26
end of this notice. Your request must state the specific restriction requested and to whom you
want the restriction to apply. We are not required to agree to these additional restrictions, except
we must agree not to disclose your health information to your health plan if the disclosure (1) is
for payment or health care operations and is not otherwise required by law, and (2) relates to a
health care item or service which you paid for in full out of pocket. If we agree to a restriction, we
will abide by our agreement (except in an emergency).
Confidential Communication:
You have
the right to receive certain communications confidentially. That means you can request that we
communicate with you by alternative means or to an alternative location by submitting a request
to us in writing using the information listed at the end of this notice. We will accommodate your
request if it is reasonable and specifies the alternative means or location. We may also condition
this accommodation by asking you for information as to how payment will be handled.
Amendment:
You have the right to amend your health information in our records for as long as
we maintain the information. You must make a request in writing, using the information listed
at the end of this notice, to obtain an amendment. Your written request must explain why the
information should be amended. If we agree to amend your health information we will make
reasonable efforts to inform others of the amendment and to include the changes in any future
disclosures of that information. We may deny your request if, for example, we determine that your
health information is accurate and complete. If we deny your request, we will send you a written
explanation and allow you to submit a written statement of disagreement to be appended to the
information you want amended.
Paper Notice:
If you receive this notice electronically you are entitled to receive this notice in
written form. Please contact us using the information listed at the end of this notice to obtain this
notice in written form.
Breach:
You have the right to be notified if you are affected by a breach of unsecured health
information.
QUESTIONS AND COMPLAINTS
If you want more information about our privacy practices or have questions or concerns, please
contact us using the information listed at the end of this notice. If you are concerned that we may
have violated your privacy rights, or you disagree with a decision we made about your rights to
your health information you may complain to us using the information listed at the end of this
notice. You may also complain to the U.S. Department of Health and Human Services. We support
your right to protect the privacy of your health information. We will not retaliate against you in
any way if you choose to file a complaint with us or with the U.S. Department of Health and
Human Services.
CONTACT INFORMATION
BioTelemetry, Inc.
Privacy Officer
1000 Cedar Hollow Road, Suite 102
Malvern, PA 19355
Telephone: 610.729.7000
Email: [email protected]
Update Effective date: August 30, 2017
I CERTIFY THAT I UNDERSTAND AND AGREE TO THE FOREGOING TERMS AND TO THE
FOLLOWING
STANDARD TERMS AND CONDITIONS.
1. Use of Cardiac Monitoring System (“System”) and access to and use of Monitoring Service
(“Service”). Subject to Patient’s compliance with the terms and conditions indicated within this
Patient Education Guide (the “Agreement”), BioTelemetry hereby grants Patient a personal,
nonexclusive, nontransferable license to use the System and to access and use the features
and functions of the Service solely for purposes of monitoring Patient’s heart rate as prescribed
by Patient’s physician. Patient expressly acknowledges and agrees that the Service, which is
available only by physician prescription, is used solely to assist physicians in diagnosis and
treatment, and is not intended for use as an emergency response system for patients who
may experience serious or life-threatening medical problems. Patient is aware that cell phone
coverage limitations and delays in land-line telephone communications could significantly delay
transmission and analysis of patient monitoring data. Patient agrees to contact BioTelemetry
immediately if problems are experienced using the system or if signs of physical discomfort
occur, and to discontinue use of the system if the physician or BioTelemetry believe service
discontinuation is advisable. Patient shall not, in whole or in part, sublicense, provide access
to, tamper with, modify, distribute, use in a service bureau or time-sharing capacity, export in
violation of applicable laws and regulations, rent, loan, transfer, disassemble, or reverse engineer
or create a derivative work of the System or Service. Patient shall not, in whole or in part, transfer
or assign this Agreement or any right granted hereunder, except upon the prior written consent
of BioTelemetry. Any prohibited transfer or assignment shall be null and void. Subject to the
licenses granted herein, as between BioTelemetry and Patient, BioTelemetry holds all right, title
and interest in and to the System and the Service including, without limitation, any patents,
trademarks, trade secrets, copyrights or other intellectual property rights therein. BioTelemetry
reserves all rights not expressly granted to Patient under this Agreement.
