I hereby authorize VRAssurance to share the health information contained in my VRAssurance PHR profile(s) in its entirety, to only those entities and individuals I designate, for the purpose of providing me with medical care and for the purpose of sharing my information with others that I choose.
I understand and agree that this authorization permits the disclosure of health or treatment information about me, to the entities and individuals I designate, that may also contain sensitive information relating to the following:
I understand and agree that this authorization also covers any record that was created by a doctor or other health care provider other than the doctor or health care provider who supplied the record to VRAssurance.
This authorization will remain in effect and permit the ongoing disclosure by VRAssurance of information in the Health5C Continuous Care Service until I delete my profile(s) in the Health5C Service entirely or revoke the authorization. I may revoke this authorization at any time by using the features or options described in the Health5C Product feature. I understand that my revocation will not apply to actions Health5C has already taken in reliance on my prior authorization.
I understand and agree that VRAssurance may only share the informationa in the limited time period I choose to share and I understand that I may request a copy of this authorization at any time.
If you create, transmit, or display health or other information while using VRAssurance services, you may provide only information that you own or have the right to use. However, VRAssurance may only use health information you provide as permitted by the VRAssurance Privacy Policy, your Sharing Authorization, and applicable law. VRAssurance is not a "covered entity" under the Health Insurance Portability and Accountability Act of 1996 and the regulations promulgated there under ("HIPAA"). As a result, HIPAA does not apply to the transmission of health information by VRAssurance to any third party.