Authorization to share Health Information
WHAT YOU'RE AUTHORIZING
By checking the consent box, you authorize MediKarma to share your health information with healthcare providers, physicians, nurses, care coordinators and other licensed clinicians.
INFORMATION THAT MAY BE SHARED
- Medical records retrieved by Jack AI
- Jill AI health recommendations and insights
- Your HICO Score and health risk predictions
- Wellness data, activity tracking, and behavioral inputs
- Lab results, medications, diagnoses, and treatment history
PURPOSE OF SHARING
This authorization allows your healthcare providers to
access your complete health profile for:
- Treatment and clinical decision-making
- Care coordination across multiple providers
- Personalized care planning
- Monitoring your health progress
IMPORTANT PRIVACY INFORMATION
Once shared with your healthcare provider:
- Your information is protected under HIPAA and your
provider's privacy policies (not MediKarma's)
- Your provider may use and disclose this information
according to their own practices
- MediKarma cannot control how providers use your
information after it has been shared
YOUR RIGHTS
You have the right to:
- Revoke this authorization at any time by contacting
support@medikarma.ai or in Settings > Privacy
- Choose which specific providers can access your data
- Request a copy of this signed authorization
- Use the MediKarma app even if you don't provide
this authorization
Please note:
- Revoking will not affect information already shared
- Information shared before revocation cannot be
"taken back"
EXPIRATION
This authorization remains in effect until you revoke it.
ELECTRONIC SIGNATURE
By checking the consent box and continuing, you confirm:
- You have read and understand this authorization
- You voluntarily agree to share your health information
- You understand you can revoke this at any time
Questions?
Contact support@medikarma.ai or call
925-628-7424.
Effective Date: March 2026