This form is for use when such authorization is required and complies with the Health Insurance Portability and Accountability Act of 1996, as amended (HIPAA) Privacy Standards.
I authorize Hoot Health, Inc. and my health care provider (“Provider”) to use or disclose all of my health information for the following purpose:
My authorization expires when I terminate my access to the Hoot Platform, which I may do by sending an email to support@ hootmyopiacare.com.
I authorize Hoot Health, Inc. and my health care provider (“Provider”) to use or disclose all of my health information for the following purpose: