Imaging Panda HIPAA Authorization
Imaging Panda offers services, such as helping you to find and learn about nearby medical diagnostic providers, booking appointments with the diagnostic provider(s) of your choice, coordinating referrals from your referring physician (each, “Your Healthcare Provider”), and managing and forwarding your health history forms and other health-related information to share with Your Healthcare Providers (“Imaging Panda Services”). As part of providing the Imaging Panda Services, Imaging Panda may collect, use, share, and exchange your health history forms and other health-related information with Your Healthcare Providers. Under the federal law called the Health Insurance Portability and Accountability Act (“HIPAA”), 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 Imaging Panda, 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
Your PHI Authorization
The purpose of this Imaging Panda Authorization (“Authorization”) is to request your written permission to allow Imaging Panda to use and disclose your PHI in the same way as we use and disclose your Non-PHI. If Imaging Panda is a Business Associate of Your Healthcare Providers, Imaging Panda 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 Imaging Panda is not working on behalf of Your Healthcare Providers, but is instead working on its own behalf. Therefore, when Imaging Panda 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 Imaging Panda 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 Imaging Panda can use your PHI to:
- Enable and customize your use of the Imaging Panda Services
- Provide you alerts or other Imaging Panda Services regarding future appointments
- Notify you regarding facilities 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 Imaging Panda Services
- Market to you about Imaging Panda and third party products and services
- Conduct analysis for Imaging Panda’s business purposes
- Support development of the Imaging Panda Services
- 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 Imaging Panda can disclose your PHI to:
- Third parties assisting Imaging Panda 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 Imaging Panda Service
- A third party as part of a potential merger, sale or acquisition of Imaging Panda
- 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 Imaging Panda is no longer working on behalf of Your Healthcare Providers
- A provider of medical services, in the event of an emergency
- Organizations that collect, aggregate and organize your information so they can make it more easily accessible to your providers.
If Imaging Panda discloses your PHI, Imaging Panda 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 Imaging Panda or for the permitted purpose of the disclosure (as described above) Imaging Panda cannot, however, guarantee that any such person or entity to which Imaging Panda 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 Imaging Panda. 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 Imaging Panda by emailing us at firstname.lastname@example.org. Your decision not to execute this Authorization or to revoke it at any time will not affect your ability to use certain of the Imaging Panda Services. A Revocation of Authorization is effective after you submit it to Imaging Panda, but it does not have any effect on Imaging Panda’s prior actions taken in reliance on the Authorization before revoked.Once Imaging Panda receives your Revocation of Authorization, Imaging Panda can only use and disclose your PHI as permitted in Imaging Panda’s agreements with Your Healthcare Provider(s). Your Revocation of Authorization does not affect Imaging Panda’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.