Thank you for sharing your experience and helping to educate, inspire, and encourage others who may face similar experiences. We’re proud to be a part of your journey, and honored to publish your story.
Unless I otherwise specify, the information described above may be disclosed to i-Health’s vendors and/or to the general public in connection with publicizing and promoting i-Health, including in print publications, multimedia presentations, television advertising, on websites and social media sites, in any other distribution media, and educational materials.
I understand that i-Health will not condition treatment, payment, enrollment or eligibility for benefits on whether I sign this authorization form.
I understand that I may revoke this authorization by sending a written request for revocation to i-Health’s Privacy Officer. If I revoke this authorization, i-Health will no longer use or disclose my medical information for the reasons covered by this authorization, except to the extent it has already relied upon this authorization. I understand that when i-Health discloses information pursuant to this authorization, the information may no longer be protected by federal or state privacy rules and may be subject to re-disclosure by the recipient of the information.
This authorization shall not expire unless requested by Patient or Patient Representative.
Twin Cities Orthopedics (TCO) is an operating division of Infinite Health Collaborative (i-Health). Infinite Health Collaborative (i-Health) is a group of local medical practices, independently owned and led by its physicians, with operating divisions representing several areas of expertise. Visit i-Health.com to view the practices that are a part of i-Health.
