By agreeing to this Authorization, you authorize the following:
- You authorize your health care provider to disclose your protected health information (“PHI”) to L-Nutra for purposes of enabling you to utilize the Online Marketplace on your health care provider’s website or L-Nutra’s website, and for L-Nutra to otherwise use and disclose your PHI in connection with fulfilling orders for L-Nutra’s products on the Online Marketplace, and for the purpose of providing customer support through L-Nutra and its partners. The PHI that may be used and disclosed pursuant to this Authorization includes your name, address, email address, telephone number, and other information that you provide on the Online Marketplace.
- If you participate in any of L-Nutra’s lifestyle coaching and/or patient educational programs (“L-Nutra Programs”), you also authorize your health care provider to disclose PHI to L-Nutra in connection with the services that you receive through the L-Nutra Programs, and for L-Nutra and its partners that offer the L-Nutra Programs to use and disclose your PHI in order to provide the L-Nutra Programs to you, including communications with your health care provider about your participation in the L-Nutra Programs. The PHI that may be used and disclosed includes your name, contact information and health information).
Additionally, you understand and agree to the following:
- You understand that you do not need to sign this Authorization to receive health care treatment from your health care provider.
- You understand that you may receive a copy of this Authorization by contacting L-Nutra at Privacy@l-nutra.com.
- You understand that the PHI subject to this Authorization may be protected by law. You understand that such PHI may be re-disclosed by the recipient and no longer protected by the federal health information privacy law known as HIPAA. However, other laws in certain states may prohibit the recipient of your PHI from making further disclosure of your information, unless another authorization is obtained from you or unless the further disclosure is specifically permitted or required by law.
- You understand that you have the right to revoke this Authorization in writing at any time by contacting L-Nutra at Privacy@l-nutra.com. Revoking this Authorization will not have any effect on actions taken in reliance on the Authorization before the notice of your revocation was received.
- You understand that this Authorization will terminate one (1) year from the date on which you agree to it, unless you revoke it sooner.