Online Clinic Signup
Congratulations you are only a few short steps away from signing up your clinic to be part of our allergy testing and immunotherapy program. Our guided signup form will allow you to rapidly onboard your clinic with a minimum of fuss and data entry.
This form must be filled out by the Primary Provider, the Practice owner or the responsible practice manager.
This form can either be signed electronically or after it is filled out, it can be printed and then signed.
We will need contact information for all providers and admin staff to correctly validate them.
Great. Then lets begin:
Office manager (same as above?)
Practice has sufficient refrigerated storage?
Billing Manager (same as previous screen?)
Name of Billing Manager
Phone Number of Billing Manager
Email of Billing Manager
More than one payer of services?
Practice is interested in skin testing?
Do you agree to the legal terms?
In order to provide seamless shipping, processing, testing, reporting and billing functions, the following information is required. This information gives Arrayit permission to test each specimen according to the selection made on the individual forms received in the laboratory. This information also gives Patient Data Solutions permission to report and store patient data, as well as grant the clinic revocable portal access.
I hereby acknowledge that samples supplied to Arrayit for allergy testing will be sent to Arrayit.
Portal Access Agreement
I hereby acknowledge Patient Data Solutions (PDS) will deliver reports as identified in this document to the individuals named according to the instructions. If special handling is required, please contact firstname.lastname@example.org
Access will be issued for each of the selected named users. Each user shall be made aware of the relevant regulations that are applicable to information that contains EPHI/ patient information. Each user shall secure his or her own access and shall not share this. Each user shall be required to immediately notify PDS of any change in cell phone number or email. Clinic shall be required to let PDS know immediately of any change in employment status for any named user. Clinic and user is/are responsible for securing the access to their own emails/faxes and for guarding portal access credentials. Any user maybe contacted by Patient Data Solutions.
Terms of Service
BUSINESS ASSOCIATE AGREEMENT - DIGITAL SIGNATURE
By agreeing to the "Terms of Service", the person submitting this form understands and acknowledges that they are entering into this Business Associate Agreement ("Agreement"), effective ("Effective Date"), upon digital submission. Furthermore, this agreement is entered into by and between (the "Business Associate") and (the "Covered Entity") (each a "Party" and collectively the "Parties").
The Parties have entered into an agreement (the "Underlying Agreement") pursuant to which Business Associate is providing Allergy ("Services") to the Covered Entity that require the disclosure and use of Protected Health Information. Both Parties are committed to complying with the Privacy Rule and the Security Rule promulgated pursuant to the Health Insurance Portability and Accountability Act of 1996 ("HIPAA").
This Agreement sets forth the terms and conditions pursuant to which Protected Health Information that is created or received by and/or maintained by the Business Associate from or on behalf of the Covered Entity, will be handled between the Business Associate and the Covered Entity and with third parties during the term of the Underlying Agreement and after its termination. All capitalized terms in this Agreement that are used as defined terms herein have the meanings ascribed to them in Section 1 below, unless otherwise noted or the context clearly requires otherwise. The Parties agree as follows:
- Administrative Safeguards. "Administrative Safeguards" has the same meaning as the term "administrative safeguards" in 45 C.F.R. $ 164.304, as such provision is currently drafted and as it is subsequently updated, amended or revised.
- Breach. "Breach" has the same meaning as the term "breach" in 45 C.F.R. $ 164.402, as such provision is currently drafted and as it is subsequently updated, amended or revised.
- Breach of System Security. "Breach of System Security" means unauthorized acquisition of computerized data, limited to the information created, received, maintained, and/or transmitted by Business Associate from or on behalf of Covered Entity, that compromises the security, confidentiality, or integrity of Sensitive Personal Information maintained by a person, including data that is encrypted if the person accessing the data has the key required to decrypt the data.
- Designated Record Set. "Designated Record Set" has the same meaning as the term "designated record set" in 45 C.F.R. $ 164.501, as such provision is currently drafted and as it is subsequently updated, amended or revised.
- Electronic Protected Health Information. "Electronic Protected Health Information" has the same meaning as the term "electronic protected health information" in 45 C.F.R. $ 160.103, , maintained, and/or transmitted, but limited to the information created, received, maintained, and/or transmitted by Business Associate from or on behalf of Covered Entity, as such provision is currently drafted and as it is subsequently updated, amended or revised.
- Health Care Operations. "Health Care Operations" has the same meaning as the term "health care operations" in 45 C.F.R. $ 164.501, as such provision is currently drafted and as it is subsequently updated, amended or revised.
- HITECH Act. "HITECH Act" means the Health Information and Technology for Economic and Clinical Health Act, as codified at 42 U.S.C. $ 1790, which was adopted as part of the American Recovery and Reinvestment Act of 2009 on February 17, 2009.
- Individual. "Individual" has the same meaning as the term "individual" in 45 C.F.R. $ 160.103, as such provision is currently drafted and as it is subsequently updated, amended or revised, and will include a person who qualifies as a personal representative in accordance with 45 C.F.R. $ 164.502(g).
