Transform9 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 (“Transform9 Services”). As part of providing the Transform9 Services, Transform9 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 Transform9, 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.
As a condition of creating your Transform9 account, you are required to read and agree to Transform9 Privacy Policy. Transform9’s Privacy Policy explains how Transform9 processes and shares information received from you that is not covered by HIPAA (“Non-PHI”).
The purpose of this Transform9 Authorization (“Authorization”) is to request your written permission to allow Transform9 to use and disclose your PHI. If Transform9 is a Business Associate of Your Healthcare Providers, Transform9 needs your Authorization to be able to use and disclose your PHI. Specifically, you agree that Transform9 can use your PHI to:
enable and customize your use of the Transform9 Services;
provide you alerts or other Transform9 Services regarding future appointments;
provide you with updates and information about the Transform9 Services;
conduct analysis for Your Healthcare Provider and Transform9’s business purposes;
support development of the Transform9 Services; and
create de-identified information and then use and disclose this information in any way permitted by law, including to third parties in connection with their commercial and marketing efforts.
You also agree that Transform9 can disclose your PHI to:
third parties assisting Transform9 with any of the uses described above;
Your Healthcare Providers to enable them to refer you to, and make appointments with, other providers on your behalf, or to perform an analysis on potential health issues or treatments, provided that you choose to use the applicable Transform9 Service;
our business partners who assist us by performing core services (such as hosting, billing, fulfillment, or data storage and security) related to the operation or provision of our services, even when Transform9 is no longer working on behalf of Your Healthcare Providers;
a provider of medical services, in the event of an emergency; and
organizations that collect, aggregate and organize your information so they can make it more easily accessible to your providers.
If Transform9 discloses your PHI, Transform9 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 Transform9 or for the permitted purpose of the disclosure (as described above). Transform9 cannot, however, guarantee that any such person or entity to which Transform9 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 Transform9.
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 Transform9 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 Transform9 Services. A Revocation of Authorization is effective after you submit it to Transform9, but it does not have any effect on Transform9’s prior actions taken in reliance on the Authorization before revoked.
Once Transform9 receives your Revocation of Authorization, Transform9 can only use and disclose your PHI as permitted in Transform9’s agreements with Your Healthcare Provider(s). Your Revocation of Authorization does not affect Transform9’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.
