AUTHORIZATION TO DISCLOSE
This screening website will allow you to confirm a recent negative COVID-19 test result or vaccination status and demonstrate this information to third parties.
To facilitate this confirmation, the website collects your COVID-19 status, and website use for the sole purpose of your receiving an
InHouse Physicians’ clearance pass, the essential information from you, which may include questions such as: First Name;
Last name; Date of Birth; Home Address; Zip Code; Race or Ethnicity; Associated Employer, School, Organization, etc.;
Phone Number; Email; vaccination location; vaccination type or COVID-19 test type; and vaccination date(s) or COVID-19 test date.
Based on this information, the application queries InHouse Physicians database through an interface and returns to you an active or inactive pass.
Your completion of this screening website results in the disclosure of personal information and constitutes your consent to the collection
and disclosure of such information by InHouse Physicians for the purposes of providing your COVID-19 test clearance and
vaccination status. Test results may be reported in compliance with government, state, and local requirements. Your name
and clearance or vaccination status you provide to, or is collected by, the website or application may be shared with your
affiliated organization. Your affiliated organization shall limit their use of their information solely to the purposes described,
with access only to your clearance status, with access only to the COVID-19 test clearance or vaccine clearance and not to
the underlying data.
The information you provide will be retained by InHouse Physicians only for the purposes described herein.
The information you provide may also be subject to any applicable privacy and security laws such as Freedom of Information
Law and Personal Privacy Protection Law. IHP may disclose personal information without applicant consent if the collection
or disclosure is: (1) necessary to perform the duties required or authorized by state or federal statute or regulation, (2) made
pursuant to a court order or by law; (3) for the purpose of validating the identity of the applicant; or (4) for the validation of
clearance to your affiliated organization as indicated in the “Employer, School, or Entity” submission field. Information
collected from you is not subject to disclosure for purposes other than those outlined above without your consent or
unless required by law.
- does not diagnose whether you or other individuals have a disease or other health conditions, including COVID-19, or identify personalized treatments;
- is not provided to you by a health care provider, so, as such, you are not providing protected health information for health care treatment, payment, or operations (as defined under Health Insurance Portability and Accountability Act (HIPAA);
By using this website, you are consenting to the disclosure of the information you have provided, consistent with the protections described above and solely for the purposes outlined above.
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