GLTrax

This authorization is made under the Health Insurance Portability and Accountability Act (HIPAA), 45 C.F.R. § 164.508, and any applicable state law.

1. Who is authorized to release my information

I authorize FPK Services LLC d/b/a Analyte Health ("Analyte Health"), together with its affiliated clinicians at Wilcrest Medical Group and the laboratories and patient service centers performing my testing, to disclose the information described in Section 3 below.

2. Who is authorized to receive it

I authorize disclosure to GLTrax, LLC, the operator of the GLTrax application, and to its service providers acting on its behalf under written contract.

3. What information may be released

• Laboratory test results, including all values, reference ranges, flags, and result comments, for every test I order through GLTrax
• Results of any reflex or confirmatory testing performed automatically on my specimen
• The laboratory requisition and order record, including the tests ordered, the ordering clinician, and the order and collection dates
• The performing laboratory, patient service center, and specimen collection details
• My name, date of birth, sex, and contact information as recorded on the order
• The status of my order, including cancellation, rejection, or specimen problems
• Any clinician note or annotation accompanying a result

This authorization covers results for orders I place through GLTrax while it is in force. It does not authorize the release of any other part of my medical record, of records from any other provider, or of results from testing I obtain elsewhere.

4. Why it is being released — the purposes

I authorize this disclosure so that GLTrax may, for my benefit:

• Deliver my results to me and store them in my account
• Display my results alongside the health data I track, including trends over time
• Provide GLTrax's products and features to me
• Perform analytics on my data to generate summaries, trends, and progress views for me
• Generate AI-generated insights about my data and provide them to me, which I understand are produced by artificial intelligence, are wellness information rather than medical advice, and may be inaccurate
• Provide customer support I request, and administer and bill for my order
• Comply with legal obligations and defend legal claims

5. My right to revoke

My revocation takes effect when GLTrax receives it and stops any further release of my results to GLTrax from that point on. I understand that:

• Revocation does not undo a disclosure already made while this authorization was in force, and cannot recall information already released.
• Analyte Health and the performing laboratory may have already acted in reliance on it.
• If I revoke after my specimen has been collected, GLTrax may be unable to show me that result. I can obtain it directly from the performing laboratory or the ordering clinician, who keep it as my medical record.
• Results GLTrax already holds stay in my account until I delete them; I can delete them separately at any time.
• I must sign a new authorization before placing another laboratory order through GLTrax.

6. When this authorization expires

This authorization expires on the earliest of:

• 10 years from the date I sign it
• the date I revoke it
• the date I close my GLTrax account

It is never open-ended and does not renew automatically.

7. Redisclosure

I understand that information disclosed under this authorization may be redisclosed by the recipient and may no longer be protected by the federal HIPAA Privacy Rule.

Once my information is released to GLTrax, LLC, its handling of that information is governed by GLTrax, LLC's own privacy policies, this authorization, its contractual obligations, and applicable law, rather than solely by the legal rules that govern my clinician-patient relationship with the disclosing provider or laboratory. GLTrax, LLC has told me that it applies safeguards appropriate to the sensitivity of the information it receives, that it is contractually required to protect this information and to use it only as this authorization and its privacy materials describe, and that it is subject to other laws including state consumer health data laws and the FTC Health Breach Notification Rule. Its handling of my information is described in its Privacy Policy and Consumer Health Data Privacy Notice.

I understand that revoking this authorization stops future disclosures to GLTrax, LLC but does not change the legal status of information already disclosed while this authorization was in effect.

8. This is voluntary

Signing this authorization is voluntary. My treatment, payment, enrollment in a health plan, and eligibility for benefits will not be conditioned on whether I sign it, and no one may refuse me healthcare because I decline.

I understand that GLTrax cannot receive or display my results without this authorization, and so cannot provide its laboratory results features to me if I decline. I remain free to order testing and receive my results directly from Analyte Health, from the performing laboratory, or through my own healthcare provider, without using GLTrax at all.

9. My representations and copy

• I am at least 18 years old and am signing on my own behalf.
• I have read and understand this authorization, and I have had the opportunity to ask questions about it.
• I am signing it freely and voluntarily.
• I am entitled to a copy, and a signed, dated copy is available to me at any time in Settings → Lab authorizations.

Document version 2026-09-16. This is the version published today; it is not necessarily the version that governs an order you have already placed. You sign this document as part of placing a lab order, and the version you signed at that time governs that order. The copy you signed, with its version and date, is available in Settings → Lab authorizations.