CPC is dedicated to protecting your privacy. This Policy/Agreement applies to personally identifiable information that is collected through the use of CPC’s Kiosk and affiliated websites: Hearthealthyliving.com and Heartcheckcenter.com
I. INFORMATION COLLECTION AND DATA SHARING POLICY DISCLAIMER
Authorization to Use or Disclose Information for Member Engagement
CPC Consumer (Consumer) hereby authorizes CPC to use or disclose the Protected Health Information (PHI) listed below, collected by CPC through registration or as part of the Consumer’s request to submit health assessment information to_________:
CPC seeks to disclose this Protected Health Information to ________________ as a service to and on behalf of __________, pursuant to its agreement with ________. This information will not be used for underwriting purposes. Consumer further understands and acknowledges that CPC is receiving financial renumeration from _________, in exchange for the above-referenced information.
By inputting any of my Protected Health Information into this Kiosk or affiliated websites, Consumer understand and agree that Consumer may be contacted by either CPC or ___________________ and/or its employees, agents or representatives, regarding _______’s services.
Consumer hereby acknowledges that he/she understands that treatment, payment, enrollment in any health plan, or eligibility for benefits is not conditioned on his/her signing of this Authorization.
Consumer is entitled to a copy of this Agreement and the information to be used or disclosed. The Agreement is available at Heartcheckcenter.com or Hearthealthyliving.com. The information used or disclosed will be available via a request form on the previously mentioned web address. Consumer may refuse to sign this Agreement if he/she so chooses.
This Agreement shall be effective on the date of CPC Kiosk visit and shall remain valid for one year unless a State or Federal Law requires otherwise.
At all times, Consumer retains the right to revoke this Agreement. Such revocation must be submitted to CPC in writing. The revocation shall be effective except to the extent that CPC has already used or disclosed information in reliance on the Agreement. Consumer may revoke this Agreement by sending a written notice to:
Cardinal Pointe Communications, Inc., 1564 Eagle Ridge Ct., Lakeland, FL 33813
Consumer understands and agrees that use of this Kiosk or aforementioned websites does not create a physician-patient relationship with CPC, ______, and/or any of their staff.
Consumer understands and agrees that this technology does not provide a diagnosis of any kind. The results may be incorrect. The results are not necessarily evidence of any disease or condition. The results are being provided for personal information and use only.
By using this Kiosk or affiliated websites, Consumer agrees to waive and release CPC, _____ and its staff from any and all claims or causes of action for damages or injury that Consumer now has or may hereafter acquire which in any way arise out of Consumer’s input of Protected Health Information, participation with the screening tool, or the results of any risk assessment, health quiz, and/or health screening offering provided in connection herewith.
Consumer has been informed and understands that information used or disclosed pursuant to this Authorization may be subject to re-disclosure by the recipient of such information, and, at that point, the information may no longer be protected under the terms of this Agreement.
The Cardinal Pointe kiosk network is designed to collect user information for marketing lead generation purposes. The data collected contains private information such as name, email, address, date of birth, height, weight, gender, etc. Additional data collected pertains to health-related information such as blood pressure results and BMI results which are maintained independently from personally identifiable data. All data collected at each kiosk in the Cardinal Pointe network is automatically securely transmitted via SSL to Microsoft’s Azure Cloud server service where it is stored in Cardinal Pointe databases subject to the security inherent within the Microsoft Azure Cloud service. Due to the sensitive nature of the private information, all user identifiable information is also encrypted as an additional layer of security in the Cardinal Pointe database so that data inspection cannot be viewed or accessed without proper keys and credentials.
I HAVE READ AND UNDERSTAND THIS INFORMATION. I HAVE RECEIVED A COPY OF THIS AGREEMENT [OR I UNDERSTAND I AM ENTITLED TO A COPY OF THIS AGREEMENT]. I AM THE CONSUMER OR AM AUTHORIZED TO ACT ON BEHALF OF THE CONSUMER TO SIGN THIS FORM VERIFYING AUTHORIZATION FOR THE USE OR DISCLOSURE OF THE PROTECTED HEALTH INFORMATION UNDER THE ABOVE STATED TERMS.
I. DATA SHARED REQUESTS
In order to receive the information that we have shared on your behalf, please email CPC at firstname.lastname@example.org. Please include as much information as necessary for us to provide you with the exceptional support you are requesting. Items that you can include to facilitate a much faster response are (Name, Location of Kiosk, Day of Visit, etc.).
II. EFFECTIVE DATE
This Policy is effective as of October 1, 2019