- Physical Safeguards. "Physical Safeguards" has the same meaning as the term "physical safeguards" in 45 C.F.R. $ 164.304, as such provision is currently drafted and as it is subsequently updated, amended or revised.
- Privacy Officer. "Privacy Officer" has the same meaning as the term "privacy officer" in 45 C.F.R. $ 164.530(a)(1), as such provision is currently drafted and as it is subsequently updated, amended or revised.
- Privacy Rule. "Privacy Rule" means the Standards for Privacy of Individually Identifiable Health Information at 45 C.F.R. part 160 and part 164, subparts A and E.
- Protected Health Information. "Protected Health Information" or "PHI" has the same meaning as the term "protected health information" in 45 C.F.R. $ 160.103, limited to the information created, received, maintained, and/or transmitted by Business Associate from or on behalf of Covered Entity, as such provision is currently drafted and as it is subsequently updated, amended or revised.
- Required by Law. "Required by Law" has the same meaning as the term "required by law" in 45 C.F.R. $ 164.103, as such provision is currently drafted and as it is subsequently updated, amended or revised.
- Secretary. "Secretary" means the Secretary of the Department of Health and Human Services or her designee.
- Security Incident. "Security Incident" has the same meaning as the term "security incident" in 45 C.F.R. $ 164.304, as such provision is currently drafted and as it is subsequently updated, amended or revised.
- Security Rule. "Security Rule" means the Security Standards for the Protection of Electronic Protected Health Information at 45 C.F.R. parts 160, 162 and 164, subpart C.
- Sensitive Personal Information. "Sensitive Personal Information" means: (1) an individual's first name or first initial and last name in combination with any one or more of the following items, if the name and the items are not encrypted: (a) social security number; (b) driver's license number; (c) account number or credit or debit card number in combination with any required security code, access, code, or password that would permit access to an individual's financial account; or (2) PHI.
- Technical Safeguards. "Technical Safeguards" has the same meaning as the term "technical safeguards" in 45 C.F.R. $164.304, as such provision is currently drafted and as it is subsequently updated, amended or revised.
- Unsecured PHI. "Unsecured PHI" means PHI that is not secured by a technology standard that (i) renders PHI unusable, unreadable, or indecipherable to unauthorized individuals, and (ii) is developed or endorsed by a standards developing organization that is accredited by the American National Standards Institute.
PERMITTED USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
Services. Pursuant to the Services Agreement, Business Associate provides Services for the Covered Entity that involve the creation, receipt, maintenance, and/or transmission of Protected Health Information. Except as otherwise specified herein, the Business Associate may make any and all uses of Protected Health Information necessary to perform its obligations under the Services Agreement. All other uses not authorized by this Agreement are prohibited. Moreover, Business Associate may disclose Protected Health Information for the purposes authorized by this Agreement only (i) to its employees, subcontractors and agents, in accordance with Sections 3.1(f) and 3.1(l); (ii) as directed by the Covered Entity; or (iii) as otherwise permitted by the terms of this Agreement including, but not limited to, Section 2.2(b) below. Even when PHI has been de-identified in accordance with the requirements of 45 C.F.R. $ 164.514(b), Business Associate may not disclose de-identified data for purposes unrelated to performance of the Services without prior approval by the Covered Entity.
Business Activities of the Business Associate. Unless otherwise limited herein, the Business Associate may:
- use the Protected Health Information in its possession for its proper management and administration and to fulfill any present or future legal responsibilities of the Business Associate provided that such uses are permitted under state and federal confidentiality laws.
- disclose the Protected Health Information in its possession to third parties for the purpose of its proper management and administration or to fulfill any present or future legal responsibilities of the Business Associate, provided that the Business Associate represents to the Covered Entity, in writing, that (i) the disclosures are Required by Law; or (ii) the Business Associate has entered into a Business Associate Agreement containing substantially similar (or more stringent) terms as this Agreement with any third party that creates, receives, maintains, or transmits PHI on behalf of the Business Associate.
- use and/or disclose Protected Health Information as permitted under 45 C.F.R. $ 164.512 except that uses or disclosures for research are not permitted without prior approval by the Covered Entity.
Additional Activities of Business Associate. In addition to using the Protected Health Information to perform the Services set forth in Section 2.1 of this Agreement, Business Associate may:
- aggregate the Protected Health Information in its possession with the Protected Health Information of other covered entities that the Business Associate has in its possession through its capacity as a business associate to those other covered entities provided that the purpose of such aggregation is to provide the Covered Entity with data analyses relating to the Health Care Operations of the Covered Entity. Under no circumstances may the Business Associate disclose Protected Health Information of one covered entity to another covered entity absent the explicit authorization of the covered entity.
