Update this consent form under HIPAA framework; Patient Consent Form for Non-Care-Related Use of Protected Health Information (PHI) Patient Information Name: ______________________________________ Date of Birth: _______________________________ Patient ID: __________________________________ Consent for Non-Care-Related Use of PHI I, [Patient's Name], understand that my Protected Health Information (PHI) may be used for purposes beyond my direct healthcare needs. I hereby provide my consent for MediCare Health Solutions to use and disclose my PHI for the following non-care-related purposes (please check as appropriate): [ ] Research activities [ ] Marketing communications [ ] Third-party services and collaborations [ ] Other: _____________________________________________ Details of Consent I understand that my consent is voluntary and that I may revoke it at any time, except to the extent that action has already been taken based on this consent. I understand that my refusal to provide consent will not affect my access to treatment or eligibility for benefits. I have been informed about the nature and purpose of the non-care-related use of my PHI. Patient Rights I understand that I have the right to access my health records and request amendments. I understand that I can request an accounting of disclosures of my PHI. Patient Acknowledgement and Signature I have read this consent form and have been given the opportunity to ask questions. I give my permission for the us