Compass Health

Authorization

I hereby authorize Health Compass, LLC (“Compass Health”), its employees, care coordinators, contractors, and affiliated network specialist physicians to access, use, and disclose my Protected Health Information (PHI) as permitted under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Compass Health may act as a care coordination service and, where applicable, as a Business Associate to certain covered healthcare entities under HIPAA.

Authorized Uses and Disclosures

I authorize Compass Health to access, use, and disclose my PHI for the following purposes:

• Treatment, payment, and healthcare operations
• Coordinating care among multiple specialist providers
• Facilitating referrals and cross-specialty consultations
• Sharing relevant medical information to ensure seamless care coordination
• Maintaining electronic health records accessible only to authorized providers
• Communicating care recommendations and treatment plans between providers

Compass Health will make reasonable efforts to limit the use and disclosure of PHI to the minimum necessary to accomplish the intended purpose, in accordance with HIPAA requirements.

Information Authorized for Disclosure

This authorization includes, but is not limited to:

• Medical history and diagnoses
• Current and past medical conditions
• Medications, allergies, and immunizations
• Laboratory results, imaging, and diagnostic testing
• Treatment plans and provider recommendations
• Other health information reasonably necessary for coordinated care

Purpose of Disclosure

The purpose of this authorization is to:

• Provide coordinated specialist care
• Facilitate referrals and continuity of care
• Enable Compass Health’s expedited access guarantee
• Support integrated care planning across providers

Nothing in this authorization guarantees specific medical outcomes, diagnoses, or treatment results.

Expiration & Revocation

This authorization remains in effect until revoked by me in writing. I understand I may revoke this authorization at any time by submitting written notice to Compass Health. Revocation will not apply to information already used or disclosed in reliance on this authorization.

Authorization

I authorize Compass Health to act as my healthcare advocate and authorized representative for administrative and care coordination purposes.

Authority Granted

This consent authorizes Compass Health to:

• Schedule appointments with network specialists
• Coordinate care between multiple providers
• Access and review my medical records from other healthcare providers
• Facilitate communication between specialists

Limitations of Authority

I understand and agree that:

• Compass Health does not provide medical advice, diagnosis, or treatment
• Compass Health does not replace my relationship with licensed healthcare providers
• This authorization does not create a medical agency, power of attorney, or fiduciary provider relationship
• Medical decisions remain solely between me and my licensed providers

Expiration

This authorization remains valid until revoked in writing.

Authorization

I authorize Compass Health to coordinate my care across its network of specialist providers, including:

• Cross-specialty consultations and second opinions
• Integrated treatment planning across multiple specialties
• Medication management coordination and interaction monitoring
• Emergency and urgent care coordination with priority access

I understand that Compass Health facilitates coordination but does not provide direct clinical care.

Electronic Communications Authorization

I consent to receive healthcare-related communications from Compass Health via:

• Secure patient portal messaging and notifications
• Email communications for appointment reminders and care updates
• Text/SMS messages for urgent communications and reminders
• Marketing information and communication

I understand that secure systems are used whenever available. I also acknowledge that certain communication methods (such as email or SMS) may carry minimal privacy risks. I may update my communication preferences or opt out of non-essential communications at any time.

Authorization

I authorize Compass Health to provide priority care coordination during emergency or urgent medical situations, including:

• Immediate coordination with network specialists
• Communication with emergency departments and hospital-based providers
• Sharing relevant medical information with emergency care teams

I understand and agree that Compass Health does not provide emergency medical services and is not a substitute for calling 911 or seeking immediate emergency care.

Acknowledgment

I acknowledge that I have:

• Read and understand the Compass Health Membership Agreement
• Reviewed and received the Notice of Privacy Practices
• Had access to all documents prior to signing
• Had the opportunity to ask questions

I understand that Compass Health’s services are administrative and coordination-based and do not constitute medical care.