AUTHORIZATION FOR MARKETING COMMUNICATIONS
- As a registered user of the LymphCare Site (“Site”), I authorize LymphCare GmbH (“LymphCare”) and any healthcare provider user on the Site that I authorize (“Healthcare Provider User”) to use or disclose the information as described below.
- The type and amount of information to be used or disclosed is as follows: first and last name, date of birth, and email address.
- This information may be disclosed to and used by LymphCare and its affiliates, WHICH INCLUDE BSN MEDICAL. THE BSN MEDICAL FAMILY OF PRODUCTS INCLUDES ALL JOBST PRODUCTS, AMONG OTHERS. THE FOREMENTIONED INFORMATION MAY ALSO BE SHARED WITH AND USED BY PATIENT-AUTHORIZED Healthcare Provider Users or THEIR subcontractors.
- I understand that this information is being used and disclosed for marketing purposes in order to provide me with information about various products or services from lymphcare and bsn medical. I understand that a Provider may receive direct or indirect remuneration from a third party for communicating with me about these products and services.
- I understand that I have the right to revoke this authorization at any time. I understand that in order to revoke this authorization, I must do so by using the “profile” features of the Site. I understand that the revocation will not apply to information that has already been released in response to this authorization.
- Unless otherwise revoked, this authorization will expire five years from the date the authorization was signed.
- I understand that once the information is disclosed pursuant to this authorization, it may be re-disclosed by the recipient and the information may not be protected by federal privacy regulations.
- I understand that I can print a copy of this signed authorization.
- I understand that a Healthcare Provider User may not condition treatment on whether I sign this authorization.