Terms and Conditions

INDIVIDUAL AUTHORIZATION FOR RELEASE OF INFORMATION
Aspen Valley Hospital understands that information about you and your health is personal, and we are committed to protecting the privacy of that information. Because of this commitment, we must obtain your written authorization before we may use or disclose your protected health information for the purposes described below. This form provides that authorization and helps us make sure that you are properly informed of how this information will be used or disclosed. Please read the information below carefully before agreeing to the terms of this authorization.

USE AND DISCLOSURE COVERED BY THIS AUTHORIZATION
Who will use and disclose my information? Aspen Valley Hospital will disclose the information you submit about your Aspen Valley Hospital experience by electronically posting it to aspenhospital.org, and/or Aspen Valley Hospital Network of Care social media channels. Aspen Valley Hospital will send you messages regarding the status of your submission through the email service provider of Aspen Valley Hospital’s choosing (currently Constant Contact). Aspen Valley Hospital may use the information

you submit to contact you to request permission to use the information you submit about your Aspen Valley Hospital experience for other purposes. Aspen Valley Hospital may also use the information you submit about your Aspen Valley Hospital experience for: (i) educational, training, and/or promotional purposes at Aspen Valley Hospital and/or at any other location(s); (ii) publicity, advertising (print, digital, and/or television), publications, and/or solicitation of contributions; and/or (iii) broadcast and/or other public display or viewing.