Authorization for the use and disclosure of health information
YoDerm, Inc. (“YoDerm”) is dedicated to providing online dermatology consultations with board-certified dermatologists. YoDerm’s online platform utilizes technology (e.g. picture sharing, telemedicine, etc.) adapted for the specific needs of healthcare. All tools and services offered by YoDerm on this website (the “Site”) are referred to as the “Services” for the purposes of this Authorization.
YoDerm allows users of the Site (the “Users”) to share personal health information online. YoDerm may also contract with or allow for use of the Site by (i) certain health care providers or networks of health care providers (collectively, “providers”) and/or (ii) health plans or health insurers (collectively, “health insurers”) to facilitate your use of the Services or to make YoDerm’s Services available to Users who are patients of such providers or who are enrollees or members of such health insurers. For the purposes of this Authorization, the terms “we” or “us” refers to YoDerm and to any of your provider(s) and/or health insurer(s) with which YoDerm contracts for the provision of the Services.
Simply stated: YoDerm is a dermatology platform. We connect you with a Provider (i.e. dermatologist) and may connect with your insurance. In this document, "We" or "Us" can refer to all of these parties.
USE AND DISCLOSURE OF YOUR HEALTH INFORMATION
As used in this Authorization, the term “health information” means all information, in any format including without limitation text, photos, and video, relating to your past, present, or future physical or mental health or condition; the provision of health care to you; or the past, present, or future payment for the provision of health care to you. It specifically includes such information after you have submitted your consult including consent and/or payment. It includes such information regardless of whether it is or has been posted on the Site, was submitted by you or by other Users of the Site, was made available to us by your providers or health insurers, or was posted on the Site by us, and regardless of whether it is subsequently removed from the Site.
Examples of “health information” include, but are not limited to:
- Photographs of you and/or your skin that are intended to document the condition of your skin.
- Information about your medical or mental condition or illness, including diagnosis date, first symptom information and family history.
- Treatment regimens, including treatment start dates, stop dates, dosages and side effects.
- Symptoms experienced, including severity and duration.
- Health risk assessment scores or surveys.
- Medications prescribed and supplements taken.
- Communications between you and your providers
- Lab tests or lab results.
- Genetic information, including information on genetic tests and test results, individual genes and/or entire genetic scans.
- Tests or test results for diseases or health conditions.
- Alcohol, drug or substance abuse information.
- Claims information relating to your health care coverage with a health insurer, including but not limited to, benefits paid; benefits denied; pre-service, concurrent and post service certification/utilization review decisions; and/or care management activities.
Simply stated: We collect your health information to provide our Service to you. This information could be directly from you or other sources like lab tests, your insurance company, and your Provider.
You hereby authorize us, and any third party vendors acting on our behalf, to use or disclose all, or any part of, your health information to the persons or entities identified below for the stated purposes:
- To your providers in order to provide the Services to you and/or your providers.
- To the extent that authorization is required by applicable law, to re-disclose your health information among ourselves, and to any third party vendors acting on our behalf, for the purpose of providing the Services to you, your providers, and/or other Users.
- To the extent that authorization is required by applicable law, to use or disclose your health information to third parties in order to properly manage our business and/or to comply with our legal responsibilities (for example, to respond to a subpoena or similar legal process); when we believe in good faith that disclosure is necessary to protect our rights or to protect your safety or the safety of others; to investigate fraud; to respond to a governmental request for information; or in connection with a merger, acquisition or sale of all or a portion of YoDerm’s assets.
- To the extent that authorization is required by applicable law, to market our products and services (and those of third parties) to you, though we will not disclose your health information in doing so. For example, we may allow third parties to choose the characteristics of users who will receive the communications, and we may use any attributes we have collected (including information you do not make available on the Site) to select the appropriate audience for those communications.
Simply stated: In order to provide our Service to you, we need to share your information with others, like your doctor and your insurance company. We will also share your information if we have to by law. We may also use your information to personalize your experience with third parties, however if they are not pertinent in your healthcare, they will receive NO personal health information.
You hereby acknowledge that health information disclosed pursuant to this Authorization may be subject to re-disclosure by the recipient and no longer protected by the privacy laws.
In some cases, communications between you and YoDerm will include health information in unencrypted forms (most notably email and text). The information included within these communications will never include highly-sensitive information including your medical history, medication prescribed outside of the YoDerm Platform, and the photos your provide in your consultation. You are authorizing YoDerm to communicate with you using unencrypted mediums (like email and text) for some PHI including, but not limited to your YoDerm treatment plan, the name of your Provider, and the condition you’re seeking treatment for.
With this authorization, you understand the following risks of communicating using unencrypted mediums:
- Email and texts can be forwarded, printed, intercepted, and stored by anyone with access to your email inbox or mobile phone.
- These mediums are convenient, but are not appropriate for emergencies or time-sensitive information.
- Your employers typically has the right to access any email received or sent by a person at work.
- Staff other than your healthcare provider may read and process email.
- Clinically relevant messages and responses will be documented and become part of your medical record at your Physician’s discretion.