2. Term and Termination. This Agreement shall commence on the date that BioTelemetry accepts
Patient’s enrollment hereunder, and shall continue until terminated by either party as set forth
herein. Either party may terminate this Agreement, for any or no reason, upon thirty (30) days’
written notice to the other party, except that this Agreement shall immediately terminate if Patient
breaches Paragraph 1 above. Upon any termination of this Agreement, Patient shall immediately
discontinue all use of the Service, and shall promptly return the System to BioTelemetry. The
limitations in Paragraph 1, and Paragraphs 3-6 shall survive any termination of this Agreement.
3. NO WARRANTY. THE SYSTEM AND THE SERVICE ARE PROVIDED BY BIOTELEMETRY
HEREUNDER SOLELY ON AN “AS-IS” AND “AS AVAILABLE” BASIS WITHOUT WARRANTY OF
ANY KIND. TO THE MAXIMUM EXTENT PERMITTED UNDER APPLICABLE LAW, BIOTELEMETRY
HEREBY DISCLAIMS ANY AND ALL WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, INCLUDING,
BUT NOT LIMITED TO, ANY WARRANTY OF MERCHANTABILITY, FITNESS FOR A PARTICULAR
PURPOSE, TITLE, NON-INFRINGEMENT AND/OR QUIET ENJOYMENT, AS WELL AS ANY IMPLIED
WARRANTIES OTHERWISE ARISING OUT OF COURSE OF DEALING, COURSE OF PERFORMANCE
OR TRADE USAGE. PATIENT FURTHER ACKNOWLEDGES AND AGREES THAT BIOTELEMETRY
SHALL NEITHER BE RESPONSIBLE NOR LIABLE FOR PATIENT’S INABILITY TO ACCESS OR USE
THE SERVICE AS A RESULT OF ANY DEFICIENCY IN THE INTERNET, THE TELEPHONE SERVICE,
OR OTHER CONNECTION BETWEEN BIOTELEMETRY AND PATIENT. PATIENT EXPRESSLY
ACKNOWLEDGES AND AGREES THAT NEITHER THE SYSTEM, NOR THE SERVICE (AS WELL AS
ANY SUPPORT GIVEN BY ANY BIOTELEMETRY SUPPORT STAFF), NOR ANY MATERIAL AVAILABLE
THROUGH PATIENT’S USE OF THE SYSTEM OR SERVICE IS INTENDED TO PROVIDE PATIENT
WITH MEDICAL ADVICE, A DIAGNOSIS OR TREATMENT. PATIENT MUST ALWAYS SEEK THE
ADVICE OF PATIENT’S PHYSICIAN OR OF ANOTHER QUALIFIED MEDICAL PRACTITIONER WITH
ANY QUESTIONS PATIENT MAY HAVE REGARDING A SPECIFIC
MEDICAL CONDITION OR PERCEIVED CONDITION.
4. LIMITATION OF LIABILITY. TO THE MAXIMUM EXTENT PERMITTED UNDER APPLICABLE
LAW: (I) IN NO EVENT SHALL BIOTELEMETRY OR ITS SUBSIDIARIES, AFFILIATES, OFFICERS,
DIRECTORS, EMPLOYEES AND AGENTS, ITS LICENSORS OR SUPPLIERS BE LIABLE TO PATIENT
FOR ANY INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL OR PUNITIVE DAMAGES ARISING
OUT OF OR RELATED TO THIS AGREEMENT INCLUDING, WITHOUT LIMITATION, LOST PROFITS,
COSTS OF DELAY, ANY FAILURE OF DELIVERY, BUSINESS INTERRUPTION, COSTS OF LOST
OR DAMAGED DATA, UNAUTHORIZED DISCLOSURE TO OR ACCESS OF PATIENT DATA, OR
LIABILITIES TO THIRD PARTIES ARISING FROM ANY PERSONAL INJURY OR PROPERTY DAMAGE
CLAIM OR ANY OTHER TYPE OF CLAIM, EVEN IF BIOTELEMETRY HAS BEEN ADVISED OF THE
POSSIBILITY OF SUCH DAMAGES; AND, (II) IN NO EVENT SHALL BIOTELEMETRY’S AGGREGATE
LIABILITY UNDER THIS AGREEMENT EXCEED THE AMOUNT PAID BY PATIENT TO BIOTELEMETRY