I have been enrolled in a clinical study sponsored by AbbVie Corporation (“AbbVie”), and am currently under the care of the study doctor, and his/her medical staff (the “Study Staff”).
I have been informed by the Study Staff that I can register for an account and access the Patient at Heart Web site (the “PaH Site”) in order to obtain information relating to the clinical study, and to manage my clinical visits related to the study. The PaH Site is sponsored and offered by AbbVie and is maintained by Rackspace US, Inc. and other third party service providers, that manage and administer the Site on behalf of AbbVie (collectively, the “Site Administrators”).
As a registered user of the PaH Site, I agree to the following:
My personal information will be disclosed to the Site Administrators for the purposes of establishing my personal account on the PaH Site. If necessary to set-up my personal account, I agree that the Site Administrators may contact me for information required for the administration of the account, either by email or by phone, at the addresses and number(s) that I provided.
I understand that the Site Administrators will have access to my personal information, including any personal health information that I choose to enter on the PaH Web site, and may use and disclose my personal information, in order to maintain and update my personal account through the PaH Site. If a current Site Administrator discontinues its involvement with the PaH Site, I consent to the transfer of my personal information to a new Site Administrator appointed by AbbVie to administer the PaH Site and I consent to the collection, use, storage and disclosure of my personal information by the new Site Administrator as described in this form.
My personal information will only be used for the purposes set out in this form or as otherwise permitted or required under the law. I understand that AbbVie will not have access to my personal information. Any collection, use or disclosure of my personal information in connection to the PaH Site will be consistent with the Study Informed Consent that I signed upon enrollment in the study, and with all applicable laws and regulations relating to the conduct of a clinical study in Canada.
In order to manage the PaH Site, I understand that my personal information may be transferred, stored and processed outside of Canada, including in the United States of America. Once my personal information is transferred outside of Canada, my information will be subject to the laws of that country where it is stored. That country may have laws that require that my personal information be disclosed to the foreign government under different circumstances than would Canada.
For more information about AbbVie’s and the Site Administrators’ policies and practices relating to personal information, please submit a written request to Rackspace US, Inc. at:
Rackspace Hosting, Inc.
5000 Walzem Road
San Antonio, TX 78218
I understand that I can request access to my personal information, correct any errors in that information or withdraw my consent for the collection, use, and disclosure of my personal information at any time in connection with the PaH Site by contacting O2 Web solutions at
1444, avenue Maguire, bur. 303
Québec, (Québec) G1T 1Z3
I understand that withdrawing my consent will mean that I can no longer be a registered user of the PaH Site and will no longer have access to a personal account. Unless consent is withdrawn, my consent is valid for as long as I am a registered user of the PaH Site and for a reasonable time thereafter.