Common use of Records and Release of Information Clause in Contracts

Records and Release of Information. Transmitted Data may become part of my medical record. Data will not be transmitted to people outside my health care team except as described below, and/or if I provideadditional written consent. • I will have access to all of the information in my medical record resulting from the telehealth services that I would have for a similar in-person visit, as provided by federal and state law. • The Providers may use or disclose my health information for treatment, continuity of care, payment, or internal operations, or when required by law or regulation in certain unique situations. • All releases of information are subject to the same laws and regulations as in-person care. If I am participating in a human subject research protocol, my medical information may also be released as described in the research consent form(s).

Records and Release of Information. Transmitted Data may become part of my medical record. Data will not be transmitted to people outside my health care team except as described below, and/or if I provideadditional provide additional written consent. • I will have access to all of the information in my medical record resulting from the telehealth services that I would have for a similar in-person visit, as provided by federal and state law. • The Providers may use or disclose my health information for treatment, continuity of care, payment, or internal operations, or when required by law or regulation in certain unique situations. • All releases of information are subject to the same laws and regulations as in-person care. If I am participating in a human subject research protocol, my medical information may also be released as described in the research consent form(s).

Records and Release of Information. Transmitted Data may become part of my medical record. Data will not be transmitted to people outside my health care team except as described below, and/or if I provideadditional provide additional written consent. •  I will have access to all of the information in my medical record resulting from the telehealth services that I would have for a similar in-person visit, as provided by federal and state law. •  The Providers may use or disclose my health information for treatment, continuity of care, payment, or internal operations, or when required by law or regulation in certain unique situations. •  All releases of information are subject to the same laws and regulations as in-person care. If I am participating in a human subject research protocol, my medical information may also be released as described in the research consent form(s).. Place Patient Identification Label Here Rev. 6/2017