I further understand and acknowledge that the manner in which HealthLynked protects my personal information is detailed in the HealthLynked Privacy Policy and the HealthLynked Terms of Use. I understand that the information submitted to my HealthLynked account is subject to the privacy and security protections of applicable Federal and State laws. Pavani Reddy Pingle and my HealthLynked Account.ДЇor Authorized Representatives of Patients younger than 18 years old: This Authorization shall expire upon the earliest of: (1) the date the minor reaches the age of 18 or (2) the date HealthLynked receives written revocation from the minor, as an emancipated minor with legal authority to manage his/her own healthcare. This authorization shall end upon the earliest of: a) the termination of the connection between my healthcare Dr. I understand that I may delete my HealthLynked account any time. However, I acknowledge that data previously submitted by Dr.Pavani Reddy Pingle as authorized by me prior to my subsequent revocation of this Authorization will remain in my HealthLynked account. Pavani Reddy Pingle as a health care provider with which I want to be connected on my HealthLynked account. I may revoke this Authorization by unlinking or removing access for Dr. Such revocation will take effect immediately to the extent that my doctor has already acted based on this Authorization. I may revoke this authorization at any time. Pavani Reddy Pingle will not electronically release my healthcare informat io n to my HealthLynked PHR. However, without this Authorization, my Dr. Pavani Reddy Pingle may, within its discretion, withhold from disclosure any of the above information as permitted or required by law.ДЄccess to treatment or services may not be denied to me if I decline to sign this Authorization or revoke my Authorization. Pavani Reddy Pingle has received about me from other healthcare practices, providers or facilities.

Pavani Reddy Pingle may disclose any information or records (within the scope of the authorization) that Dr. I acknowledge that with this authorization Dr. I acknowledge that such healthcare information may include information regarding mental health screenings and/or treatment, including psychotherapy notes HIV/AIDS, infectious disease, sexually transmitted infection testing, screening, diagnosis, and/or treatment genetic testing history of domestic violence, child abuse, and/or family abuse and, substance/ alcohol use and treatment history. I acknowledge that such healthcare information may include the following: xВ rays, clinical diagnosis, histories of present illnesses, immunizations, allergies, prescription drug information, laboratory results, diagnostic screening and testing, clinical procedures, medical research, clinical trials, billing, account, and insurance information. Pavani Reddy Pingle to release any and all healthcare information about me to my HealthLynked personal health record (PHR) for my own uses and purposes.

Healthlynked Authorization Release of Information

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