- YoDerm is not liable for information lost or misdirected due to technical errors or failures.
Simply stated: By using YoDerm, you're allowing us to send you some basic health-related information by email and/or text. We do this to improve your experience, i.e. an email receipt including information about your consultation. There are some risks in sending information by email, and you need to be OK with these risks to use the Service. We will NOT communicate any highly sensitive information by email like your photos, any medications you're taking outside of YoDerm, or any other medical conditions you have.
This Authorization will expire as of the earliest of the following: (i) your valid revocation of this Authorization in accordance with the procedures set forth below; (ii) deactivation of your User account; or (iii) the maximum period permitted by applicable law.
We are required by law to make sure that PHI that identifies you is kept private, give you this Notice of our legal duties and privacy practices concerning your PHI, and follow the terms of this Notice currently in effect.
Right To Inspect and To Receive Copies. You have the right to view and receive copies of the PHI used to make decisions about your care, provided you submit your request in writing to firstname.lastname@example.org. Usually, this includes medical and billing records. Contact Customer Service for more information at email@example.com or (408) 596-3376.
Right To Amend. If you think that PHI YoDerm has about you is wrong or incomplete, and you cannot edit it in the patient dashboard, you have the right to ask for an amendment to your record. To ask for a change to your record, you must make your request in writing, state a reason that supports your request and submit it to Customer Service at firstname.lastname@example.org. YoDerm may also deny your request if you ask YoDerm to amend information that:
- YoDerm did not create, unless the person or entity that created the information is no longer available to make the amendment;
- is not part of the records used to make decisions about you;
- is not part of the information which you are permitted to inspect and to receive a copy; or is accurate and complete.
Right To an Accounting of Disclosures. You have the right to get a list of the disclosures YoDerm has made of your PHI. This list will not include all disclosures that YoDerm made. For example, this list will not include disclosures that YoDerm made for treatment, payment or health care operations. It will not include disclosures made before June 1, 2012, or disclosures you specifically approved. To ask for this list, you must submit your request through our request form. To ask for a form, send a message to email@example.com.
Right To Request Restrictions. You have the right to ask for a restriction or limitation on the PHI YoDerm uses or discloses for treatment, payment or health care operations. You also have the right to ask for a limit on the PHI YoDerm discloses with someone who is involved in your care or in the payment for your care. Such a person may be a family member or friend. YoDerm is not required to comply with your request. If YoDerm does agree, we will fulfill your request unless the information is needed to provide you with emergency treatment or if otherwise required by law. To ask for restrictions, you must make your request through an approved form. Get the form by messaging firstname.lastname@example.org. You must tell us:
- What information you want to limit;
- How you want us to limit the information, and
- To whom you want the limits to apply.
Right To Request Confidential Communications. You have the right to request confidential communications of your PHI or medical matters. You may request that YoDerm communicate with you through alternate means or at an alternate location. You must make your request in writing on a form that will be provided to you upon request. YoDerm will fulfill all reasonable requests.
Right To a Paper Copy of This Notice. Right To a Paper Copy of This Notice. You may ask YoDerm to give you a written copy of this Notice at any time. Even if you have agreed to get this Notice electronically, you still have a right to a paper copy of this Notice.
Simply stated: You have many rights regarding your health information including: receiving copies, changing the information we have, asking us who we share it with, restricting who we share it with, communicating confidentially, and receiving a paper copy of this notice. If you'd like to pursue any of these rights, send us a message at email@example.com.
If you think your privacy rights have been violated, you may file a complaint with Our Privacy Officer or in writing at the address listed below. You may also file a complaint with the Secretary of the Department of Health and Human Services. Click here to find out how to file a complaint with the Secretary of the Department of Health and Human Services. You many also file a complaint with the applicant pharmacy. Contact the pharmacy directly with such a complaint. You will not be penalized for filing a complaint. You may also contact us for further information about your privacy rights by emailing us at firstname.lastname@example.org as well as by post mail:
101 Broadway, Suite 310
Oakland, CA 94607
Attn: Privacy Officer
Simply stated: If you feel as though we've handled your information inappropriately, you can submit a complaint to YoDerm as well as the HHS who oversees and enforces HIPAA compliancy.
You may refuse to execute this Authorization. However, if you refuse to sign this Authorization, you will not have access to the YoDerm platform, including its online dermatologic consultations with board-certified dermatologists.
You may revoke this Authorization at any time. Your revocation must be in writing, signed by you and delivered to the following address: Chief Privacy Officer, YoDerm, Inc. 101 Broadway Ave Suite 310, Oakland, CA 94607. Your revocation will be effective upon receipt, but will not be effective to the extent that we or others have previously acted in reliance upon this Authorization. In the event you revoke this Authorization, you will no longer have access to your YoDerm account.
Simply stated: It's up to you if you'd like to accept this release of information. Unfortunately, if you refuse to accept this release we can't confidently perform our Service, so you can't submit a consultation or receive treatment on YoDerm.
Thanks again for using YoDerm!