Set forth below are: (i) a HIPAA authorization for USC to use and release your health information as described in the document; and (ii) a Terms and Conditions of Use and Disclaimer. Please read each document below carefully. You will be asked to sign the HIPAA authorization below, and also to agree to comply with and to the terms of the Disclaimer (this “Agreement” prior to participating in this health risk assessment (“Risk Assessment”).
USC HIPAA AUTHORIZATION TO USE HEALTH INFORMATION FOR HEALTH RELATED COMMUNICATIONS AND MARKETING ACTIVITIES
Purpose of this Authorization:
A federal law known as the Health Insurance Portability and Accountability Act (HIPAA) protects how your health information is used. HIPAA does not allow your health information to be used or released for certain purposes without your written permission. State laws also protect how your health information may be used.
USC is a nonprofit academic health care institution dedicated to providing teaching, research and high quality patient care. USC periodically contacts patients and others to inform them of programs, services and initiatives that may be of interest.
By signing this form, you are allowing USC to use and release the health information you disclose in the Risk Assessment for the marketing efforts described in this form.
How will my information be used?
This authorization permits USC clinical personnel and USC’s Public Relations Office (including its employees and agents) to use your demographic information, the name(s) of your treating physicians and health information you disclose in the Risk Assessment in order to include you on USC’s mailing lists and/or telephone solicitations and to use information about your health care, to identify USC programs and initiatives that are likely to interest you.
USC does not receive any compensation for sharing that information. USC will not provide this information to unrelated parties for their own marketing. USC will not sell patient lists to third parties for their own marketing activities. Specially protected information, such as HIV status, will not be used for marketing purposes without specific permission from you.
How long will this authorization be in effect?
This authorization will remain in effect for one (1) year from the date of signature. Once your authorization expires, we may need your signature again.
What if I don’t want to sign, or later change my mind?
Signing this form is entirely voluntary. If you don’t sign, this will not affect the commencement, continuation or quality of USC’s treatment of you, payment for that treatment, or your eligibility for benefits. If you change your mind at any time, you can revoke this authorization by providing a written notice of revocation to USC Office of Compliance at 3500 Figueroa Avenue, Suite 105, Los Angeles, CA 90089-8007, stating that you are revoking your authorization regarding marketing. It will be effective upon receipt.
Are the individuals who receive my health information pursuant to this authorization permitted to use or disclose it for other purposes?
No. USC policies and California law prohibit anyone who receives your health information pursuant to this authorization from using or re-disclosing it for other purposes except with your written authorization or as specifically required or permitted by law. Federal privacy protections are narrower and may not apply to everyone who receives your health information, but California law would still apply.
You may contact the Office of Compliance at 213-740-8258 or by email at email@example.com.
I have read and understand the terms of this authorization and I knowingly and voluntarily authorize USC to use such information for the purposes described above.
TERMS & CONDITIONS OF USE
By accessing, browsing and/or otherwise using this Risk Assessment, you acknowledge that you have read, understood and agree to be bound by these terms and conditions described here, and to comply with all applicable laws and regulations. If you do not agree to all of these terms and conditions, you may not access, browse, and/or use this Risk Assessment. The material provided in this Risk Assessment is protected by law, including, but not limited to, United States copyright law and international treaties.
These terms and conditions of use apply to your access to and use of this Risk Assessment only and do not alter in any way the terms and conditions of any other agreement you may have with USC for health services or otherwise.
This Risk Assessment is not designed or intended for minors. Minors under 18 years old are not permitted to use this Risk Assessment without the permission of a parent or guardian.
All Risk Assessment materials, including, without limitation, text, pictures, graphics, and other files and the selection and arrangement thereof are copyrighted materials of USC and/or its licensors, or by the original creator of the material. You may download the materials on this Risk Assessment for your use only and only for the purposes for which USC provided you access to the Risk Assessment, provided you do not modify the materials and that you do not remove any copyright and other proprietary notices contained in the materials. You may not, however, distribute, copy, reproduce, display, republish, download, or transmit any material on this Risk Assessment for commercial use without the prior written approval of USC. You may not “mirror” any material contained on this Risk Assessment on any other server without prior written permission from USC. Any unauthorized use of any material contained on this Risk Assessment may violate copyright laws, trademark laws, the laws of privacy and publicity and communications regulations and statutes.
