To ensure that PatientPing is only disclosing the minimum necessary amount of protected health information (“PHI”) through its delivery of the service, please complete the following.

Your use of the PatientPing Services includes, but is not limited to, access to the following PHI:

(1) Demographic information, including but not limited to, name; date of birth; gender; social security number; telephone number; and address.
(2) Attribution information including but not limited to attributed provider, program attribution, and/or practice information.
(3) Insurance information, including, but not limited to name of insurer and/or plan type.
(4) Program-level and/or patient-level care instructions, care directives, care plans, discharge summaries, and advanced clinical directives and/or POLSTs.
(5) Encounter information, including, but not limited to care event (admit, discharge, and transfer) information; allergy information; diagnostic information (including diagnostic codes); DRG codes; and other billing information.

For the avoidance of doubt, the above PHI may be displayed via the PatientPing Services on an individual or aggregated basis.

To the extent that your access to the PHI is not exempt from the HIPAA Privacy Rule’s “minimum necessary” standard at 45 C.F.R. § 164.502(b), you hereby certify that:
The above constitutes the minimum PHI reasonably necessary to accomplish the intended purposes of your treatment, payment, and/or health care operations activities;
If you receive notice that, or subsequently discover through your use of, the PatientPing Services have expanded to include additional PHI not included in the above description, and such PHI is not reasonably necessary to accomplish the intended purposes of your treatment, payment, or health care operations activities, you will immediately notify PatientPing, in writing; and
All Authorized Users for whom you have or will request or grant access rights to the PatientPing Service require access to the above PHI to perform their job duties.

By hitting accept, you hereby acknowledge and agree with the foregoing.