- de-identify any and all Protected Health Information provided that the de-identification conforms to the requirements of 45 C.F.R. $ 164.514(b), and further provided that the Covered Entity maintains the documentation required by 45 C.F.R. $ 164.514(b) which may be in the form of a written assurance from the Business Associate. Pursuant to 45 C.F.R. $ 164.502(d)(2), de-identified information does not constitute Protected Health Information and is not subject to the terms of this Agreement.
RESPONSIBILITIES OF THE PARTIES WITH RESPECT TO PROTECTED HEALTH INFORMATION
Responsibilities of the Business Associate. With regard to its use and/or disclosure of Protected Health Information, the Business Associate will:
- comply with the portions of the HIPAA Privacy Rule and Security Rule applicable to Business Associates;
- use and/or disclose the Protected Health Information only as permitted or required by this Agreement or as Required by Law and to use appropriate safeguards to prevent impermissible use or disclosure of PHI.
- report to the designated Privacy Officer of the Covered Entity, in writing, any use and/or disclosure of the Protected Health Information that is not permitted or required by this Agreement of which Business Associate becomes aware within three (3) business days of the Business Associate's discovery of such unauthorized use and/or disclosure.
- mitigate, to the greatest extent possible, any deleterious effects from any improper use and/or disclosure of Protected Health Information or other Sensitive Personal Information of which the Business Associate becomes aware and/or reports to the Covered Entity.
- implement Administrative, Physical and Technical Safeguards consistent with industry standards that reasonably and appropriately maintain the security of, prevent unauthorized use and/or disclosure of, and protect the confidentiality, integrity, and availability of any Electronic Protected Health Information or other Sensitive Personal Information it creates, receives, maintains, or transmits on behalf of Covered Entity.
- At a minimum, Business Associate shall employ Safeguards that are compliant with 45 C.F.R. Part 164, Subpart C and the National Institute of Standards and Technology ("NIST") guidelines.
- require all of its subcontractors and agents that create, receive, maintain, or transmit Protected Health Information under this Agreement to agree, in the form of a Business Associate Agreement that meets the requirements at 45 C.F.R. $ 164.314(a), to adhere to substantially similar or more stringent restrictions and conditions on the use and/or disclosure of Protected Health Information that apply to the Business Associate pursuant to Section 3 of this Agreement.
- ensure that any agent, including a subcontractor, agrees to implement reasonable and appropriate safeguards to protect the confidentiality, integrity, and availability of the Electronic Protected Health Information that it creates, receives, maintains, or transmits on behalf of the Covered Entity.
- make available all records, books, agreements, policies and procedures relating to the use and/or disclosure of Protected Health Information to the Secretary, in the time and manner designated by the Secretary, for purposes of the Secretaryâs determination that the Covered Entity and Business Associate have complied with the Privacy Rule, subject to attorney-client and other applicable legal privileges.
- within fourteen (14) days of receiving a written request from the Covered Entity, make available during normal business hours at Business Associate's offices all records, books, agreements, policies and procedures relating to the use and/or disclosure of Protected Health Information for purposes of enabling the Covered Entity to determine the Business Associate's compliance with the terms of this Agreement.
- within fifteen (15) days of receiving a written request from the Covered Entity, provide to the Covered Entity such information as is requested by the Covered Entity to permit the Covered Entity to respond to a request by an Individual for an accounting of the disclosures of the Individual's Protected Health Information in accordance with 45 C.F.R. $ 164.528.
- to the extent that Business Associate is obligated to carry out one or more of Covered Entity's obligations under the Privacy Rule, comply with the Privacy Rule requirements that apply to the Covered Entity in the performance of such obligations;
- subject to Section 5.4 below, return to the Covered Entity or destroy, within sixty (60) days of the termination of this Agreement, the Protected Health Information in its possession and retain no copies;
- disclose to its subcontractors, agents or other third parties only the minimum Protected Health Information necessary to perform or fulfill a specific function required or permitted under the Services Agreement or this Agreement.
- report to the designated Privacy Officer of the Covered Entity, in writing, any Security Incident or unintentional use or disclosure of Unsecured PHI, identified internal/external breach of data, or disaster occurrence of which Business Associate becomes aware within three (3) business days of the Business Associate's discovery of such incident. The Business Associate must include the following information, to the extent known, when reporting a breach:
- Identification of the individual whose
Unsecured PHI has been, or is reasonably believed by
the Business Associate to have been, accessed,
acquired, used, or disclosed during a breach;
Circumstances of the breach;
Date of the breach;
Date of the discovery;
Type of PHI involved (such as full name, Social Security number, date of birth, home address, account number, or medical record number); and Any other additional information the Covered Entity requests.
This Section 3.1 will survive the termination of this Agreement solely with respect to the Protected Health Information that Business Associate retains in accordance with Section 5.4 below because it is not feasible to return or destroy such Protected Health Information.
