HIPAA Authorization for Use and Disclosure of Information
Elewell LLC — ElewellRx Telehealth and Prescription Services
Last Updated: August 4, 2026
1. Information to be Used and Disclosed
In connection with the telehealth and prescription services I am receiving through ElewellRx, I authorize Wasef Health Provider Group and its licensed healthcare providers, engaged subcontractors, and affiliated compounding pharmacies (collectively, the "Providers") to use and disclose to Elewell LLC and its affiliates, service providers, and third-party partners the information collected about me through ElewellRx, including but not limited to:
•Name, date of birth, and address
•Telephone number(s) and email address
•Medical information and health questionnaire responses
•Prescription and prescription-related information
•Compounding pharmacy name and fulfillment information
•Internet and electronic activity on Elewell's websites and applications
•Device information and usage information
•IP address and persistent identifiers (such as device IDs and browser identifiers)
•City and zip code associated with my account
•Commercial information (e.g., payment and account information)
•How I interact with Elewell's website and services
•My long-term value as a customer of Elewell
Some sensitive information as defined under applicable law (e.g., HIV status, genetic information, psychotherapy notes, or STI status) will not be used or disclosed without separate written authorization.
2. Purpose
As permitted by applicable law, the purpose of this Authorization is to:
a. Permit Elewell LLC to use and disclose my registration and transactional information for marketing purposes, including contacting me at my contact information saved in my profile to provide me with marketing and promotional messages about Elewell products and services, including but not limited to prescription medications, compounded treatments, longevity supplements, savings offers, refill reminders, and other pharmacy, pharmaceutical, or medical services either provided directly by Elewell or by companies that may partner with Elewell;
b. Permit Elewell LLC to use and disclose my information to third-party advertising platforms (such as Google and Meta), data analytics vendors, and tracking technology providers that assist in measuring advertising performance, tracking activity across Elewell's sites and applications, and delivering personalized advertising content based on how I interact with Elewell's services;
c. Permit Elewell LLC to use and disclose my information to help provide, personalize, and contextualize services provided by Elewell to me, and to provide me with relevant content based on how I interact with Elewell's services, which may include marketing, advertising, and other analytics and operations related to advertising and marketing; and
d. Permit Elewell LLC to use and disclose my information for Elewell's business operations, including to provide, change, market, or optimize Elewell's services and products, to perform analytics, and to create new services and products.
3. Your Rights
I understand that this Authorization is voluntary. I am not required to sign this Authorization as a condition of receiving treatment, payment, enrollment, or eligibility for benefits from Elewell LLC or Wasef Health Provider Group.
I may revoke this Authorization at any time by sending a written request to care@elewell.shop with the subject line "Revocation of HIPAA Marketing Authorization." Revocation is effective after it is received and processed by Elewell, but does not affect any uses or disclosures made prior to the revocation.
I understand that information used or disclosed as a result of this Authorization may be subject to re-disclosure by the recipient and may no longer be protected by the Health Insurance Portability and Accountability Act (HIPAA).
4. Expiration
This Authorization will remain in effect for two (2) years from the date of signing, or two (2) years from the date of last service received from Elewell LLC or Wasef Health Provider Group, whichever is longer, unless revoked earlier by me in writing.
5. Confirmation
By checking the related box during account creation or intake, I confirm that this Authorization accurately reflects my wishes with respect to the use and disclosure of my health information. In the event I am making a request on another's behalf, I certify that I am the legal representative of the individual who is the subject of this Authorization.