When a patient completes an application, the patient is submitting and disclosing to Foundation personal health and other individually identifiable information. If you are submitting or providing information to us electronically, you are doing so at your own risk. The Foundation cannot guarantee the privacy of personal information you transmit over the internet or that may be collectable in transmit by others.
By submitting and completing an application for financial assistance you agree the Foundation may use and disclose the information you provide for its lawful purposes including but not limited to (a) determining your eligibility; (b) providing grant funding, and (c) the Foundation’s internal administration. The Foundation is not a “covered entity” as defined by HIPAA and information submitted by you in connection with the application is not protected by or subject to HIPAA.
The Foundation will, however, endeavor to protect the confidentiality and security of the information you submit by implementing commercially reasonable policies to safeguard and protect your personal information and will comply with federal and state consumer privacy laws to the extent applicable to the Foundation. Despite the attempt to protect such information, the Foundation cannot guarantee that there will be not be an unauthorized use or disclosure. If any unauthorized use of disclosure is brought to the Foundation’s attention, the Foundation will attempt to contact the patient at the last address provided in an application.
By clicking "Next," you acknowledge and understand the above.