Responsibilities of the Covered Entity. With regard to the use and/or disclosure of Protected Health Information by the Covered Entity to the Business Associate or the use and/or disclosure of Protected Health Information by the Business Associate, the Covered Entity will:
- provide Business Associate with a copy of its notice of privacy practices (the "Notice") that the Covered Entity provides to Individuals pursuant to 45 C.F.R. $164.520.
- notify the Business Associate, in writing, of any changes in, or revocation of, the consent or authorization provided to the Covered Entity by Individuals pursuant to 45 C.F.R. $164.506 or $164.508, to the extent such changes may affect Business Associate's use or disclosure of Protected Health Information.
- notify the Business Associate, in writing and in a timely manner, of any arrangements permitted or required of the Covered Entity under 45 C.F.R. parts 160 and 164 that may impact in any manner the use and/or disclosure of Protected Health Information by the Business Associate under this Agreement, including, but not limited to, restrictions on use and/or disclosure of Protected Health Information as provided for in 45 C.F.R. $ 164.522 agreed to by the Covered Entity, to the extent such restrictions may affect Business Associate's use or disclosure of Protected Health Information.
d. not request Business Associate to use or disclose Protected Health Information in any manner that would not be permissible under the Privacy Rule if done by the Covered Entity.
ADDITIONAL RESPONSIBILITIES OF THE PARTIES WITH RESPECT TO PROTECTED HEALTH INFORMATION
Responsibilities of the Business Associate with Respect to Handling of Designated Record Set. In the event that the Parties mutually agree in writing that the Protected Health Information constitutes a Designated Record Set, the Business Associate will:
- within fifteen (15) days of receipt of a written request by the Covered Entity, provide access to the Protected Health Information to the Covered Entity or the Individual to whom such Protected Health Information relates or his or her authorized representative in order to meet a request by such Individual under 45 C.F.R. $ 164.524.
- within fifteen (15) days of receipt of a written request by Covered Entity, make any amendment(s) to the Protected Health Information that the Covered Entity directs pursuant to 45 C.F.R. $ 164.526. Provided, however, that the Covered Entity makes the determination that the amendment(s) are necessary because the Protected Health Information that is the subject of the amendment(s) has been, or could foreseeably be, relied upon by the Business Associate or others to the detriment of the Individual who is the subject of the Protected Health Information to be amended.
Responsibilities of the Covered Entity with Respect to the Handling of the Designated Record Set. In the event that the Parties mutually agree in writing that the Protected Health Information constitutes a Designated Record Set, the Covered Entity will:
- notify the Business Associate, in writing, of any Protected Health Information that Covered Entity seeks to make available to an Individual pursuant to 45 C.F.R. $ 164.524 and the time, manner and form in which the Business Associate will provide such access.
- notify the Business Associate, in writing, of any amendment(s) to the Protected Health Information in the possession of the Business Associate that the Business Associate will be required to make and inform the Business Associate of the time, form and manner in which such amendment(s) will be made.
HITECH Act Obligations. Business Associate acknowledges that:
- Sections 164.306, 164.308, 164.310, 164.312, 164.314 and 164.316 of title 45 of the Code of Federal Regulations (regarding administrative, physical and technical security standards) apply to Business Associate in the same manner in which such sections apply to Covered Entity. The provisions of the HITECH Act that impose additional requirements and standards on Covered Entities with respect to health information security are also applicable to Business Associate and are hereby are incorporated into the Agreement.
- the HITECH Act requires it to use or disclose PHI only if such use or disclosure is in compliance with all applicable requirements of Section 164.504(e) of the Privacy Rule. The additional requirements of the HITECH Act that impose requirements and standards on Covered Entities with respect to privacy are also applicable to Business Associate and are hereby incorporated into the Agreement.
Survival. Sections 4.1 and 4.2 of this Agreement will survive the termination of this Agreement, provided that Covered Entity determines that the Protected Health Information being retained pursuant to Section 5.4 below constitutes a Designated Record Set.
TERM AND TERMINATION
- will continue in effect until all obligations of the Parties have been met, unless terminated as provided in this Section 5. In addition, certain provisions and requirements of this Agreement will survive its expiration or other termination in accordance with Section 5.4 herein.
Termination by Business Associate. If the Business Associate makes the determination that a material condition of performance has changed under any Services Agreement or this Agreement, or that the Covered Entity has breached a material term of this Agreement, Business Associate may provide thirty (30) days written notice of its intention to terminate this Agreement and the Services Agreement. Business Associate agrees, however, to in good faith cooperate with Covered Entity to find a mutually satisfactory resolution to the matter prior to terminating and further agrees that, notwithstanding this provision, it will not terminate this Agreement so long as any Services Agreement is in effect.
Each Party acknowledges and agrees that:
- it is duly organized, validly existing, and in good standing under the laws of the jurisdiction in which it is organized or licensed, it has the full power to enter into this Agreement and to perform its obligations hereunder, and that the performance by it of its obligations under this Agreement have been duly authorized by all necessary corporate or other actions and will not violate any provision of any license, corporate charter or bylaws.
