5/27/2023 0 Comments Stanley penc md![]() I understand that the information submitted to my HealthLynked account is subject to the privacy and security protections of applicable Federal and State laws. Stanley F Penc and my HealthLynked Account.įor Authorized Representatives of Patients younger than 18 years old: This Authorization shall expire upon the earliest of: (1) the date the minor reaches the age of 18 or (2) the date HealthLynked receives written revocation from the minor, as an emancipated minor with legal authority to manage his/her own healthcare. This authorization shall end upon the earliest of: a) the termination of the connection between my healthcare Dr. I understand that I may delete my HealthLynked account any time. However, I acknowledge that data previously submitted by Dr.Stanley F Penc as authorized by me prior to my subsequent revocation of this Authorization will remain in my HealthLynked account. Stanley F Penc as a health care provider with which I want to be connected on my HealthLynked account. I may revoke this Authorization by unlinking or removing access for Dr. Such revocation will take effect immediately to the extent that my doctor has already acted based on this Authorization. I may revoke this authorization at any time. Stanley F Penc will not electronically release my healthcare informat io n to my HealthLynked PHR. However, without this Authorization, my Dr. Stanley F Penc may, within its discretion, withhold from disclosure any of the above information as permitted or required by law.Īccess to treatment or services may not be denied to me if I decline to sign this Authorization or revoke my Authorization. Stanley F Penc has received about me from other healthcare practices, providers or facilities. Stanley F Penc may disclose any information or records (within the scope of the authorization) that Dr. I acknowledge that with this authorization Dr. I acknowledge that such healthcare information may include information regarding mental health screenings and/or treatment, including psychotherapy notes HIV/AIDS, infectious disease, sexually transmitted infection testing, screening, diagnosis, and/or treatment genetic testing history of domestic violence, child abuse, and/or family abuse and, substance/ alcohol use and treatment history. I acknowledge that such healthcare information may include the following: x rays, clinical diagnosis, histories of present illnesses, immunizations, allergies, prescription drug information, laboratory results, diagnostic screening and testing, clinical procedures, medical research, clinical trials, billing, account, and insurance information. Stanley F Penc to release any and all healthcare information about me to my HealthLynked personal health record (PHR) for my own uses and purposes. Healthlynked Authorization Release of Information
0 Comments
Leave a Reply. |