HIPAA Authorization

The documents linked below are collectively referred to as the "HIPAA Authorization." Use of this website constitutes acknowledgement and acceptance of the HIPAA Authorization.

THIS FORM IS AN AUTHORIZATION TO DISCLOSE YOUR PROTECTED HEALTH INFORMATION (PHI) TO THIRD PARTIES. 

In accordance with the Health Insurance Portability and Accountability Act (“HIPAA”), certain health and health-related information may be considered “protected health information” or “PHI” if it is received from or on behalf of your healthcare providers.

Covered Entities

Under HIPAA, healthcare providers and health plans (“Covered Entities”) are required to protect and secure the privacy of your PHI by limiting the uses and disclosures of PHI.

Business Associates

Companies that provide certain types of assistance to Covered Entities such as LMD (“Business Associates”) are also required to protect and secure the privacy of your PHI.

LMD Services

The LMD web site and related applications provide services that allow you to:

send proposals (“Link Requests”) for healthcare services to healthcare providers;

negotiate and confirm pricing for healthcare services with healthcare providers; 

search, filter, meet, and hire healthcare providers; 

schedule, confirm, and request appointments with healthcare providers;

exchange messages with healthcare providers;

exchange files and documents with healthcare providers; 

receive follow-up messages from healthcare providers;

receive and pay medical bills from healthcare providers; 

share and send health-related information to healthcare providers;

store, share, manage and forward your health history forms and other health-related information with healthcare providers; and

perform all of the above services on behalf of family members including a spouse and/or minor child managed under your account (collectively the "LMD Services").

Third Party Disclosure

In connection with providing the LMD Services, your PHI will be disclosed to:

third parties assisting LMD with any of the LMD Services described above;

your healthcare providers when you use the LMD Services or in the event of a medical emergency;

our service providers to host and manage our web site, data, software, security, monitoring, back-ups, fulfillment, applications, payment systems, and development and provide any related operation support including during periods in which LMD is no longer working on your behalf;

emergency medical service providers;

a third party as part of a potential merger, sale or acquisition of LMD;

your healthcare providers such that they can refer you other providers, review and analyze your health issues, and enable them to refer you to, and make appointments with, other providers (collectively the “Third Parties ”).

Authorization

The purpose of this Authorization (“Authorization”) is to request your written permission to allow LMD to use and disclose your PHI to Third Parties in providing the LMD Services. Under certain circumstances described in HIPAA, an individual needs to sign an Authorization form before a Covered Entity can disclose protected health information to a third party.

If you e-sign this Authorization, you give your permission to LMD to retain your PHI and to use and/or disclose your PHI such that LMD may use, share, store, and exchange your health history forms and other health-related information with your healthcare providers.

Expiration

Your Authorization remains in effect until you provide written notice of revocation to LMD.

Revocation of Authorization

You have the right to revoke this Authorization at any time, except to the extent that LMD has already taken action based on the Authorization before revoked.

If you wish to revoke this Authorization, you must notify LMD by submitting a revocation through your membership page. Your decision not to execute this Authorization or to revoke it at any time will not affect your ability to use certain of the LMD Services. A Revocation of Authorization is effective after you submit it to LMD, but it does not have any effect on LMD's prior actions taken in reliance on the Authorization before revoked.

Once LMD receives your Revocation of Authorization, LMD can only use and disclose your PHI as permitted in LMD’s agreements with Your Healthcare Provider(s).

Your Revocation of Authorization does not affect LMD’s use of your Non-PHI.

We will make available to Your Healthcare Provider(s), current and past, your agreement to or revocation of this Authorization.

THIS FORM IS AN AUTHORIZATION TO USE YOUR PROTECTED HEALTH INFORMATION IN ORDER TO PROVIDE OUR SERVICES TO YOU.

In accordance with the Health Insurance Portability and Accountability Act (“HIPAA”), certain health and health-related information may be considered “protected health information” or “PHI” if it is received from or on behalf of your healthcare providers.

Covered Entities

Under HIPAA, healthcare providers and health plans (“Covered Entities”) are required to protect and secure the privacy of your PHI by limiting the uses and disclosures of PHI.

Business Associates

Companies that provide certain types of assistance to Covered Entities such as LMD (“Business Associates”) are also required to protect and secure the privacy of your PHI.

Non-PHI

Our Privacy Policy describes how we manage information about you that is not covered by HIPAA (“Non-PHI”). Currently, your Non-PHI may be used in accordance with our Privacy Policy.

