Consent for the use of health information
I hereby give my consent for the use of my personal health information to Meru Health Inc. and employees of Meru Health Inc., healthcare professionals working with my treatment, in order to implement my personal healthcare. Information concerning my health will be handled solely in order to organize and provide treatment in the Meru Health service. This consent covers all of my information recorded in the patient register of Meru Health as well as any information registered after giving this consent. This consent is valid until further notice, and I can revoke it at any time by contacting firstname.lastname@example.org.
In addition, I give my consent for the referring healthcare professional to receive information about the progress of my treatment and for transferring my personal and health information to the referring professional. Any information will be shared solely with the healthcare professional who issued my referral.
If you so please, you can prohibit sharing specific information by contacting email@example.com.
The consent granted here is mandatory for you to use this Service. Giving your consent to process your patient information is a necessary precondition to use this Service, since the purpose of this Service is to provide specific treatment and support for sustaining health as part of the healthcare of the patient. If you revoke your consent, you will no longer be able to use this Service.
Meru Health, Inc. | 470 Ramona St. | Palo Alto, CA 94301