- neither the execution of this Agreement, nor its performance hereunder, will directly or indirectly violate or interfere with the terms of another agreement to which it is a party, or give any governmental entity the right to suspend, terminate, or modify any of its governmental authorizations or assets required for its performance hereunder. Each Party certifies to the other Party that it will not enter into any agreement the execution and/or performance of which would violate or interfere with this Agreement.
- it is not currently the subject of a voluntary or involuntary petition in bankruptcy, does not currently contemplate filing any such voluntary petition, and is not aware of any claim for the filing of an involuntary petition.
- all of its employees, agents, representatives and members of its workforce, whose services may be used to fulfill obligations under this Agreement are or will be appropriately informed of the terms of this Agreement and are under legal obligation to each Party, respectively, by contract or otherwise, sufficient to enable each Party to fully comply with all provisions of this Agreement including, without limitation, the requirement that modifications or limitations to which the Covered Entity has agreed to adhere regarding the use and disclosure of Protected Health Information of any Individual that materially affect and/or limit the uses and disclosures that are otherwise permitted under the Privacy Rule will be communicated to the Business Associate, in writing, and in a timely fashion.
- it will reasonably cooperate with the other Party in the performance of their mutual obligations under this Agreement and their respective obligations under HIPAA.
The Parties will indemnify, defend and hold harmless each other and each others respective employees, directors, officers, subcontractors, agents or other members of its workforce, each of the foregoing hereinafter referred to as "indemnified party," against all actual and direct losses suffered by the indemnified party and all liability to third parties arising from or in connection with any breach of this Agreement or of any warranty hereunder or from any negligence or wrongful acts or omissions, including failure to perform its obligations under the Privacy Rule, the Security Rule, or the HITECH Act by the indemnifying party or its employees, directors, officers, subcontractors, agents or other members of its workforce. This indemnification provision is enforceable against Covered Entity only to the extent authorized under the constitution and laws of the State of Texas.
Business Associate. For purposes of this Agreement, Business Associate will include the named Business Associate herein. However, in the event that the Business Associate is otherwise a covered entity under the Privacy Rule, that entity may appropriately designate a health care component of the entity, pursuant to 45 C.F.R. $ 164.504(a), as the Business Associate for purposes of this Agreement.
Amendments; Waiver. This Agreement may not be modified, nor will any provision hereof be waived or amended, except in a writing duly signed by authorized representatives of the Parties. The Parties agree to take such action as is necessary to amend this Agreement from time to time as is necessary for Covered Entity to comply with the requirements of the Privacy Rule, the Security Rule, HIPAA, and the HITECH Act. A waiver with respect to one event will not be construed as continuing, or as a bar to or waiver of any right or remedy as to subsequent events.
No Third Party Beneficiaries. Nothing express or implied in this Agreement is intended to confer, nor will anything herein confer, upon any person other than the Parties and the respective successors or assigns of the Parties, any rights, remedies, obligations, or liabilities whatsoever.
Notices. Any notices to be given under this Agreement will be made to respective parties' provided email addresses. Each Party may change its address and that of its representative for notice by the giving of notice thereof in the manner hereinabove provided.
Counterparts; Facsimiles. This Agreement may be executed in any number of counterparts, each of which will be deemed an original. Facsimile copies hereof will be deemed to be originals.
Disputes. If any controversy, dispute or claim arises between the Parties with respect to this Agreement, the Parties will make good faith efforts to resolve such matters informally.
- Interpretation. Any ambiguity in this Agreement will be resolved in favor of a meaning that permits Covered Entity to comply with the Privacy Rule and the Security Rule.
USE OF WEBSITE
Your access to and use of the Nationwide Allergy website (the "Web Site") is subject to the provisions contained in these terms and conditions. By accessing or using any part of this Web Site, you agree to all of these terms and conditions and enter into a legally binding agreement with Nationwide Allergy, Arizona LLC. ("Nationwide Allergy") to abide by the provisions of these terms and conditions as described herein. Nationwide Allergy reserves the right to modify these terms and conditions by posting such modifications to this Web Site. Your continued access to or use of this Web Site after such posting will signify your agreement to such modifications, if any. You can read more about our company, obtain investor information, contact us at www.NationwideAllergy.net.
Throughout these terms and conditions, Nationwide Allergy and this Web Site are sometimes referred to herein as "we," "us," "our". "References herein to "you" and "your" and the rest of the second-person nouns refer to users of the Website.
Content and Other Information: All of the content and information displayed or accessible on this Web Site, including without limitation the educational materials, scientific content, graphic designs, video, audio, photographic or literary content (collectively, "Information"), is owned by Nationwide Allergy, its business associates, or other third parties. This Information is provided to you solely for your personal use. You may not access or use this Information for commercial, competitive, or any other purposes. You may not modify, republish, post, transmit or distribute any Information without the express written consent of Nationwide Allergy. You may copy this information only to the extent necessary for your personal use. Nationwide Allergy expressly retains all right, title and interest in and to any proprietary Information. Failure to adhere to these provisions could subject you to serious penalties under federal copyright law.
