HIPAA Authorization for Use and Disclosure of Information

Last Updated on August 29, 2024

1. Information to be Used and Disclosed. In connection with the telehealth services (the “Care Services”) I am receiving, I authorize HeyDoctor Medical Group, P.C., HeyDoctor Medical Group (FL), P.A., HeyDoctor Medical Group (NJ), P.C., and HeyDoctor Medical Group (KS), P.A. (collectively, the “HeyDoctor Medical Group”) and its engaged subcontractors to use and disclose to GoodRx, Inc. and its affiliates (collectively, “GoodRx”), its service providers, or third-parties, the information collected about me by the Care Services, including, but not limited to: name, date of birth, address, telephone number(s), e-mail address, medical information, prescription and prescription-related information, pharmacy name, internet/electronic activity, device information, usage information, commercial information (e.g., payment and account information),  and other contact information for the purposes enumerated below. Some sensitive information as defined under applicable law (e.g., HIV status, genetic information, psychotherapy, or STI status) will not be used or disclosed without your written authorization.
   
   
2. Purpose. As permitted by applicable law, the purpose of this Authorization is to: 
   1. Permit GoodRx to use and disclose my registration and transactional information for marketing purposes, including contacting me at my contact information saved in my profile to provide me with marketing and promotional messages about GoodRx products and services, including but not limited to, prescription pricing and coupons, savings offers, refill reminders, and marketing and promotional messages about other pharmacy, pharmaceutical, medical, or laboratory services, either provided directly by GoodRx or by companies that may otherwise partner with GoodRx, and inform me that GoodRx may receive direct or indirect compensation in relation to such marketing. I understand that GoodRx may contact me using my contact information for these purposes;
   2. Permit GoodRx to use and disclose my information to help provide, personalize and contextualize services provided by GoodRx to me and provide me with relevant content based on how I interact with GoodRx services, which may include marketing, advertising, and other analytics and operations related to advertising and marketing;
   3. Permit GoodRx to use and disclose my information for GoodRx’s business operations, including to provide, change, market, or optimize GoodRx services and products, to perform analytics, and to create new services and products; and 
   4. Permit GoodRx to otherwise use and disclose my information in accordance with GoodRx’s privacy policy, available here. 
      
      
3. Your Rights. I understand that this Authorization is voluntary. I may revoke this Authorization in full or partially by sending a request to care-legal@goodrx.com, except to the extent that action has been taken in reliance upon my Authorization. I understand that information used or disclosed as a result of this Authorization may be subject to re-disclosure by GoodRx and may no longer be protected by certain applicable privacy laws. I understand that GoodRx Care, LLC may not condition treatment, payment, enrollment or eligibility for benefits on my execution of this Authorization. I understand that if I agree to this Authorization by checking the related box, which I am not required to do, I can obtain a copy at any time by sending a request to care-legal@goodrx.com.
   
   
4. Expiration. This Authorization will remain in effect until I revoke it.

By signing this Authorization or by checking the related box, I am authorizing the use and disclosure of my information as outlined above.