MyDirectives

MyDirectives® HIPAA Notice

As part of your enrollment in MyDirectives®, ADVault, Inc. requests that you (the Patient) or your representative authorize the use and/or disclosure of certain Protected Health Information (as that term is defined under United States law at 45 CFR 164.501) between ADVault and hospitals and other medical treatment centers subject to the United States Federal Health Insurance Portability and Accountability Act of 1996, as amended (HIPAA), or to similar laws outside the United States of America.  Each of these entities is referred to below as a Covered Entity. The PHI may include advance medical directives and other indicators of the Patient's medical treatment goals, preferences and priorities (emergency, critical and advance care plans; medical proxies; living wills; do-not-resuscitate orders; and organ donation forms), as well as the Patient's identifying information linking the Patient to the PHI and/or information related to the Patient's current and future health care, medical history, treatment, or any other related information.  We may disclose the PHI either directly to the Covered Entity or indirectly across an electronic health record, personal health record, benefits verification, or health information exchange platform in which ADVault participates (these third parties are sometimes referred to as Business Associates under HIPAA). We request your authorization for the use and/or disclosure of such PHI for purposes of permitting ADVault to store and send to the Covered Entities and the Business Associates, as appropriate, and the Covered Entities and Business Associates to provide to ADVault, as well as to locate, retrieve, view and print, such documents and PHI to determine the Patient's medical treatment goals, preferences and priorities in a time of need. By enrolling in MyDirectives, either directly or with the help of a representative, and using either MyDirectives.com or MyDirectives MOBILE™, the Patient agrees as follows:

  • The Patient agrees that ADVault and the Covered Entities and Business Associates may disclose the Patient's PHI to each other only for purposes listed above.

  • Once the information above is released, the information may be subject to re-disclosure by ADVault or a Covered Entity or Business Associate and may not be protected under the privacy rules promulgated under HIPAA or similar laws outside the United States of America.

  • The Covered Entity or the Business Associate, as appropriate, will provide the Patient with a copy of the PHI for which this authorization is being sought upon the written request of the Patient.

  • The Covered Entity may not condition treatment, payment, enrollment, or eligibility for benefits (as applicable) on whether the Patient signs this authorization.

  • The Patient is voluntarily signing this authorization.

  • The Patient may print a copy of the signed authorization or request a copy from ADVault.

  • This authorization will remain in effect until it is revoked by the Patient and no further use or disclosure of the Patient's PHI is permitted to any Covered Entity or Business Associate beyond that date.

  • The Patient has the right to revoke this authorization at any time. The revocation must be in writing, and submitted to the following address: ADVault, Inc., P.O. Box 832624, Richardson, Texas 75083 United States of America.

  • Once this authorization is revoked, ADVault, the Covered Entities and the Business Associates will not use or disclose the PHI for the above-stated purpose except to the extent that ADVault or a Covered Entity or Business Associate has already relied on the authorization.

(Version 2016.09.13)