HIPAA AUTHORIZATION Sample Clauses
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HIPAA AUTHORIZATION. I give permission to Right Dose to use or disclose certain aspects of my health information to the individual listed as my personal representative, my long-term care facility, federal and state health agencies, insurance companies, third-party data aggregators, pharmacy benefit managers, and other health-related agencies. NOTICE OF PRIVACY PRACTICES [▇▇▇▇://▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/hipaa-privacy-policy/] I certify that I have received a copy of Right Dose privacy practices and have been given an opportunity to review the document and ask questions to assist my understanding of resident’s rights relative to the protection of resident’s health information. I know that I can access the Notice of Privacy Practices on the Guardian Pharmacy website at [▇▇▇▇://▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/hipaa-privacy-policy/]. I further acknowledge that I am satisfied with the explanations provided to me and am confident that Right Dose is committed to protecting my health information. I certify that I have read and understand this agreement: I certify that I have received a copy of Right Dose Notice of Non-Discrimination and Complaint Procedures and have been given an opportunity to and did review the document including the free disabilities aids and language services available and was given an opportunity to ask questions to assist my understanding of it. I am confident I understand my rights and my options if I believe I have been discriminated against or guardian has failed to provide certain services. I received instructions and understand that Medicare defines the that I received as being either a capped rental or an inexpensive or routinely purchased item. I have been given the opportunity to and did examine the Medicare Capped rental and inexpensive or routinely purchased items notification and was given an opportunity to ask questions to assist my understanding of it.
HIPAA AUTHORIZATION. I give permission to Guardian Pharmacy of St. Louis to use or disclose certain aspects of my health information to: the individual listed as my personal representative, my long-term care facility, federal and state health agencies, insurance companies, third-party data aggregators, pharmacy benefit managers, and other health-related agencies. I have read and understand the above terms and conditions and agree to be bound by each of them: Signature [Resident or Responsible Party]: Date: NOTICE OF PRIVACY PRACTICES [▇▇▇▇://▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/hipaa-privacy-policy/] I certify that I have received a copy of Guardian Pharmacy of St. Louis’s privacy practices and have been given an opportunity to review the document and ask questions to assist my understanding of resident’s rights relative to the protection of resident’s health information. I know that I can access the Notice of Privacy Practices on the Guardian Pharmacy website at [▇▇▇▇://▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/hipaa- privacy-policy/]. I further acknowledge that I am satisfied with the explanations provided to me and am confident that Guardian Pharmacy of St. Louis is committed to protecting my health information. I certify that I have read and understand this agreement: I certify that I have received a copy of Guardian Pharmacy of St. Louis’s payment information and understand the available ways to pay my bills and have been given an opportunity to and did review the document and was given an opportunity to ask questions to assist my understanding of it.
HIPAA AUTHORIZATION. I give permission to [MTPS] to use or disclose certain aspects of my health information to: the individual listed as my personal representative, my long-term care facility, federal and state health agencies, insurance companies, third-party data aggregators, pharmacy benefit managers, and other health-related agencies.
HIPAA AUTHORIZATION. I give permission to Guardian Pharmacy to use or disclose certain aspects of my health information to the individual listed as my personal representative, my long-term care facility, federal and state health agencies, insurance companies, third-party data aggregators, pharmacy benefit managers, and other health-related agencies. NOTICE OF PRIVACY PRACTICES [▇▇▇▇://▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/hipaa-privacy-policy/] I certify that I have received a copy of Guardian Pharmacy privacy practices and have been given an opportunity to review the document and ask questions to assist my understanding of resident’s rights relative to the protection of resident’s health information. I know that I can access the Notice of Privacy Practices on the Guardian Pharmacy website at [▇▇▇▇://▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/hipaa-privacy-policy/]. I further acknowledge that I am satisfied with the explanations provided to me and am confident that Guardian Pharmacy is committed to protecting my health information. I certify that I have read and understand this agreement.
HIPAA AUTHORIZATION. Business Associate agrees that it shall not use in any other manner or disclose to any other person or entity Covered Entity’s PHI, except as otherwise provided by this Agreement, without first obtaining a HIPAA-compliant authorization (“HIPAA Authorization”) from the Individual about whom the information pertains, including, but not limited to, whenever Covered Entity would be required to do so in accordance with federal or state laws and regulations.
HIPAA AUTHORIZATION. Business Associate shall not, except as provided in this Agreement and permitted or required under HIPAA and HITECH, use in any other
HIPAA AUTHORIZATION. If the research involves the creation, use or disclosure of PHI, separate authorization is required under the HIPAA Privacy Rule. Please provide the HIPAA Research Authorization Form and/or a request for waiver of HIPAA authorization. (For further information, see the Yale HIPAA website at http://info.med.yale.edu/▇▇▇▇▇/).
HIPAA AUTHORIZATION. I give permission to Midwest LTC to use or disclose certain aspects of my health information to: the individual listed as my personal representative, my long-term care facility, federal and state health agencies, insurance companies, third-party data aggregators, pharmacy benefit managers, and other health-related agencies. NOTICE OF PRIVACY PRACTICES [▇▇▇▇://▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/hipaa-privacy-policy/] I certify that I have received a copy of Midwest LTC privacy practices and have been given an opportunity to review the document and ask questions to assist my understanding of resident’s rights relative to the protection of resident’s health information. I know that I can access the Notice of Privacy Practices on the Guardian Pharmacy website at [▇▇▇▇://▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/hipaa-privacy-policy/]. I further acknowledge that I am satisfied with the explanations provided to me and am confident that Midwest LTC is committed to protecting my health information. I certify that I have read and understand this agreement: