HIPAA
HIPAA Release Authorization
Authorize InnovaRx Inc to release your protected health information (PHI) to the people or organizations you designate. Your signed authorization is sent securely to our care team.
About this authorization
By signing this authorization, you allow InnovaRx Inc to use and disclose the protected health information (PHI) described below to the person(s) or organization(s) you identify, for the purpose you specify.
You may revoke this authorization at any time by submitting a written request to our Privacy Official, except to the extent we have already acted in reliance on it. Information disclosed under this authorization may be re-disclosed by the recipient and may no longer be protected by federal privacy regulations. You are not required to sign this authorization to receive treatment.
Unless you specify otherwise, this authorization expires one year from the date signed.