What personal information does Quilt Health collect?

Quilt Health collects contact details such as company name, first and last name, email address, state, and phone number when provided. They also collect communications exchanged with users, marketing preferences, device data including operating system and browser type, and usage data such as pages viewed and browsing history.

How does Quilt Health use personal information?

Quilt Health uses personal information to provide and improve services, respond to inquiries, administer and operate services, communicate with users, analyze service usage, create aggregated statistics, and for business promotion and compliance purposes.

How can I opt out of marketing communications?

Users can unsubscribe from marketing communications, block cookies in their browser, use privacy plug-ins or browsers with privacy features, and opt out of Google Analytics by installing the browser plug-in available at https://tools.google.com/dlpage/gaoptout.

HIPAA Authorization for Release of Protected Health Information (PHI)

Last Updated : December 10, 2025

REQUEST AND AUTHORIZATION FOR DISCLOSURE OF PROTECTED HEALTH INFORMATION

By proceeding, I authorize the following:

1. Authorization to Disclose PHI

I hereby request and authorize my healthcare providers, physicians, hospitals, clinics, laboratories, imaging centers, and any other covered healthcare entities (collectively, the “Disclosing Entities”) to disclose my medical records that contain Protected Health Information (“PHI”), as described below.

2. Recipient of PHI

I authorize the Disclosing Entities to release all PHI that is available about me to the following recipient (the “Receiving Entity”):

Quilt Health Inc.
Attn: Medical Records
160 Federal St. Suite 2100
Boston, MA 02110
support@quilthealth.com

3. Description of Information to Be Disclosed

I authorize the Disclosing Entities to release to the Receiving Entity all PHI available about me, including but not limited to: diagnoses, treatment history, lab results, imaging, radiology, prognosis, visit notes, and any related medical records for all conditions.

4. Purpose of Disclosure

I understand that my PHI will be used by the Receiving Entity for the following purpose: patient care coordination / verification / record retrieval / research / analytics / identifying treatment options.

5. Re-Disclosure Warning

I understand that once my PHI is disclosed to the Receiving Entity, it may be subject to re-disclosure by the Receiving Entity and may no longer be protected by federal privacy regulations. However, I also understand that the Receiving Entity will treat my information in accordance with its Privacy Policy then in effect.

6. Expiration and Right to Revoke

This authorization will remain in effect from today’s date until I revoke it. I may revoke this authorization at any time by submitting a written request to the Disclosing Entity. Revocation does not affect any disclosures made prior to the date the revocation is received and processed.

7. Voluntary Authorization

I understand that signing (or electronically accepting) this authorization is voluntary. My treatment, payment, enrollment in a health plan, or eligibility for benefits will not be conditioned on my decision to authorize this disclosure.

8. Electronic Acceptance

By clicking “Agree and Continue,” checking the applicable consent box, or submitting this form electronically, I acknowledge that:

I have read and understand this Authorization;
I am providing my valid authorization to release PHI to the Receiving Entity;
I am the individual identified above or their legally authorized representative.

I agree and authorize the release of my PHI as described above.

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