LMD Services

The LMD web site and related applications provide services that allow you to:

send proposals (“Link Request”) for healthcare services to healthcare providers;

negotiate and confirm pricing for healthcare services with healthcare providers; 

search, filter, meet, and hire healthcare providers; 

schedule, confirm, and request appointments with healthcare providers;

exchange message with healthcare providers;

exchange files and documents with healthcare providers; 

receive follow-up messages from healthcare providers;

receive and pay medical bills from healthcare providers; 

share and send health-related information to healthcare providers;

store, share, manage and forward your health history forms and other health-related information with healthcare providers; and

perform all of the above services on behalf of family members including a spouse and/or minor child managed under your account (collectively the "LMD Services").

Direct Services

In addition to providing LMD Services in which LMD is working on your behalf with your healthcare providers, LMD will also provide services that do not involve your healthcare provider in which your PHI is not shared with healthcare providers but instead used to:

provision and customize our web site, systems, and applications to provide LMD Services to you;

provide notifications, emails, follow-ups, and messages to you;

provide an appointment system including appointment requests, confirmations, notices, change, and status reports to you;

provide notices, display, or bring to your attention healthcare providers that we believe you may be interested in;

provide descriptions, details, pricing, and information regarding services you may use or have an interest in;

provide updates to you including provide you with updates and information about the LMD Services;

promote, market, or offer LMD and third party products and services to you;

conduct review and analysis for LMD or third parties for analytics and other business purposes including to; 

support development, programming, and design of the LMD Services; and

create de-identified information and then use and disclose this information in any way permitted by law, including to third parties in connection with their commercial and marketing efforts (collectively, the “Direct Services”).

Authorization

The purpose of this Authorization (“Authorization”) is to request your written permission to allow LMD to use and disclose your PHI in providing the Direct Services in accordance with the way our Privacy Policy manages your Non-PHI. In providing these Direct Services, LMD will not be working on your behalf with your healthcare provider. Therefore, when LMD relies on this Authorization, and uses PHI as described in this Authorization, it is not working as a Business Associate and the HIPAA requirements that apply to Business Associates will not apply to such uses.

If you e-sign this Authorization, you give your permission to LMD to retain your PHI and to use your PHI in the same way that you have agreed that your Non-PHI can be used and disclosed.

Redisclosure

If LMD discloses your PHI, LMD will require that the person or entity receiving your PHI agrees to only use and disclose your PHI to carry out its specific business obligations to LMD or for the permitted purpose of the disclosure (as described above). LMD cannot, however, guarantee that any such person or entity to which LMD discloses your PHI or other information will not re-disclose it in ways that you or we did not intend or permit. I understand that my medical and/or billing information could be re-disclosed and no longer protected by federal health information privacy regulations

Expiration

Your Authorization remains in effect until you provide written notice of revocation to LMD.

Revocation of Authorization

You have the right to revoke this Authorization at any time, except to the extent that LMD has already taken action based on the Authorization before revoked.

If you wish to revoke this Authorization, you must notify LMD by submitting a revocation through your membership page. Your decision not to execute this Authorization or to revoke it at any time will not affect your ability to use certain of the LMD Services. A Revocation of Authorization is effective after you submit it to LMD, but it does not have any effect on LMD's prior actions taken in reliance on the Authorization before revoked.

Once LMD receives your Revocation of Authorization, LMD can only use and disclose your PHI as permitted in LMD’s agreements with Your Healthcare Provider(s).

Your Revocation of Authorization does not affect LMD's use of your Non-PHI.

We will make available to Your Healthcare Provider(s), current and past, your agreement to or revocation of this Authorization. 

THIS FORM CONFIRMS THAT YOU (SPOUSE) HAVE READ AND AGREE TO THE FOLLOWING:

HIPAA Authorization: Disclosure of PHI to Third Parties

HIPAA Authorization: Use of PHI in Providing Our Services 

 

THIS FORM IS AN AUTHORIZATION TO DISCLOSE YOUR CHILD'S PROTECTED HEALTH INFORMATION.

In accordance with the Health Insurance Portability and Accountability Act (“HIPAA”), a parent, guardian, or other person acting in loco parentis (collectively, “parent”) is a personal representative of a minor child and can exercise the minor’s rights with respect to protected health information. This form confirms:

that you, are the parent of the minor child listed hereunder in your LMD account, 

that you have the authority to make health care decisions on behalf of your minor child;

that you, as the parent of the child listed hereunder in your LMD account, authorize LMD to use and share PHI in the delivery and performances of the LMD Services pursuant to the HIPAA Authorization.