HIPAA AUTHORIZATION

PACT GO 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 (“PACT GO Services”). As part of providing the PACT GO Services,PACT GO may collect, use, share, and exchange your health history forms and other 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.

Safeguards for PHI

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 PACT GO, 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.

Non-Protected Health Information

As a condition of creating your PACT GO account, you are required to read and agree to PACT GO’s Privacy Policy. PACT GO’s Privacy Policy explains how PACT GO processes and shares information received from you that is not covered by HIPAA (“Non-PHI”).

Your PHI Authorization

The purpose of this PACT GO Authorization (“Authorization”) is to request your written permission to allow PACT GO to use and disclose your PHI in the same way as we use and disclose your Non-PHI. If PACT GO is a Business Associate of Your Healthcare Providers, PACT GO 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 PACT GO is not working on behalf of Your Healthcare Providers, but is instead working on its own behalf. Therefore, when PACT GO 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 PACT GO 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 PACT GO can use your PHI to:

enable and customize your use of the PACT GO Services;
provide you alerts or other PACT GO Services regarding future appointments;
notify you regarding providers we think you may be interested in learning more about;
share information with you regarding services, products or resources about which we think you may be interested in learning more;
provide you with updates and information about the PACT GO Services;
market to you about PACT GO and third party products and services;
conduct analysis for PACT GO’s business purposes;
support development of the PACT GO 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 PACT GO can disclose your PHI to:

third parties assisting PACT GO 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 PACT GO Service;
a third party as part of a potential merger, sale or acquisition of PACT GO;
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 PACT GO 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.
Redisclosure

If PACT GO discloses your PHI, PACT GO 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 PACT GO or for the permitted purpose of the disclosure (as described above). PACT GO cannot, however, guarantee that any such person or entity to which PACT GO discloses your PHI or other information will not re-disclose it in ways that you or we did not intend or permit.

Expiration and Revocation of Authorization

Your Authorization remains in effect until you provide written notice of revocation to PACT GO.

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 PACT GO 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 PACT GO Services. A Revocation of Authorization is effective after you submit it to PACT GO, but it does not have any effect on PACT GO’s prior actions taken in reliance on the Authorization before revoked.

Once PACT GO receives your Revocation of Authorization, PACT GO can only use and disclose your PHI as permitted in PACT GO’s agreements with Your Healthcare Provider(s). Your Revocation of Authorization does not affect PACT GO’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.