Health data electronic transmission request

This will allow the third-party app to receive certain information about you including certain encounter, claims, and clinical data (collectively, “health data”) about you held by Aetna or certain of its government program health plan subsidiaries and affiliates (collectively, “Aetna”).

Before proceeding, please review this important information:

• You have this ability to direct Aetna to disclose your health data to third party apps for your convenience and as permitted and required by law.
• Aetna is not affiliated with and does not control or endorse any third-party apps or their developers.
• Aetna has no control over how a third party app may use or share your health data. Some third party apps may share your health data with other third parties.
• Aetna does not review or evaluate third party apps or their privacy or security practices with regard to your health data.
• Once your health data is disclosed, it is no longer protected by certain health privacy laws, such as the Health Insurance Portability and Accountability Act (“HIPAA”).
• The health data that a third party app may receive from Aetna is a limited set of claims data, encounter data, and certain clinical data maintained about you by Aetna as your health plan under parts of certain government programs, like Medicare or Medicaid. The health data that a third party app may receive from Aetna may include data Aetna may have about you as a member of one of its commercial health plans. The health data Aetna has may not reflect your complete medical history and should not be used as a substitute for your full, official health records or professional medical judgment. You should consult with your health care provider before making any decisions related to your health.
• Please note that later terminating a third party app’s access to your health data in your Aetna account only prevents the app from continuing to receive your health data from Aetna. It does not determine what the app or its developer may do with health data it has already received from you.

By clicking “Allow Access” below, you agree to the following statements:

1. I understand that I (or my personal representative) have the right to direct Aetna to disclose my encounter data, claims data, and clinical data (collectively, health data) held by Aetna to a designated third party, including a third-party application that holds information for my personal use.
2. I authorize Aetna to disclose my health data from any Aetna-affiliated plan to the third party app electronically on an ongoing basis, in accordance with my right to access my health data under HIPAA. I understand that this health data may include sensitive information.
3. I acknowledge that there may be privacy and security risks to my health data once it has left Aetna's systems and that the use and disclosure of my health data may no longer be protected by federal and/or state law.
4. I understand that this request is valid on an ongoing basis until I revoke it.
5. I agree to the Allina Health | Aetna Web and Mobile Terms of Use and Privacy Policy.