
PHI that Will be Used/Disclosed:
The PHI that will be transmitted includes:
Purposes for Which Your PHI will be Used/Disclosed:
We will use and share your PHI only with your doctors and any other individuals you consent to release your information to. We will use and share your PHI to provide you with care management content specific to your treatment plan and medications. We will also use and share your PHI to conduct normal business operations. We may share your de-anonymized data with other people and places that help us conduct this initiative, such as laboratories, data management centers, data monitors, contract research organizations, Institutional Review Boards (IRBs), and other institutions. If you leave the PatientNexo™ powered by Sympto, we may use your non-personally identifiable information for software improvement and any other business-related operations.
Use and Disclosure of Your Information that is Required by Law:
We will use and disclose your PHI when we are required to do so by law. This includes laws that require us to report child abuse or abuse of elderly or disabled adults. We will also comply with legal requests or orders that require us to disclose your PHI. These include subpoenas or court orders.
Authorization to Use PHI is Required to Participate:
By signing this form, you give us permission to use and share your PHI as described in this document. You do not have to sign this form to authorize the use and disclosure of your PHI. If you do not sign this form, then you may not receive text messages from the PatientNexo™ powered by Sympto.
People Who will Use/Disclose Your PHI:
The following people and groups will use and disclose your PHI:
Optional Storage of Data
PHI That will be Used/Disclosed in the Future:
The PHI that we will use and/or disclose (share) for the optional storage and future research of your PHI includes your medication adherence, response to all text messages, and survey responses. These will be de-identified for all future use.
Purposes for which your PHI will be Used/Disclosed:
We will use and disclose your PHI for the conduct and oversight of future research regarding efficacy of the PatientNexo™ powered by Sympto as well as further iteration of this platform.
People Who will Use/Disclose Your PHI:
The same people and groups who will use and disclose your PHI, as mentioned above, will also have the ability to use your de-identified data in future research-based instances.
Expiration of Your Authorization:
Your PHI will be used until your enrollment in the PatientNexo™ powered by Sympto ends. If any data is used post-enrollment, it will be de-identified prior to use.
Revoking Your Authorization:
If you sign this form, at any time later you may revoke (take back) permission to allow the PatientNexo™ powered by Sympto to use your information. If you want to do this, you must contact the MEDINEXO team via email at:
At that point, no more of your PHI would be collected or transmitted via text message. PatientNexo™ powered by Sympto may use or disclose the information you already gave them so they can follow the law, protect your safety, or make sure that the collected data is correct. If you revoke your authorization, you will not be able to stay on the platform.
Other Items You Should Know about Your Privacy
Not all people and entities are covered by the Privacy Rules. HIPAA only applies to health care providers, health care payers, and health care clearinghouses. If we disclose your information to people who are not covered by the Privacy Rules, including HIPAA, then the Privacy Rules won’t protect your information. People who do not have to follow the Privacy rules can use or disclose your information with others without your permission if they are allowed to do so by the laws that cover them.
At any time, you may request access to your PHI either via text message or directly from the PatientNexo™ powered by Sympto. A designated record set containing your PHI will be provided to you, if requested. A designated record set is data that includes all data you have provided over the course of your enrollment on the PatientNexo™ powered by Sympto.
We may remove identifying information from your PHI. Once we do this, the remaining information will not be subject to the Privacy Rules. Information without identifiers may be used or disclosed with other people or organizations for purposes outside of your care.
Contact Medinexo USA, LLC at firstname.lastname@example.org
CUSTOMER’S USE OF THE SERVICES TERMS AND CONDITIONS.
The Customer acknowledges and understands that certain Services may require and utilize phone service, data access or text messaging capability. Except as otherwise noted as part of the Services, Medinexo does not charge for the use of Services, but carrier rates for phone, data and text messaging may apply. Medinexo makes no warranty with respect to the Services provided to the Customer based upon the Customer’s location and data access which can be affected by a wide variety of items including but not limited to a lack of data network access, spotty network coverage or other factors.
In providing the Services, Medinexo does not actively monitor the display, transmission and/or exchange of any Material (defined in Section 1.3) that is accessible by means of the Services, while Medinexo reserves the right to monitor the Services for purposes of determining that their usage is in compliance. When using the Services, the Customer shall: (i) observe all traffic laws and otherwise drive safely; (ii) not otherwise interact with the Mobile Application, unless the Customer’s vehicle is stationary and legally parked; (iii) not use the Services for any illegal, unauthorized, unintended, or unlawful purposes.