The trademarks, service marks, trade names, and logos (the “Trademarks”) used and displayed on this Risk Assessment are registered and unregistered Trademarks of USC and/or its licensors. In addition, all page headers, custom graphics, button icons, and scripts are Trademarks, and/or trade dress of USC and/or its licensors. The Trademarks and trade dress may not be copied, imitated or used, in whole or in part, without the prior written permission of USC and/or its licensors. You acknowledge that the Trademarks and trade dress used and displayed on this Risk Assessment are and shall remain the sole property of USC and/or its licensors. Nothing in this Agreement shall confer to you any right of ownership of any of the Trademarks or trade dress. Further, nothing in this Risk Assessment shall be construed as granting, by implication, estoppel or otherwise any license or right to use any Trademark used or displayed on the Risk Assessment, without the express written permission of USC and/or its licensors. The misuse of the Trademarks displayed on this Risk Assessment, or any other content on the Risk Assessment, is strictly prohibited.
Except as otherwise expressly permitted by USC and/or its licensors, any access or attempt to access other areas of USC and/or its licensors’ computer system or other information contained on the system for any purpose is strictly prohibited. You agree that you will not use any robot, spider, other automatic device, or manual process to “screen scrape,” monitor, “mine,” or copy the pages on the Risk Assessment or the content contained therein. You will not spam or send unsolicited e-mail to any other user of the Risk Assessment for any reason. You agree that you will not use any device, software or routine to interfere or attempt to interfere with the proper working of the Risk Assessment. You agree that you will not take any action that imposes an unreasonable or disproportionately large load on USC and/or its licensors’ infrastructure. You further agree not to disseminate, store, or transmit viruses, Trojan horses or any malicious code or program or engage in any other activity deemed by USC to be in conflict with the spirit or intent of this Agreement. You agree that you will not use this Risk Assessment in violation of any local, state, federal, or non-United States law or regulation. You agree that you will not post on, or transmit through, this Site any material or content that is unlawful, harmful, threatening, abusive, harassing, defamatory, vulgar, obscene, profane, hateful or otherwise objectionable including, but not limited to, any material or content that may constitute a criminal offense, give rise to civil liability or otherwise violate any applicable law.
LINKS FROM AND TO THIS SITE
You acknowledge and agree that USC has no responsibility for the accuracy or reliability of information provided by linked sites. Links to external web sites do not constitute an endorsement by USC of the sponsors of such sites or the content, services, products, advertising or other materials presented on such sites. USC shall not be liable for any decision made or action taken by you or others based upon reliance on information or materials obtained through use of the information or content provided on the linked sites. Information on the web pages that are linked to this Site comes from a variety of sources. USC does not author, edit, or monitor these unofficial pages or links. You acknowledge and agree that USC shall not be responsible or liable, directly or indirectly, for any damage or loss caused or alleged to be caused by or in connection with use of or reliance on any such content, goods or services available on such external sites or resources.
THIS RISK ASSESSMENT DOES NOT PROVIDE A MEDICAL SERVICE OF ANY KIND. THE INFORMATION CONTAINED IN THE RISK ASSESSMENT IS FOR YOUR PERSONAL USE ONLY, AND IS NOT INTENDED TO DIAGNOSE, CURE, MITIGATE, TREAT, OR PREVENT DISEASE OR OTHER CONDITIONS AND IS NOT INTENDED TO PROVIDE A DETERMINATION OR ASSESSMENT OF YOUR STATE OF HEALTH. ALWAYS CONSULT A LICENSED HEALTHCARE PROFESSIONAL SUCH AS YOUR FAMILY PHYSICIAN OR YOUR SPECIALIST TO MAKE HEALTHCARE DECISIONS OR BEFORE STARTING ANY DIET OR EXERCISE PROGRAM. USC MAKES NO WARRANTIES, EXPRESSED OR IMPLIED, IN CONNECTION WITH THE RISK ASSESSMENT OR THE PERFORMANCE OF THE RISK ASSESSMENT, NOR SHALL USC’S LICENSORS OR USC BE HELD RESPONSIBLE OR LIABLE FOR ANY COSTS OR DAMAGES RELATED TO USE OF THE RISK ASSESSMENT OR ANY INFORMATION PROVIDED THEREFROM.
