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APN Connection HIPAA Patient Authorization

If you would like to access and use the Community, please review and agree to the terms of this Patient Authorization.

IF YOU AGREE TO THE TERMS OF THIS PATIENT AUTHORIZATION, YOUR INFORMATION WILL NO LONGER BE PROTECTED BY HIPAA and 42 CFR Part 2.

PATIENT AUTHORIZATION

I authorize All Points North Lodge (“APN Lodge”) to use and disclose the information maintained in my profile of the APN Connection platform, which may contain my health, demographic, geolocation, and contact information (“My Profile Information”), to provide me with access and the ability to use and communicate with other APN Connection users via the platform’s Community functionality.  I understand that by consenting to this Authorization, the Notice of Privacy Practices will no longer apply to My Profile Information, and that any information I share with the Community (including profile information and communications made in the Community) is subject to the Community Privacy Policy and not the All Points North Lodge Notice of Privacy Practices.

I understand that consenting to this Authorization is voluntary and that I may refuse to sign this authorization by checking “I Do Not Agree to the terms of the Patient Authorization.”  APN Lodge may not condition treatment, enrollment or eligibility for benefits on my signing this Authorization.

I understand that I may revoke this authorization at any time by emailing privacy@apnlodge.com with my name and a request to revoke my Patient Authorization.  My revocation will be effective upon its receipt by APN Lodge.  My revocation will not be effective to the extent that APN Lodge has acted in reliance on this Authorization.  If I do not revoke this Authorization, it will expire after (2) years from the date I agree to this Authorization, whichever is sooner.  I understand that if my information is disclosed, it may be subject to redisclosure by the recipients and no longer protected by HIPAA.  I also understand that I am entitled to a copy of this Patient Authorization.

By checking “I Agree to the terms of the Patient Authorization” and clicking on “Submit,” I understand that I will be signing this Authorization.

  • I Agree to the terms of the Patient Authorization.

APN Lodge’s Notice of Privacy Practices may be viewed at [link].