HIPPA Compliant Consent Form
This is a HIPAA-compliant consent form for the use of written, oral, or video plan holder testimonials in marketing and promotion.

 

Consent for Use of Testimonials
 
Introduction
This consent form is provided by Advocate Health, LLC., to obtain your permission to use your written, oral, or video testimonials for marketing and promotional purposes. We are committed to complying with the Health Insurance Portability and Accountability Act (HIPAA) to protect your privacy and personal health information.
 
Personal Information and Testimonial Usage
 

Type of Information to be Used: Your testimonial, which may include your personal experiences, opinions, and outcomes related to our plan holder services.

Optional personal information: First Name, Last Name, Phone, Email, Location.
 

Purpose of Use: Your testimonial will be used for marketing and promotional purposes, which may include use on our website, social media platforms, printed materials, company documentaries, and other marketing channels.
 

How Your Information Will Be Used: Your testimonial may be edited for clarity or length but will remain true to the spirit of your original message.
 
We will not use your personal health information or disclose any details that may compromise your privacy without your explicit consent.
 
Consent and Authorization
By agreeing to this form, you: Grant Advocate Health LLC., have the right to use your testimonial as described above. Acknowledge that the use of your testimonial is voluntary, and you will not receive any financial or non-financial compensation. Understand that you may withdraw your consent at any time by notifying Advocate Health Advisors in writing.
 
Right to Withdraw Consent
You have the right to withdraw your consent at any time. Withdrawal will not affect any use of your testimonial made before the withdrawal.
 
Contact Information
If you have any questions, please contact us at John Lane, Omnichannel Marketing Manager, via email at john.lane@advocatehealthllc.com.