Privacy Notice

PLEASE READ THE PRIVACY NOTICE CAREFULLY BEFORE USING THIS SITE.

I hereby authorize eNational Testing (“Company”), including its physicians, their staff, agents and designees, and affiliated physician network Cynergy Wellness (“Authorization Service”) as agent and administrative services provider and the laboratories that perform services requested by or consented to be me to use and disclose health information about me in the manner and for the purposes stated below.

This authorization applies to the use and disclosure of the following information about me: all information in requests(s) submitted by me or about me with my consent and the laboratory test values/results/information which are the result of the request(s) so submitted.

For avoidance of doubt, I specifically authorize the transfer and release of this information to, between and among myself and the following individuals, organizations and their representatives: (a) eNational Testing and its affiliates, their staff and agents; (b) Company and its affiliates, and their staff and agents (including Cynergy Wellness ; (c) the designated Company physician of record and its staff, agents and designees; (d) the applicable laboratory of record and its staff and agents; and (e) certain providers for the purposes herein, and as required or permitted by law.

The information which is the subject of this authorization will be used or disclosed for the following purposes:

1. To facilitate and execute the services requested by me or performed with my consent (including receiving, reviewing and approving a laboratory request; reviewing, processing and delivering the laboratory test value(s)/result(s)).
2. For treatment, health care operations and payment service
3. To provide me with information and materials on treatment alternatives, health related offerings and services and products which may assist me with health, wellness and overall care or be of interest to me.
4. To conduct statistical research studies, and as required or permitted under state and federal laws.

I may opt to not have my personal information disclosed for some purposes above with prior written notice to the Company as set forth below. I understand that such opt-out may affect the services I have voluntarily elected.

This authorization evidences my informed decision to allow release of the information to the parties referenced in this authorization. This authorization is effective immediately and will expire ten years after the date of this authorization.

I understand that I have a right to receive a copy of this authorization. I have the right to refuse to agree to this authorization in which case my refusal may affect the services provided to me. When my information is used or disclosed pursuant to this authorization, it may be subject to re-disclosure by the recipient and may no longer be protected by the federal HIPAA Privacy Rule.

Furthermore, the Authorization Service may provide access to your protected health information for additional purposes:

State and federal law may have more requirements on how we use and disclose your health information. If there are specific, more restrictive requirements, even for some of the purposes listed above, we may not disclose your health information without your written permission as required by such laws. We may also be required by law to obtain your written permission to use and disclose your information related to treatment for a mental illness, developmental disability, or alcohol or drug abuse. We may do this without your written permission for the following limited purposes:

1. Treatment
2. Payment
3. Required by Law
4. Public Health
5. Reporting Victims of Abuse or Neglect
6. Health Care Oversight
7. Legal Proceedings & Law Enforcement
8. Death
9. Serious Threats to Health or Safety

We may also disclose any information that you provide to use or that is provided on your behalf. You have the right to request a restriction or limitation on the disclosure of such information as set forth below.

For questions, concerns, or to place a written request to inspect or copy the information that I have permitted to be used or disclosed, if permitted by law, contact eNational Testing and/or Cynergy Wellness using the contact information provided below: