HIPAA Marketing Authorization

HIPAA Marketing Authorization

I authorize BlendcareRx, LLC. (“BlendcareRx”) to use, and to disclose to other members of the BlendcareRx family of companies and to third parties with whom BlendcareRx partners, my information, including my name, age, other demographic information, phone number, e-mail address, and other contact information, treatment information and all prescription-related data on file with BlendcareRx and my pharmacy for the following purposes:

• Offer information, services, products, targeted advertising and other promotional and marketing content related to health and wellness that is tailored to my preferences;
• Send me health-related messages regarding treatment options or other health- related products or services, including but not limited to invitations to participate in adherence programs, educational information about my prescriptions, availability of additional vaccines (e.g., shingles, pneumococcal conjugate, seasonal influenza, routine childhood vaccinations), disease screening services, and availability of programs to manage particular health conditions (e.g., asthma, diabetes, heart disease);
• Communicate with me about BlendcareRx and its partners' products or services and to evaluate the effectiveness of any communication program.

I understand that BlendcareRx may receive direct or indirect remuneration for making such communications or disclosing such information to third parties.

I also understand that:

• Communications I receive under this Authorization may be made within the BlendcareRx mobile application, BlendcareRx's website, by text message, by email, social media, and/or direct mail.
• Any of my information disclosed pursuant to this Authorization may be subject to re-disclosure by the recipient and its confidentiality may no longer be protected by federal and state law.
• Granting this Authorization is voluntary, and my receipt of treatment or eligibility for health benefits will not be conditioned on whether I agree to this Authorization, and I will still be able to use the BlendcareRx's services as a registered user even if I do not sign this Authorization.

This Authorization shall remain in effect until revoked or three (3) years from the date signed, or such shorter period as required by state law, whichever occurs first.

I understand, as set forth in our Notice of HIPAA Privacy Practices, that I may revoke this Authorization at any time, except to the extent BlendcareRx has acted in reliance upon it, by:

• Emailing: [email protected]
• Mailing a written request to: BlendcareRx, Attn: Privacy Officer, 9521 town and country Blvd., Suite 100, Houston, TX. 77054 (and including my name, mobile phone number, and pharmacy name in the written request).

I can obtain a copy of this HIPAA Authorization on my “Account” page in the BlendcareRx mobile application.