Password and Security: You are solely responsible for maintaining the confidentiality of any user name and password you use to access the Nationwide Allergy Web Site and are fully responsible for all activities that occur under your password or account. You agree to (i) immediately notify Nationwide Allergy of any unauthorized use of your password or account or any other breach of security, and (ii) ensure that you exit from your account at the end of each session. Nationwide Allergy cannot and will not be liable for any loss or damage arising from your failure to comply with this provision.
Sites, or from the products, content, material or information presented by or available through those sites.Links to Other Web Sites: The Web Site may provide links to the web sites or services of other third party web sites ("Third-Part Sites"). Links from our Web Site to such Third-Party Sites do not constitute an endorsement by Nationwide Allergy of such Third-Party Sites, or the products, content, materials or information presented or made available by such sites. You acknowledge and agree that Nationwide Allergy is not responsible for any damages or losses of you or any other person caused or alleged to have been caused by your use of any Third-Party
Disclosure of Affiliations: Nationwide Allergy works with a variety of third parties to provide the Services available on this Web Site, and to provide links to Third-Party Sites. These third parties include, for example, accrediting bodies, content providers, technology providers, and suppliers of medical products, information and services. These entities may supply information for posting on or access through this Web Site, and, solely in the case of accrediting bodies, may set standards applicable to certain content, but they do not control the content or the operation of this Web Site.
Introduction: Nationwide Allergy is concerned about your privacy. We want you to understand what personal and personally identifiable information ("personal information") we collect about you, and how we use your personal information. The nature of the Services that we provide through our Web Site requires that we collect and use personal information about you as more fully described below. Some of your personal information may be disclosed to third parties (for example, accrediting bodies) in order to provide the Information and services that you request, and may be used by both Nationwide Allergy and third parties to provide that Information and/or perform those Services. In addition, Nationwide Allergy and third parties may use your personal information to offer you additional information, products or services that match your areas of interest.
How we use personal information: We use the personal information you provide through the registration process: to provide you with the Information and services you request; to communicate with you on matters relating to the Web Site and your account; to provide necessary information to the accrediting bodies and other of our affiliates in connection with the Information and Services you request from us; and to provide you with information about related services and/or products. You may choose to disclose or not disclose the personal information we request during the registration process. However, if you choose not to disclose the requested information, we may not be able to provide you with some or all of the Information or services you request.
We share your personal information with Nationwide Allergy's affiliates and partners and third parties licensed to access your personal information by any of the foregoing. We reserve the right to rent e-mail lists compiled from e-mail addresses gathered from this Web Site. We sometimes provide aggregated usage or tracking information collected from this website to third parties. We may also provide certain of your personal information to third parties that provide services to us in operating the Web Site or our businesses, such as account services, web hosting, software development and information processing. If you do not wish to receive certain communications from the Web Site, you have the ability to opt out by declining the service offered or informing us that you no longer wish to receive such communications. The opt-out feature and instructions for its use are available on the Web Site. We will comply with your request unless such communications are necessary for the administration of your account, required by law, or necessary to protect our rights.
Besides using information to provide our services, the Web Site uses information maintained about you, and other information obtained from your current and past activities to resolve disputes, troubleshoot problems and enforce our rights. At times, Nationwide Allergy may review the information of multiple users to identify problems or to resolve disputes.
Disclosing personal information: Nationwide Allergy uses commercially reasonable efforts to limit disclosures of your personal information. We may disclose your personal information to accrediting organizations and other third parties that we work with to the extent necessary to provide the Information and Services you request through Nationwide Allergy, and/or to provide you with related information, to communicate with you, and to provide you with information on other products and services in your areas of interest.
Technical and legal circumstances beyond our control could prevent Nationwide Allergy from ensuring that your information will never be disclosed in ways not otherwise described herein. For example, among other things, we may be required by law, regulation or court order to disclose personal information to government representatives or third parties under certain circumstances. If Nationwide Allergy is requested by law enforcement officials or judicial authorities to provide personal information, Nationwide Allergy may, without your consent, provide such personal information. In matters involving claims of personal or public safety or in litigation where the data is pertinent, Nationwide Allergy may use or disclose your personal information without your consent or court process. Unauthorized parties may unlawfully intercept or access transmissions despite any commercially reasonable security efforts by Nationwide Allergy. You acknowledge that despite the use of such technology, no website is 100% secure. Further, corporate restructuring, sale of assets, merger, divestiture and other changes of control or financial status affecting Nationwide Allergy may require disclosure as an incidental result of a transfer of assets by operation of law or otherwise, and the consummation of a sale, merger, bankruptcy or liquidation transaction involving Nationwide Allergy or certain of its affiliates or business divisions could require the sale, assignment or transfer of your personal information to a purchaser or Nationwide Allergy's successor in interest. Therefore, Nationwide Allergy and affiliates do not promise, and you should not expect, that your personal information shall remain private or under the sole control of Nationwide Allergy under all circumstances.
