HIPAA Authorization
Last Updated: August 25, 2026
By signing (including electronically) this Authorization, you permit the entities below to use and disclose your Protected Health Information ("PHI") as described here:
1. Information to Be Used or Disclosed
The following PHI may be used or disclosed under this Authorization: information in your medical records, including contact and demographic information; information related to your care or treatment; medical and pharmacy records, including test results; and information about your receipt of health care services.
Specially protected information (initial or check to include, if applicable):
-
Substance use disorder information (protected under 42 CFR Part 2)
-
HIV/AIDS-related information
-
Genetic information / genetic test results
-
Mental or behavioral health information (excluding psychotherapy notes)
-
Reproductive health information
2. Purpose of the Use or Disclosure
Your PHI may be used and disclosed for:
-
Developing, improving, or offering health and wellness products, services, and technologies.
-
Communicating with you about products, services, or opportunities that may interest you.
-
Conducting or supporting research, including recruitment and maintaining research databases.
3. Who May Receive Your PHI
Your PHI may be disclosed to:
-
Entities conducting or sponsoring research.
-
Partners and vendors that help us develop, improve, and deliver services.
4. Additional Information You Should Know
-
Redisclosure. Information disclosed under this Authorization may be redisclosed by the recipient and may no longer be protected by HIPAA.
-
Voluntary. This Authorization is voluntary. We will not condition your treatment, payment, enrollment, or eligibility for benefits on whether you sign it.
-
Copy. You are entitled to a copy of this signed Authorization.
5. Expiration
This Authorization expires: one year from the date signed / when you are no longer a user of MG Health Tech services / at the end of the research study.
6. Right to Revoke
You may revoke this Authorization at any time by sending written notice to the address below. Your revocation will take effect when we receive it, except to the extent we have already acted in reliance on it.
Revocation notices to:
MG Health Tech
59/2M, Ayyarkadu, Erumaipatti, Edappadi, Salem - 637102, Tamil Nadu, INDIA
Phone: +91 96778 42031
E-mail: privacy@mghealthtech.com
Website: techgramam.com