Heads Up Health provides general wellness, clinical support, and administrative services to individual users (“Users”) and healthcare providers (“Providers”) through its health analytics dashboard (the “Dashboard”) app, website, and services (collectively the “Services”). The Services allow Users to collect and track their personal health data (“User Data”). Users may elect to share their data with a Provider who is a covered entity under HIPAA. User Data may include protected health information (“PHI”) under HIPAA or personally identifiable information (“PII”) not covered under HIPAA.
Heads Up Health HIPAA Authorization
Heads Up Health is partnering with clinical study providers (collectively, the “Research Providers”) to identify individuals who may be eligible for participation in certain clinical studies. This includes the Research Providers listed below.
I authorize Heads Up Health to disclose to the Research Providers indicated below details associated with wearable device data, demographics, assessments, and general health data in order for them to:
● Determine my eligibility for clinical studies being run by the Research Provider.
● Contact me about clinical studies for which I may be eligible.
I understand that:
A. Granting Authorization is voluntary. My receipt of services from Heads Up Health or treatment from my Provider won’t be conditioned on whether I agree to this Authorization, and I’ll still be able to use the Dashboard and Services associated with Heads Up Health if I don’t sign this Authorization.
B. Information voluntarily disclosed is subject to re- disclosure. Any of my information disclosed pursuant to this Authorization may be subject to re-disclosure by the Research Provider and no longer protected by HIPAA.
C. You can revoke Authorization. This Authorization is valid until revoked or three (3) years from the date signed, or such shorter period as required by state law, whichever occurs first. I may revoke this Authorization by notifying Heads Up Health in writing at legal@headsuphealth.com. However, I understand that my decision to revoke this Authorization will not affect any uses or disclosures made by Heads Up Health before my revocation in reliance on this Authorization.
D. You can request a copy of this authorization at any time. Just contact Heads Up Health in writing at legal@headsuphealth.com
