MEDICAL RECORDS AUTHORIZATION
Authorize only the records needed for this case.
Vialen uses a separate, case-specific authorization before medical records are requested or sent for outside clinical review. The authorization identifies what may be released, who may receive it, why it may be used and when it expires.
NO RECORDS ARE COLLECTED ON THIS PAGE
For an approved case, Vialen provides a secure, case-specific signing and records-transfer route. Do not email medical records, images, pathology files or signed authorizations through ordinary email.
01 · AUTHORIZATION SCOPE
Only records relevant to the defined case.
The case-specific authorization may cover recent oncology or specialist notes, diagnosis information, pathology reports, imaging reports and files when needed, treatment summaries, relevant procedure or discharge reports, laboratory results, biomarker or genomic reports, medication information relevant to the case, and radiation records when applicable.
Unrelated portions of the medical record are not requested by default. Psychotherapy notes and substance-use-disorder records protected by 42 CFR Part 2 are not included unless separately and expressly authorized and legally appropriate.
02 · WHO MAY RELEASE AND RECEIVE
The authorization names the record holder and the receiving clinical route.
WHO MAY RELEASE
The signed authorization identifies the hospital, physician, laboratory, imaging center, pathology service or other record holder permitted to disclose records. A provider may still require its own release form or identity-verification process.
WHO MAY RECEIVE
Golden Echoes Holding LLC, operating the Vialen Health brand, may receive the authorized records for the case. Outside clinical disclosure is limited to the specifically identified licensed clinician or treatment center named in the authorization.
If Vialen later proposes a materially different outside clinical recipient, a new authorization or separate written instruction is required before records are sent to that recipient.
03 · PURPOSE
Use is limited to the case and its defined next step.
Authorized records may be used to verify and organize case information, identify missing material, determine whether the case is ready for formal clinical review, submit the case to the specifically named receiving clinician or treatment center, coordinate a treatment-access step if the receiving clinical team agrees to proceed, and support a structured handoff back to the existing care team when applicable.
The authorization does not permit identifiable case information to be sold, used as public content or advertising, or used for unrelated research or unrelated independent model training.
04 · APPROVED SERVICE PROVIDERS
Case information may be processed only as needed to operate the authorized case.
Vialen may use approved secure software and service providers to store, translate, organize or summarize authorized records. Those providers may act only for the authorized case and under Vialen’s instructions and confidentiality obligations. Vialen does not make a blanket claim that every Vialen activity or vendor is covered by HIPAA; the actual data-flow and provider requirements control.
05 · CROSS-BORDER DISCLOSURE
A named non-U.S. recipient requires an explicit case-specific authorization.
If the authorized receiving clinical team is outside the United States, the signed authorization identifies that recipient and country. Records may then be transferred to and processed in that country, where privacy and medical-record laws may differ from U.S. law. No cross-border clinical transfer occurs merely because a route exists.
06 · EXPIRATION AND RETENTION
The authorization is time-limited.
EXPIRATION
Unless the signed authorization states another case-specific date or event, it expires 12 months after signature or when the specifically authorized review / access episode is completed, whichever occurs first.
RETENTION
Expiration or revocation stops future disclosures under the authorization. It does not require an authorized recipient to delete records already lawfully received or undo actions already taken in reliance on the authorization.
07 · YOUR RIGHT TO REVOKE
You may withdraw the authorization in writing.
Send a written revocation to access@vialenhealth.com with the subject “Revoke Medical Records Authorization” and include the patient name or case ID used in the authorization. Vialen will stop future uses and disclosures that rely on the authorization after the revocation is received and processed.
Revocation cannot undo disclosures already made or actions already taken in reasonable reliance on a valid authorization. A record holder may also require revocation to be sent directly to that provider.
08 · IF YOU DO NOT AUTHORIZE
Your existing care is not conditioned on signing this Vialen authorization.
Refusing to sign does not affect the care you receive from your existing physicians, hospital or health plan. It may, however, prevent Vialen from obtaining the records needed to verify the case, arrange outside clinical review or organize a treatment-access step. Vialen may therefore stop the case or ask you to provide information through another lawful route.
09 · REDISCLOSURE
A privacy limit you should understand.
Information disclosed under an authorization may be redisclosed by an authorized recipient and, depending on the recipient and applicable law, may no longer be protected by the same U.S. privacy rules. Vialen limits its own disclosure to named recipients and case-specific purposes, but cannot promise that every outside recipient is governed by the same law.
10 · SECURE SIGNING
The signed authorization is issued case by case.
For an approved case, Vialen provides a secure authorization that contains the patient or authorized representative, the record holder(s), the specific recipient(s), the case purpose, the selected record categories, the expiration date or event and the signature date. If signed by a personal representative, the authorization also records that person’s authority to act for the patient.
A copy of the signed authorization is provided to the signer. Do not send a signed authorization through ordinary email unless Vialen specifically instructs you to use a secure email route for the case.
QUESTIONS OR REVOCATION
access@vialenhealth.com · Subject: Medical Records Authorization
Vialen Health is operated by Golden Echoes Holding LLC. This authorization process does not create a physician-patient relationship with Vialen and does not guarantee clinical review, treatment eligibility, provider acceptance or treatment availability.