HIPAA Authorization for Use and Disclosure of Protected Health Information

Practice Name: Onduo Professionals, P.C. and its associated entities

Purpose: This authorization permits Onduo Professionals, P.C., Onduo Professionals of Alaska, Onduo Professionals of California, P.C., Onduo Professional of Hawaii, P.C., Onduo Professional of Kansas, P.A., Onduo Professional of New Jersey, P.C., Onduo Professional of Texas, P.A., and Onduo, LLC ("Practice") to use and disclose your protected health information ("PHI") as described below for purposes of product development, technical support, and other similar activities that benefit the Practice, Verily Life Sciences, LLC, its partners and their services.

Information to Be Used or Disclosed

The following PHI may be used or disclosed under this Authorization:

  • Medical history, diagnoses, and treatment information.
  • Health records, including but not limited to laboratory results, diagnostic imaging, and medications.
  • Demographic information (e.g., age, gender, address).

Purpose of Use or Disclosure

The PHI described above may be used and disclosed for the following purposes:

  • Development and improvement of medical products, services, and software.
  • Technical support services, including troubleshooting and maintenance.
  • Research and analysis related to product or service enhancement.
  • Monitoring and evaluation of medical technologies and related services.

Recipients of the Information

Your PHI may be disclosed to:

  • Companies or partners engaged by the Practice for the purpose of product development, research, or technical support.
  • Software developers and IT service providers assisting with the improvement of the Practice's systems and technologies.
  • Consultants, contractors, and other professionals involved in product and service development.

Expiration

This Authorization will remain in effect indefinitely unless revoked by the patient.

Right to Revoke

You have the right to revoke this Authorization at any time by providing written notice to the Privacy Officer of the Practice. Please note that your revocation will not apply to information already used or disclosed in reliance on this Authorization.

Potential for Re-Disclosure

Once your PHI is disclosed under this Authorization, it may no longer be protected under HIPAA if it is disclosed to a non-covered entity. However, we will take steps to ensure that any third party receiving your information agrees to protect its confidentiality.

No Conditions

You understand that your treatment, payment, enrollment, or eligibility for benefits with the Practice is not conditioned upon your signing of this Authorization.

Signature

By checking the box, you acknowledge that you have read and understand the terms of this Authorization, and that you voluntarily agree to the use and disclosure of your PHI for the purposes described above..

Practice Contact Information:

Onduo Professionals, P.C.
10 Langley Road, Ste 400
Newton, MA 02459