Primary Users are mySeizureDiary.com account holders who
intend to use to the diary to record seizure and health
information. These users may also choose to share diary
information with a third party such as a caregiver, nurse or doctor.
Invited User
Invited Users are mySeizureDiary.com account holders who
intend to use to the diary to view seizure and/or health
information that has been shared with them. If this option
is selected, the account home page is the Diary Share page
which lists each diary instance (each person) who has shared
their diary. If an Invited User later decides to personally
record seizure or health information, the User Type
designation will need to be updated to “Primary User”.
NeuroPace® RNS® System
If you wish for NeuroPace to be able to provide your doctor with data displays
combining your mySeizureDiary.com information with data from your
neurostimulator you will
need to enter the serial number of your currently implanted neurostimulator
and your date of birth. This number, combined with your name, will be used
to match up your diary and neurostimulator data. Please contact your doctor
if you have questions about NeuroPace providing these reports to your epilepsy
healthcare team.
At the time of your RNS® System implant you may have received a
medical implant identification card that lists the serial number of your
RNS® Neurostimulator. The serial number is preceded by "S/N". If you
have not received the identification card, please contact your treating
epileptologist to obtain your neurostimulator serial number. You can enter
or update this number at any time.
I authorize NeuroPace or any person or entity acting on NeuroPace’s
behalf (collectively “Company”) to disclose my Medical Information
(as defined below) to any medical professional, medical care
institution, government agency (including departments of public
safety and motor vehicle departments), consumer reporting agency,
or technical or network vendors working on Company’s behalf
(including, but not limited to cloud providers, web site vendors,
or research and analytic companies, collectively “Technical Vendors”),
and to any individual or entity I expressly direct Company to provide
with my Medical Information.
Medical Information means any individually identifiable information,
in electronic or physical form, regarding your medical history,
mental or physical condition, or treatment for any medical condition,
that alone or in combination with other publically available
information, could reveal your identity.
I understand that Company may disclose my Medical Information to
treating physicians and other medical providers to inform treatment
of my epilepsy and treatment of other individuals with similar forms
of epilepsy, for Company’s own research and development, and for
research and development as to which Company and third parties
collaborate.
I understand that Company may disclose information to third party
Technical Vendors for purposes of defining improvements to Company’s
RNS® System, and for electronic storage and/or Web site operations
and/or back-up preservation on a cloud, or other electronic medium.
I understand that Company may disclose my Medical Information to any
third party I explicitly authorize to receive such information.
Unless otherwise revoked, I agree that this authorization will
remain in effect for five years from the date of execution, after
which Company is no longer authorized to disclose such information,
absent execution of a new authorization.
I agree that a copy of this authorization is as valid as the
original. I understand I am entitled to receive a copy of this
authorization.
I understand that I may revoke this authorization at any time, and
that my revocation will require the deletion of my account. I
understand that revocations must be submitted in writing to
msd-info@neuropace.com and include my full name and email address as
registered with my account.
