HIPAA Marketing Authorization
I authorize NimbleRx, Inc. (“NimbleRx”) to use, and to disclose to other members of the NimbleRx family of companies and to third parties with whom NimbleRx partners, my information, including my name, age, other demographic information, phone number, e-mail address, and other contact information, treatment information and all prescription-related data on file with NimbleRx and my pharmacy for the following purposes:
- Offer information, services, products, targeted advertising and other promotional and marketing content related to health and wellness that is tailored to my preferences;
- Send me health-related messages regarding treatment options or other health-related products or services, including but not limited to invitations to participate in adherence programs, educational information about my prescriptions, availability of additional vaccines (e.g., shingles, pneumococcal conjugate, seasonal influenza, routine childhood vaccinations), disease screening services, and availability of programs to manage particular health conditions (e.g., asthma, diabetes, heart disease);
- Communicate with me about NimbleRx and its partners’ products or services and to evaluate the effectiveness of any communication program.
I understand that NimbleRx may receive direct or indirect remuneration for making such communications or disclosing such information to third parties.
I also understand that:
- Communications I receive under this Authorization may be made within the NimbleRx mobile application, NimbleRx’s website, by text message, by email, social media, and/or direct mail.
- Any of my information disclosed pursuant to this Authorization may be subject to re-disclosure by the recipient and its confidentiality may no longer be protected by federal and state law.
- Granting this Authorization is voluntary, and my receipt of treatment or eligibility for health benefits will not be conditioned on whether I agree to this Authorization, and I will still be able to use the NimbleRx’s services as a registered user even if I do not sign this Authorization.
This Authorization shall remain in effect until revoked or three (3) years from the date signed, or such shorter period as required by state law, whichever occurs first.
I understand, as set forth in our Notice of HIPAA Privacy Practices, that I may revoke this Authorization at any time, except to the extent NimbleRx has acted in reliance upon it, by:
- Emailing: firstname.lastname@example.org
- Mailing a written request to: NimbleRx, Attn: Privacy Officer, 2317 Broadway, Suite 100, Redwood City, CA. 94062 (and including my name, mobile phone number, and pharmacy name in the written request).
I can obtain a copy of this HIPAA Authorization on my “Account” page in the NimbleRx mobile application.