Health Insurance Portability and Accountability Act (“HIPAA”) - Authorization
Last revised: 03/23/2022
GoGetDoc, LLC (“GoGetDoc”) offers services (the “Services”), including but not limited to, helping you find and learn about healthcare options, utilizing healthcare tools, and accessing telemedicine or telehealth services provided by third-party licensed medical providers for certain conditions (“Your Healthcare Providers”). For purposes of this authorization (“Authorization”), “Your Healthcare Providers” shall mean licensed health care providers contracted with Wheel Care, LLC or Wheel-affiliated professional entities. HIPAA protects the privacy and security of your protected health information (“PHI”) (as defined by HIPAA). Your PHI includes, but is not limited to your medical history, drug history, and doctor history. GoGetDoc has entered into a business associate agreement with Your Healthcare Providers, pursuant to which GoGetDoc may collect, use, share, and exchange your health history and other health related information with Your Healthcare Providers. Your Healthcare Providers will not condition treatment, enrollment, eligibility for benefits or payment for your treatment on the signing of this Authorization. Capitalized terms used herein but not defined shall have the meaning ascribed to such terms by HIPAA.
Safeguards for PHI
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.
Non-Protected Health Information
As a condition of creating your GoGetDoc account, you are required to read and agree to GoGetDoc’s Terms of Service. GoGetDoc’s Terms of Service explains how GoGetDoc processes and shares information received from you that is not covered by HIPAA (“Non-PHI”). This Authorization has no effect on, or application to, GoGetDoc’s treatment of any of your Non-PHI information.
Your PHI Authorization
The purpose of this Authorization is to authorize GoGetDoc and Your Healthcare Providers to use and disclose your PHI as described herein. By e-signing this Authorization, you authorize Your Healthcare Providers to disclose your PHI to GoGetDoc and you authorize GoGetDoc to retain your PHI and to use same in the performance of GoGetDoc’s Services and for other purposes as described herein.
Such authorized uses include, but are not limited to, using your PHI for the following:
- enable and customize your use of the GoGetDoc Services;
- provide you alerts of other GoGetDoc Services;
- notify you regarding providers or healthcare tools GoGetDoc thinks you may be interested in learning more about;
- share information with you regarding services, products or resources about which GoGetDoc thinks you may be interested in learning more about;
- provide you with updates and information about the GoGetDoc Services;
- market to you about GoGetDoc and third party products and services;
- conduct analysis for GoGetDoc’s business purposes;
- support development of the GoGetDoc Services; and
- de-identify your PHI and then use and disclose such de-identified information in any way permitted by law, including to third parties in connection with their commercial and marketing efforts.
You also agree that GoGetDoc can disclose your PHI to:
- third parties assisting GoGetDoc with any of the uses described herein;
- a third party as part of a potential merger, sale or acquisition of GoGetDoc;
- parties that assist GoGetDoc by performing services (such as hosting, billing, fulfillment, or data storage and security) related to the operation or provision of the Services, even when GoGetDoc is no longer working on behalf of Your Healthcare Providers; and
- organizations that collect, aggregate and organize your PHI so they can make same more easily accessible to Your Healthcare Providers.
In connection with any of the marketing services described herein, GoGetDoc and/or Your Healthcare Providers may receive remuneration from third parties.
If GoGetDoc discloses your PHI to a third party, except for a Covered Entity with its own HIPAA obligations and documentation, GoGetDoc will require the third party receiving your PHI to agree to only use and disclose your PHI to carry out its specific business obligations to GoGetDoc or for the permitted purpose of the disclosure (as described herein). GoGetDoc does not guarantee that any such third party will not re-disclose your PHI in ways that you or GoGetDoc did not intend or permit. If the third party that receives your PHI is not covered by privacy regulations, your PHI may be re-disclosed by such third party and will no longer be protected by privacy regulations.
Expiration and Revocation of Authorization
This Authorization remains in effect until the earlier of: (i) the receipt by GoGetDoc and Your Healthcare Provider of a written notice of revocation from you; and (ii) ten (10) years from the date you terminate your GoGetDoc account. However, the revocation does not have any effect on GoGetDoc or Your Healthcare Provider’s prior actions taken in reliance on this Authorization before revocation. Your revocation of this Authorization to GoGetDoc does not affect any authorization you may have entered with third parties.
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 GoGetDoc by submitting a revocation in writing through email at email@example.com and Your Healthcare Provider by submitting a revocation in writing through email at firstname.lastname@example.org. Your decision not to execute this Authorization or to revoke it at any time will affect your ability to use certain components of the Services.