AUTHORIZATION TO USE AND SHARE HEALTH INFORMATION
Healigo Inc. ("Healigo") offers an interactive way for you to monitor your health status and communicate with your health care providers and others ("Healigo App"). This Healigo App allows you to receive reminders about and keep track of therapy activities and send the readings to a provider or a third party, right from a mobile phone. By signing this Authorization, you are asking your health care provider to use the Healigo App as an alternative means of communicating with you. You are also allowing your Information, as defined below, to be used and disclosed as explained in this Authorization.
Description of Information that May Be Used or Disclosed:
Healigo may receive, grant access to, and disclose information relating to your health including types of exercises prescribed, days and times when exercises should be or were performed, name, mailing address, birth date, phone number, and email address, as well as other information related to your health that may be communicated through the Healigo App ("Information").
Data Security Risks:
Sending Information via mobile phone applications or mobile devices involves a degree of risk. For example, messages could get misdirected or intercepted. The device could get lost or stolen, and someone else could see the Information. Information held by Healigo that is transmitted from or to your mobile device or as otherwise permitted by this Authorization may be re-disclosed by the recipient and may not be protected by state and federal privacy laws if it is held by an individual or entity not subject to those laws. Your mobile device may be unencrypted. More secure methods of communication with your health care provider, such as mail or telephone, are available. You do not have to use the Healigo App.
Why Information Will Be Used/Purpose:
This document authorizes Healigo to send and receive messages between Healigo's secure server and a mobile device. It allows Healigo to show you personalized educational health content. Your Information will be used to help monitor your health, transmit data, to run the Healigo App, and for Healigo's business operations related to its health care services, including developing improvements and new products. The Information may also be used to determine the health-related materials you will receive as part of the Healigo App. The health-related materials may include information related to treatments and therapies. Healigo may collect, compile, store, analyze and otherwise benefit from statistical data related to your Information, such as activities included in your care plans and your progress with the care plans ("Healigo Analytics"). Healigo may sell, publish, or otherwise share the Healigo Analytics, as long as it is only disclosed in de-identified form. You will not be paid by Healigo for the use of your Information in connection with the Healigo Analytics.
Who May Release Information and Who May Receive It?:
Healigo will receive your Information through the Healigo App from you and your health care providers. Healigo may give your Information to health care providers, health plans and other individuals and entities that have a relationship with you or who have been invited by you to join the Healigo App (referred to on this form as "Recipients"). Healigo may also give your Information to employees, agents, and business associates of Healigo as necessary to operate the Healigo App, for the proper management and administration of Healigo, and as otherwise explained in this Authorization.
How Information Will Be Handled:
Your Information will be used and disclosed only as described in this form. Healigo will safeguard your Information while it is maintained by Healigo, but Healigo cannot safeguard the Information once it is transmitted, such as to a mobile phone or via text. Protection of Information held by Recipients will be the responsibility of those Recipients. You will be responsible for protecting your mobile device.
Revoking the Authorization:
If you no longer want Information to be used or shared as allowed on this form and want to stop using the Healigo App, you may write to Healigo requesting this form be revoked. You must include in the letter the following data: name, date of birth, and clinician's name. The revocation must be sent to: Privacy Official, email@example.com. This revocation will not affect any action taken by the Recipients or Healigo before you revoked the authorization.
Participation in the Healigo App is Voluntary:
You understand that you not required to sign this form. Your health care providers and health plans cannot condition treatment, health care payment, enrollment or eligibility for benefits, on whether or not you sign this form. If you do not sign, you cannot participate in the Healigo App.
This Authorization form expires once you delete your account or one year from the date the Authorization form is signed, whichever comes first.
Limit of Liability.
UNDER NO CIRCUMSTANCES, INCLUDING, BUT NOT LIMITED TO BREACH OF CONTRACT, TORT, OR NEGLIGENCE, WILL HEALIGO BE LIABLE FOR ANY DIRECT, INDIRECT, SPECIAL, INCIDENTAL, PUNITIVE, EXEMPLARY, OR CONSEQUENTIAL DAMAGES (INCLUDING LOST PROFITS) THAT ARISE OUT OF OR ARE RELATED TO YOUR USE OF THE HEALIGO WEBSITE, HEALIGO APP AND RELATED SERVICES AND CONTENT. If assets or ownership of Healigo Inc. and/or the Healigo App are sold, transferred, or otherwise conveyed, in whole or in part, you agree that your Information may be transferred to such third party.
USE OF THE HEALIGO WEBSITE, HEALIGO APP AND RELATED SERVICES AND CONTENT. If assets or ownership of Healigo Inc. and/or the Healigo App are sold, transferred, or otherwise conveyed, in whole or in part, you agree that your Information may be transferred to such third party.
Patient can download a copy of this document at http://www.healigo.com