THIS RISK ASSESSMENT, INCLUDING ALL SOFTWARE, FUNCTIONS, MATERIALS, AND INFORMATION IS PROVIDED “AS IS” WITHOUT WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED. USC AND/OR ITS LICENSORS DISCLAIM ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, WARRANTIES OF QUIET ENJOYMENT AND NON-INFRINGEMENT AND IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, TITLE, DATA ACCURACY, AND INFORMATIONAL CONTENT. USC AND/OR ITS LICENSORS DO NOT WARRANT OR MAKE ANY REPRESENTATIONS REGARDING THE OPERATION OF THIS RISK ASSESSMENT, THE USE, VALIDITY, ACCURACY, OR RELIABILITY OF, OR THE RESULTS OF THE USE OF THE MATERIALS ON THIS RISK ASSESSMENT OR ANY OTHER SITES LINKED TO THIS RISK ASSESSMENT. USC AND/OR ITS LICENSORS DO NOT AND CANNOT GUARANTEE OR WARRANT THAT THE FILES AVAILABLE FOR DOWNLOADING FROM THIS RISK ASSESSMENT WILL BE FREE FROM INFECTION, VIRUSES, WORMS, TROJAN HORSES, OR OTHER CODE THAT MANIFEST CONTAMINATING OR DESTRUCTIVE PROPERTIES. USC AND/OR ITS LICENSORS DO NOT WARRANT THAT THIS RISK ASSESSMENT OR ITS SERVICES WILL BE UNINTERRUPTED OR ERROR-FREE OR THAT ANY DEFECTS IN THIS RISK ASSESSMENT OR ITS SERVICES WILL BE CORRECTED.
LIMITATION OF LIABILITY
TO THE MAXIMUM EXTENT PERMITTED BY LAW, IN NO EVENT WILL USC AND/OR ITS LICENSORS OR OTHER THIRD PARTIES MENTIONED IN THIS AGREEMENT BE LIABLE FOR ANY DAMAGES, INCLUDING, WITHOUT LIMITATION, DIRECT, INDIRECT, SPECIAL, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, OR EXEMPLARY DAMAGES OF ANY KIND, INCLUDING DAMAGES FOR LOST GOODWILL, LOST PROFITS, LOST BUSINESS OR OTHER INDIRECT ECONOMIC DAMAGES, DAMAGES RELATING TO THE USE OR INABILITY TO USE THIS RISK ASSESSMENT, THE MATERIALS OR OTHER INFORMATION CONTAINED IN THIS RISK ASSESSMENT, WHETHER SUCH DAMAGES ARISE FROM CLAIMS BASED ON WARRANTY, CONTRACTS, STATUTES, REGULATIONS, TORT (INCLUDING, BUT NOT LIMITED TO, NEGLIGENCE), OR ANY OTHER LEGAL THEORY AND WHETHER OR NOT ADVISED OF THE POSSIBILITY OF SUCH DAMAGES IN ADVANCE. SOME STATES DO NOT ALLOW THE EXCLUSION OR LIMITATION OF INCIDENTAL OR CONSEQUENTIAL DAMAGES, SO THE ABOVE LIMITATION OR EXCLUSION MAY NOT APPLY TO YOU.
No waiver of any term, provision or condition of this Agreement, whether by conduct or otherwise, in any one or more instances, shall be deemed to be, or shall constitute, a waiver of any other term, provision or condition hereof, whether or not similar, nor shall such waiver constitute a continuing waiver of any such term, provision or condition hereof. No waiver shall be binding unless executed in writing by the party making the waiver.
If any provision of this Agreement is determined to be illegal or unenforceable, then such provision will be enforced to the maximum extent possible and the other provisions will remain fully effective and enforceable.
This Agreement is made in and shall be governed and construed by the laws of the State of California, United States of America, without reference to conflicts of laws. If you access this site from locations outside California or the United States, you are voluntarily and purposefully availing yourself of the laws of the State of California, United States of America, and you are solely responsible for compliance with all your local laws. Access to the Site from locations where the Site’s contents may be unlawful is prohibited. All disputes arising under or in connection with this Agreement shall be submitted to Judicial Arbitration and Mediation Services, Inc. (“JAMS”) or successor organization for binding arbitration in Los Angeles County by a single arbitrator who shall be a former California Superior Court judge. The arbitrator shall be selected by JAMS in an impartial manner determined by it. Except as may be otherwise provided herein, the arbitration shall be conducted under the California Arbitration Act, Code of Civil Procedure 1280 et seq. The arbitrator shall have complete authority to render any and all relief, legal and equitable, appropriate under California law. The arbitrator shall award costs of the proceeding, including reasonable attorney’s fees, to the Party determined to have substantially prevailed. The captions and headings of this Agreement are included for ease of reference only and shall be disregarded in interpreting or construing this Agreement.
This Agreement constitutes the complete and exclusive statement of the agreement between the parties and supersedes any and all prior or contemporaneous communications, representations, statements and understandings, whether oral or written, between the parties.
REVISIONS TO THIS AGREEMENT
USC and/or its licensors may revise this Agreement at any time by updating this posting. By using this Risk Assessment, you agree to be bound by any such revisions and should therefore periodically visit this Site and page to determine the then current terms and conditions of use to which you are bound.