Authorization to Use and Disclose Protected Health Information
By checking the box below, you authorize GenericContacts.com ("Company") to use and disclose your protected health information (PHI), including your contact lens prescription, for the purposes of fulfilling your contact lens order, verifying your prescription with your prescribing eye care provider, and maintaining records as required by applicable law.
Information to be used/disclosed: Contact lens prescription, including power, base curve, diameter, and any additional parameters.
Purpose: To fill your contact lens order and verify prescription accuracy with your licensed eye care professional.
Expiration: This authorization remains in effect for the duration of your active prescriptions saved in your account, or until you revoke it in writing.
Right to Revoke: You may revoke this authorization at any time by contacting us at
privacy@genericcontacts.com. Revocation does not affect actions already taken.
Data Security: All PHI is encrypted using AES-256 encryption, stored in HIPAA-compliant infrastructure, and accessed only by authorized personnel. We maintain a Business Associate Agreement (BAA) with all subcontractors who access PHI.
You are not required to sign this authorization. Refusing to sign will prevent us from fulfilling your contact lens order.
All fields marked * are required. Your prescription is encrypted with AES-256 and stored in a HIPAA-compliant AWS S3 bucket. It never passes through our web server unencrypted.
