Disclosure and Use of Protected Health Information. Parties Blue Cross and Blue Shield and the Account acknowledge and agree that the Account enters into the terms of this Business Associate Agreement on behalf of itself and of its Health Engagement Program(s) and/or its HRA, TFS, PFS, HC-FSA, or DC-FSA Account-Based Offerings (the Plan).
Disclosure and Use of Protected Health Information. I, , hereby authorize the disclosure of my protected health information by Xxxx Xxxxxxxxxxxxx M.D. and Manhattan Internal Medicine, PLLC (together, for this purpose, the “Practice”) to Knoepflmacher CCPHP, LLC (the “Company”), a company with which the Practice works to help carry out Practice administrative and related functions, and to deliver certain Enhancements which are described in a Membership Agreement between me and the Company. I further authorize the disclosure of my protected health information by the Company as necessary to enable the Company to carry out those functions. For purposes of this document, protected health information means any and all information relating to healthcare services provided to me by the Practice including, but not limited to, information relating to healthcare services provided to me prior to this date and information received by the Practice in connection with my care. I understand that I am not required to electronically sign this authorization/consent in order to receive treatment, and I understand that information disclosed pursuant to this authorization/consent may be re-disclosed by the recipient and no longer protected by privacy regulations; although I understand that any Company re-disclosure is anticipated, unless otherwise required by law, to be for the limited purpose of carrying out the functions described above.