If you have any questions that are not answered elsewhere on this site, if you would like to review the personally identifiable information we have collected about you, or if you believe that this policy has been violated, please contact us. Our response to such inquiries may be limited to information under our direct control.
Information on Children: As a business-to-business company, we do not knowingly collect information from children. On-line registration and web site usage is restricted to adults who are professionally engaged in the businesses we serve.
GENERAL TERMS AND CONDITIONS
No Medical Advice: This Web Site is not intended to provide, and disclaims any suggestion that it does provide, medical advice of any nature. The information made available through this Web Site should not be construed as medical advice by you or your patients and such information should not be used in place of seeking professional opinions by licensed practitioners. Only licensed medical professionals may offer medical advice, diagnosis and recommendations for treatment of medical conditions. Nationwide Allergy and its affiliates do not practice medicine or law, and do not offer any other professional advice or services. You assume full responsibility for appropriate use of the information available through this Web Site. Furthermore, any information on billing and coding practices for allergy services is public information and not an explicit recommendation of any billing or coding practice.
Disclaimer of Warranty: This Web Site and all services and Information made available on or through this Web Site are provided on an "as is", "where is" and "as available" basis. OTHER THAN AS EXPLICITLY SET FORTH IN THESE TERMS AND CONDITIONS, NATIONWIDE ALLERGY DISCLAIMS ANY EXPRESS OR IMPLIED REPRESENTATIONS, WARRANTIES, GUARANTIES, AND CONDITIONS TO THE FULLEST EXTENT THAT SUCH DISCLAIMERS ARE LEGALLY PERMISSIBLE, INCLUDING BUT NOT LIMITED TO ANY EXPRESS OR IMPLIED WARRANTIES OR CONDITIONS OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, TITLE AND NON-INFRINGEMENT, SUITABILITY, ACCURACY OR FREE FROM ERROR, CURRENCY TIMELINESS, SECURITY, EFFICACY, AVAILABILITY, RELIABILITY, COMPLETENESS OR NON-INTERRUPTION OR THAT DEFECTS WILL BE CORRECTED.
Any information downloaded or otherwise obtained through the use of this Web Site is done at your own discretion and risk. You shall be solely responsible for any damage or loss of data that results from the downloading or use of the information and for any results or lack of results from the use of such data.
Limitation of liability: Our liability regarding damages occurring from your use of the Web Site is limited and your use of the Web Site is at your own risk. In no event shall Nationwide Allergy or affiliates, or their shareholders, directors, officers, employees or agents, be liable for any claims or losses whatsoever of any kind, whether direct, indirect, special, incidental, consequential or punitive, and whether arising from an action in contract, tort, or otherwise, related to or in connection with this Web Site or any services or information made available on or through this Web Site, or your use thereof. Without limiting the generality of the foregoing, Nationwide Allergy and its affiliates shall not be liable for any claims or losses in connection with errors, omissions, or inaccuracies of informational content, or any decision made in reliance on the Information contained on or accessible through the Web Site, including without limitation personal injury or death.
Your sole remedy for any claims in connection with this Web Site is to discontinue using this Web Site and the related Information and services. The foregoing limitation shall apply and survive notwithstanding any failure of essential purpose of any remedy. Some jurisdictions do not allow the exclusion of certain warranties or the limitation or exclusion of liability for incidental or consequential damages. Accordingly, some of the above limitations may not apply to you.
Indemnification: You agree to indemnify, defend and hold harmless Nationwide Allergy and its affiliates from any and all claims or losses arising from your use of or reliance on this Web Site or any services or information made available on or through this Web Site.
Choice of Law: These terms and conditions and your use of the Web Site shall be governed by and interpreted in accordance with laws of the State of Arizona, without giving effect to any conflict of laws provisions. By using this Web site, you hereby consent to the exclusive jurisdiction of and agree that venue is proper and convenient in the state and federal courts situated in the State of Arizona.
Waiver: Our failure to exercise or enforce any right or provision of these terms and conditions will not constitute or be deemed a waiver of such right or provision.
THIS WEBSITE IS NOT INTENDED FOR THE PURPOSE OF PROVIDING MEDICAL ADVICE
All information, content, and material of this website
is for informational purposes only and are not
intended to serve as a substitute for the
consultation, diagnosis, and/or medical treatment of a
qualified physician or healthcare provider.
Contract of Services
In agreeing to the "Terms of Service", the rendering
provider agrees that they have hereby made an explicit
request to pre-mix allergenic extracts for their
patient using the guidelines as discussed in the
Allergen Immunotherapy Extract Preparation Manual,
Chapter 9 of the AAAAI Practice Management Resource
Guide, 2014 edition.
