Authorization for Access to Protected Health Information by Walmart
ecommerce
This authorization is required to enable delivery of healthcare items through Walmart
ecommerce.
I Veronica Lara authorize Walmart Inc. Health & Wellness Pharmacy operations to disclose
protected health information described below to Walmart Inc. affiliates (companies in
Walmart’s corporate family) that provide ecommerce functionality. Ecommerce functionality
includes the online retail services of [Link] and the Walmart app (“Walmart
ecommerce”) (which include delivery and pick-up services).
I understand that I am not required to execute this authorization to continue receiving
treatment or healthcare services from Walmart Health & Wellness. I expressly affirm that,
when I execute this authorization for others, I do so based on my status as the personal
representative of the patient(s) whose information is managed through this account. I further
expressly affirm that I can provide documentation evidencing my role as personal
representative(s) for those other patients upon request.
User accounts (i.e. “patients”) which I am authorizing for Walmart ecommerce access:
Veronica Lara
This authorization will permit Walmart Inc.’s Health & Wellness Pharmacy operations
to share the following protected health information with Walmart ecommerce:
● Information that identifies the patients’ medication name(s) and pharmacy transaction(s)
● Patient name(s)
● Insurance coverage status
● Medication cost(s)
How your data will be used:
Walmart ecommerce will use the protected health information you authorized to provide you,
and any other patients you authorize, with Walmart ecommerce services. Ecommerce
features using protected health information may include:
● Displaying the prescription items in your ecommerce cart on [Link] or the
Walmart app.
● Notifications regarding prescription items ready for pick-up or in route for delivery.
● Access to status, tracking, and historical records related to the transaction.
● Operations necessary to support ecommerce functionality, business processes,
improvements and compliance.
Data processed in reliance on an executed authorization will not be subject to HIPAA as
protected health information and could be redisclosed. If your delivery instructions require
prescription items to be delivered to a previously unidentified party, Walmart will treat that
party as your authorized agent.
This authorization will stay in effect while the primary account holder maintains an active
digital pharmacy account. Authorizations for minor patients will automatically terminate when
the minor(s) reach the age of eighteen (18) years old.
Revoking access:
To revoke this authorization at any time, navigate to the Pharmacy Account settings and
select Manage Permissions. Under Prescription Delivery Authorization, disable the toggle
next to your name to revoke authorization to share prescription data with Walmart’s delivery
services. If your pharmacy account is linked to another party, and you execute an
authorization, you will need to revoke the authorization and unlink your account from the
other party to remove that party’s ability to manage your prescriptions. A new authorization
will have to be executed if you later wish to reenable Walmart ecommerce functionality. If you
revoke while prescriptions are added to your ecommerce cart, those prescriptions will remain
available for delivery until transaction is complete Once you revoke authorization, new
prescriptions will not be able to be added in the ecommerce cart for delivery until a new
authorization is executed. Any disclosures of data made by Walmart Inc. in reliance on your
executed authorization will not be affected by your revocation. Pharmacy transactions made
while this authorization was in effect will remain visible in your Walmart ecommerce account
after revocation.