Information covered
This authorization covers information reasonably needed to provide the service, including identity and contact details, test orders, specimen identifiers, laboratory results, clinical notes related to interpretation, payment status, and fulfillment communications.
Who may use or disclose it
Intrinsic Prism, ordering clinicians, laboratories, fulfillment providers, payment processors, technology vendors, and other authorized service providers may use or disclose the minimum necessary information to perform testing, return results, coordinate care, process payment, support you, and operate the service.
Purposes
Permitted purposes include eligibility review, test ordering, specimen processing, result delivery, clinical interpretation, customer support, payment, quality assurance, legal compliance, security, and healthcare operations where applicable.
Redisclosure
Information disclosed to a recipient may no longer be protected by the same privacy law in every circumstance, though contractual and other legal safeguards may still apply.
Expiration
This authorization remains effective while needed to complete the requested service and for the record-retention period required by applicable law and operational obligations.
Your rights
You may request a copy of this authorization and may revoke it in writing for future uses, except to the extent action has already been taken in reliance on it or retention is required by law.
Voluntary signature
Signing is voluntary, but Intrinsic Prism may be unable to arrange testing or return results without the permissions needed to provide the service.