As well as, outside individuals or entities that have a need to access this information to perform functions on behalf of Optimize Today's Wellness Therapy Solutions, INC. and its affiliates (for example, insurers, legal advisors, data storage companies We recognize that some of those who receive protected health information may not have to satisfy the privacy requirements that we do and may re-disclose it, so we share this information only if necessary and we use all reasonable efforts to request that those who receive it take steps to protect your privacy.
How long will protected health information about me be used or shared with others? There is no scheduled date for your health information that is being used or shared for this research to be destroyed, because research is an ongoing process, during which information may be analyzed and re-analyzed in light of scientific and medical advances, or reviewed for quality assurance, oversight or other purposes.
Statement of privacy rights: - You have the rights to withdraw your permission for the researchers and participating with entities to use or share your protected health information. We will not be able to withdraw all of the information that already has been used or shared with others to carry out related activities such as oversight, or that is needed to ensure the quality of the study. If you want to withdraw your permission, you must do so in writing by contacting Optimize Today's Wellness Therapy Solutions, INC. - You have the right to choose not to sign this form. If you decide not to sign, you cannot participate in this research study. However, refusing to sign will not affect your present or future care and will not cause any penalty or loss of benefits to which you are otherwise entitled. - You have the right to request access to your protected health information that is used or shared during your treatment or payment for your treatment, but you may access this information only after the study is completed. - You have the right to receive a copy of this form after you have signed it.
/ have read this form and all my questions about this form have been answered. By signing below, / acknowledge that / have read and accept
Yo confirmo haber recibido información de la notificación de normas de privacidad del profesional mencionadas anteriormente y que he tenido la oportunidad de leerlo y entenderlo. Este consentimiento es requerido por la ley gubernamental.