Authorization to Use and Disclose Health Information
You agree that as part of your use of the ZibdyHealth website (“Site”) and ZibdyHealth Services, including the ZibdyHealth Mobile Applications and social network Applications (“Services”), Zibdy, Inc. (“ZibdyHealth” or “Zibdy”) may use and disclose your health information, including information that may personally identify you (“Personal Health Information”), as described in this Authorization to Use and Disclose Health Information (“Authorization”).
Specifically, by clicking the “I Consent” button below, you authorize ZibdyHealth to use and disclose your Personal Health Information to the following persons or entities for the following purposes:
- To the family members, friends or caregivers who you authorize as secondary users of your ZibdyHealth account. ZibdyHealth may share your Personal Health Information with these persons so that they can help you obtain ZibdyHealth’s services and manage your account, manage your health and wellness, and to obtain care and advice from healthcare providers.
- To the family members you select using the personal settings of you ZibdyHealth account. ZibdyHealth may share the Personal Health Information you select, with the family members you select, so that those family members can use it in obtaining ZibdyHealth’s services, to manage their own health and wellness, and to obtain care and advice from their healthcare providers.
- To none of your family members according to the default settings on your account. You understand that the default settings of your account won’t permit ZibdyHealth to share your information with family members.
- To the healthcare providers, pharmacists and pharmacies you select using the personal settings of your ZibdyHealth account. ZibdyHealth may share your Personal Health Information with the healthcare providers, pharmacists and pharmacies you select for their use in diagnosis or treatment (including direct or indirect treatment by other healthcare providers involved in your treatment and the provision of medication), obtaining payment from third party payers, and in their health care operations.
- To other ZibdyHealth Applications. ZibdyHealth may send your Personal Health Information to the specific other ZibdyHealth Applications that you select through your ZibdyHealth account for the uses described by those Applications.
- To other third-parties you select to receive your Personal Health Information. You may specify additional third-parties to whom ZibdyHealth may share your Personal Health Information for the purposes you specify at the time you select them, including for purposes of diagnosis or treatment, payment, or the third-parties’ health care operations.
ZibdyHealth is not responsible for the manner in which third parties, including healthcare providers, use or disclose your Personal Health Information. You should review the privacy policies of any healthcare providers or other third parties to whom you allow such information to be provided.
This Authorization applies to any of your Personal Health Information, including by not limited to individually identifiable health information and medical records regarding any past, present, or future medical or mental health condition, including, but not limited to, any and all information relating to the diagnosis and treatment of sexually transmitted diseases, mental illness (including information protected under California’s Lanterman-Petris-Short Act), HIV/AIDS, drug or alcohol abuse, and genetic testing information.
You understand that you may cancel this Authorization at any time. However, if you cancel this Authorization, you will no longer be able to use the ZibdyHealth Services. You can send an e-mail to ZibdyHealth at email@example.com, with the subject line “Cancel Authorization re Health Information.” If you cancel this Authorization, information that was already collected and disclosed about you may continue to be used in the manner you had previously authorized.
You should print and retain a copy of this Authorization for your records. You have the right to receive a copy of this Authorization. To receive a copy, please email firstname.lastname@example.org, with the subject line “Request for Copy of Authorization.”
By clicking the “I Consent” button, you agree to the use and release of your Personal Health Information as described in this Authorization.