Further, the Customer expressly agrees: (i) to comply with all applicable foreign, federal, state/provincial and local laws relating to use of the Services under this Agreement (including without limitation, export and control laws and regulations); (ii) not to upload, post, email or otherwise transmit content through use of the Services that (1) infringes any third-party intellectual property or other proprietary rights or rights of publicity or privacy or that is unlawful, threatening, abusive, harassing, tortuous, libelous, deceptive, fraudulent, invasive of another’s privacy, vulgar, obscene, hateful or racially, ethnically or otherwise contains objectionable material of any kind or nature; (2) violates any law, statute, ordinance or regulation (including without limitation the laws and regulations governing export control, unfair competition, anti-discrimination or false advertising); (3) is defamatory, trade libelous, unlawfully threatening or unlawfully harassing; (4) is profane, indecent, obscene, harmful to minors or child pornographic; (5) contains any viruses, Trojan horses, worms, time bombs, cancelbots, corrupted files or other computer programming routines that are intended to damage, detrimentally interfere with, surreptitiously intercept or expropriate any system, data or personal information or property of another; (6) that includes any unsolicited or unauthorized advertising or marketing requiring prior consent under the TCPA (Telephonic Consumer Protection Act) regulations; or (7) is materially false, misleading or inaccurate or that Customer does not have the right to transmit under any law or under contractual or fiduciary relationships. Medinexo may restrict, disable, block access to, or cancel the Services provided to the Customer or its End Users if it has a reasonable suspicion of abuse or fraudulent use after providing a prompt notice of the restriction or termination to the Customer and following thirty (30) days without resolution by the Customer.
Medinexo may disclose information about Customer’s use of Services to satisfy any law, regulation, government agency request, court order, search warrant, subpoena or other legal process. Services are encrypted in normal operation, although it is solely Customer’s responsibility to ensure use of Services comply with the internal policies and procedures including any applicable Federal and State requirements which may include HIPAA, HITECH, OMNIBUS and TCPA regulations.
The Services may include and incorporate certain audio and video conferencing features (“TeleHealth Services”) as explicitly specified in the Agreement. With respect to such TeleHealth Services, where applicable, each of Customer’s End Users will have the ability to make video calls to other End Users using the Services in a single call up to the limited group size with each participant who dials into the video and/or voice call considered one participant. For optimal audio performance, a built-in mobile device speaker and microphone will be necessary to make use of the TeleHealth Services. Medinexo cannot guarantee that every computer or mobile device will successfully operate the TeleHealth Services based upon available Internet bandwidth, network/firewall settings and other circumstances.
Medinexo may restrict, disable, block access to, or cancel the Services provided to the Customer or its End User if it has a reasonable suspicion of abuse or fraudulent use after providing a prompt notice of the restriction or termination to such Customer or End User and following thirty (30) days without resolution by the Customer or End User. Abuse and fraudulent use of Services include, but are not limited to:
Attempting or assisting another to access, alter, or interfere with the communications of and/or information about another video customer; Tampering with or making an unauthorized connection to the Services Network; Subscription Fraud; Using the Services in such a manner so as to interfere unreasonably with the use of Services by one or more other Customers or End Users or to interfere unreasonably with Medinexo’s or any third party service provider’s ability to provide Services; Using the Services for obscene, salacious, or unlawful information; Using the Services without permission on a stolen or lost Device; Unauthorized Access; and Sharing access to an End User account.
Customer acknowledges and accepts that, Medinexo and it’s PatientNexo Service, the information provided by Medinexo or PatientNexo portals, and the services provided by healthcare professionals using the communications platform of Medinexo, are not a substitute to medical services provided in-person by a licensed healthcare professional where the Customer is located at the time of need for service.
Customer acknowledges and accepts that, Medinexo and it’s PatientNexo Service, does not guarantee the quality of the services provided by a healthcare professionals using the communications platform of Medinexo. Furthermore, Customer acknowledges, that once Medinexo and it’s PatientNexo Service, enables the communications between healthcare professionals using the communications platform of Medinexo and the Customer, the responsibility to a truthful verification of identity, credentials and accuracy of the information exchanged, relies solely on the healthcare professional using the communications platform of Medinexo and the Customer.
With your consent to this Terms and Conditions, you consent to the above information and waive your HIPAA privacy rights for the purpose of receiving and sending PHI and any other health information over text message, to and from the PatientNexo© Service and to the CUSTOMER USE OF SERVICES TERMS AND CONDITIONS.
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