It is acknowledged that this is a pre-mix only and that any and all final mixing procedures must be performed at the provider's office and at their sole discretion. Furthermore, the rendering prescriber acknowledges that all use of sublingual immunotherapy (SLIT) is considered experimental and that as of this date, no standard dilution formula exists.
If you have a medical emergency, call 911 immediately.
WEBSITE INFORMATION INTENDED FOR USE BY INDUSTRY
NationwideAllergy.net and its provided products and services is geared toward licensed healthcare industry professionalsâNOT CONSUMERS. The information contained on this website is compiled from a variety of sources and is not considered complete. The information accessed through this website is provided "AS IS" and without any warranties, whether expressed or implied.
To the fullest extent permitted by law, Nationwide Allergy DISCLAIMS ALL REPRESENTATIONS AND WARRANTIES, EXPRESSED OR IMPLIED, regarding any information or other material displayed on this website, whether authored by Nationwide Allergy or others; and the operation of this website, including any warranty of merchantability and/or fitness for a particular purpose.
Nationwide Allergy makes no representation or warranty as to the reliability, accuracy, timeliness, usefulness, adequacy or suitability of the information or products provided or discussed in this website and does not represent and/or warrant against human or machine error.
The information contained in this website is not intended to recommend the self-management of health problems or wellness. It is not intended to endorse or recommend any particular type of medical treatment. All use of products and services is at the SOLE DISCRETION OF A LICENSED RENDERING PROVIDER. No information contained in this website should be used by any reader to influence their medical and/or health-related advice or provide a basis to delay consultation with a physician or a qualified healthcare provider.
You should not use any information contained in this website to initiate use of dietary supplements, vitamins, herbal and nutritional products or homeopathic medicine, and other described products prior to consulting first with a physician or healthcare provider. Nationwide Allergy disclaims any liability based on information provided in this website.
Allergenic extracts are indicated for skin test diagnosis and treatment (immunotherapy) of patients with seasonal and perennial allergies.
See the package inserts for the full Prescribing Information for the specific extracts at https://stagrallergy.com/treatment/.
IMPORTANT SAFETY INFORMATION
- Do not inject intravenously.
- Do not administer these products to patients with severe, unstable, or uncontrolled asthma.
- Allergenic extracts may cause severe life-threatening systemic reactions, including the rare occurrence of anaphylaxis or death. Systemic reactions include: generalized skin erythema, urticaria, pruritus, angioedema, rhinitis, wheezing, laryngeal edema, and hypotension. Other adverse reactions include: nausea, emesis, abdominal cramps, and diarrhea.
- Intended for use only by physicians who are experienced in the administration of allergenic extracts.
- Observe patients in the office for at least 30 minutes following treatment. Emergency measures and personnel trained in their use must be available immediately in the event of a life-threatening reaction.
- Patients with extreme sensitivity to these products, those on an accelerated immunotherapy build-up schedule, those switching to another allergenic lot, those receiving high doses of these products, or those also exposed to similar allergens may be at increased risk of a severe allergic reaction.
- Immunotherapy may not be suitable for patients with medical conditions that reduce their ability to survive a severe allergic reaction.
- These products may not be suitable for patients who may be unresponsive to epinephrine or inhaled bronchodilators, such as those taking beta-blockers.
Please go to https://starallergy.com/treatment/. for Package Inserts with full Prescribing Information, including Boxed Warnings.
Sign here to accept terms and conditions as Provider/Authorized Practice Signee
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We need to signup any providers here.
The basic information we require is a Provider Name, NPI Number and a signature.
If the Provider wishes to be issued portal access then we
need their email address and cell phone.
These will only be used for portal authenication means, we will not spam your providers or call them up unless necessary.
Provider or authorized party to sign here:
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We need to signup any contacts here.
You do not need to re-enter any providers here.
The basic information we require is a Contact Name and a signature.
If the Contact wishes to be issued portal access then we
need their email address and cell phone.
These will only be used for portal authenication means, we will not spam your contacts or call them up.
Contact or authorized party to sign here:
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Thank you very much you've successfully registered your office for allergy testing. Should you have any immediate questions, please contact your representative: Rene Schena / (408) 821-4884, within a day or so, you will receive login credentials by email AND SMS with instructions on accessing your Patient Data Solutions portal. Following that, within a few days you will receive testing kits. Each kit contains a blood capture card, lancet and alcohol wipe. We will contact you to schedule an orientation call around the time you receive your kits. Once you have portal access, you will use it to:
- Access patient reports
- Print test requisitions
- Print shipping labels
- Order additional kits
- Order Immunotherapy if you've requested that functionality
If you have IT related questions in the meantime please email email@example.com and yes, there are real people that do respond quickly to questions from that email address
We look forward to being of service to ensure your experience with introducing this test into your practice is beneficial and smooth.