December 21, 2018
Obtaining Your Consent
You and your physician have made a treatment decision involving a high cost medication which requires reimbursement support and/or other patient support services. In order for HepCURE to provide you such services, we require your consent to have your physician disclose your Information to us by fax or electronic submission.
Information About You
Information We Collect
“Personal Information” means any information which can be used to identify a person including by way of example, but not limitation, name, date of birth, mailing address, phone number, e-mail address, credit card information, and/or social insurance number.
“Personal Health Information” means any information of a person related to health or medical status, including, by way of example, but not limitation, names of doctors, health conditions, medicines, and/or prescription information and history, paired with Personal Information.
The following are examples of the types of uses and disclosures of your Information as permitted once you have you have provided consent. These examples are not meant to be exhaustive, but are intended to describe the types of uses and disclosures that may be made by our staff once you have provided consent.
Treatment: We will use and disclose your Information to provide, coordinate, or manage your health care and any related services. For example, we may disclose Information to physicians and their staff who may be treating you and as required to obtain or renew a prescription. In addition, we may disclose your Information from time-to-time to your pharmacy or other health care providers who, at the request of your physician, become involved in your care by providing assistance with your treatment.
Payment: Your Information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for health care services, such as, making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a prescription may require that your relevant Information be disclosed to the health plan to obtain approval for your medication.
We may be required to disclose Information if we are informed of an adverse event/side effect relating to your medication(s), in which case we may be required to disclose such information to your physician and their staff and bodies such as, but not limited to, Canadian and/or international regulatory authorities. Information disclosures to such parties may involve the storage or processing of personal information outside of Canada (including in the United States) where local privacy laws may require the disclosure of Information to governmental authorities under circumstances that are different than those that apply in Canada.
We reserve the right to share statistical information regarding the use of support services and funding outcomes at our sole discretion provided that the information is non personally identifiable.
Any additional use of Information other than outlined above will be communicated either orally or in writing, before or at the time of collection and consent shall be obtained and documented for its intended purpose.
Third Party Websites
Links to third-party websites from our Sites are provided for the convenience of the user. We have no control over, and therefore have no responsibility or liability for, the manner in which the organizations that operate such linked websites may collect, use, disclose or otherwise treat your Information. The inclusion of any links on our Sites does not imply our endorsement of any other organization, its websites, or its products and/or services. These linked websites have separate and independent privacy policies, which we recommend you read carefully.
Protection Of Information
Our Commitment to Security
We take your privacy and security seriously. Our Sites use security measures that we believe are reasonably designed to protect against the loss, misuse, and alteration of the Information under our control. Information is stored in restricted access, secured databases and only our staff or other authorized personnel supporting your enrollment or services are authorized to have access to our databases. We employ security measures consistent with industry-standard encryption.
We comply with applicable Canadian privacy laws, including the Personal Information and Electronic Documents Act.
To Contact Us
You may contact us at any time to review your Information to ensure it is accurate and complete. Consent is voluntary and may be withdrawn at any time by sending us a written request. Cancellation will be in effect upon receipt of a written request and any further collection, use and disclosure of your Information will cease.
C/O Privacy Officer
PO Box 60054
Queen Beverley PO
Toronto, ON M5V 0C5