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Medically Reviewed By: Expert-24 Medical Review Board on March 27, 2014 | References | Terms of Use & Privacy

HEALTHTOOLS™ (HEALTHRISK™ AND HEALTHAGE™) DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.

Expert Review Panel – Expert-24 Ltd

Terms of reference

The aim of the Expert Review Panel is to ensure that all Expert-24 clinical and epidemiological content is robust, independent and up to date.


Medical Director and Editor

Dr. Timothy Dudley

Chairman of the Expert Review Panel

Dr. Robin Christie

Current authors and reviewers for the Health Risk Assessment

Dr. Martin Dawes

Dr. Jonathan Mant

Emeritus authors and reviewers for the Health Risk Assessment

The following individuals were deeply involved in the creation of the health risk assessment at its inception, but are no longer active reviewers on the panel:

Dr. John Fletcher

Dr. Emma Boulton

Professor Larry Ramsay

Professor Klim McPherson

Patient-centered health risk using an Evidence Based Medicine approach

Who created it and how often is it reviewed and updated?

This health risk assessment is brought to you by Expert-24 Limited. Expert-24 Ltd has full editorial control over content and strives to ensure that the content is: 

  • Robust - All information used is derived from reputable, referenced sources and subject to rigorous expert review. The content is written by the medical staff of Expert-24 and reviewed by an independent Expert Review Panel. All content is subject to regular review and updated to incorporate the latest evidence. Oxford Health Consulting was commissioned to conduct independent research to determine the model for disease and mortality-specific risks, the contents and its assumptions. The research and statistical modeling behind the risk assessment has been led by Dr. John Fletcher. Dr. Fletcher is deputy editor of the Canadian Medical Association Journal. He holds a Masters degree in Public Health Quantitative Methods and is a member of the Royal College of General Practitioners. 
  • Independent - The content on the site is provided by Expert-24 Limited, an independent UK company providing knowledge automation and decision support tools to improve health and wellbeing. No member of the Expert Review Panel has any financial stake in Expert-24 Ltd. Content creation and ongoing Quality Assurance is provided by Expert-24 Ltd and its Expert Review Panel. 
  • Up to date - All clinical material is subject to review by Expert-24 and its Expert Review Panel at least annually.

Why is this health risk assessment different than others?

Most health risk assessments say if a person is at high, medium or low risk of either dying from or developing a given medical condition. Most also indicate what lifestyle factors contribute to this risk. What they do not say is the magnitude of each risk for an individual and how much that person’s risk will decrease if they change their lifestyle. For example, if one is at moderate risk of two diseases, say bowel cancer and heart disease, most people would be unaware that their risk of heart disease is still five times higher than their risk of bowel cancer. 

In order to construct an electronic risk assessment tool for health and disease states, it is necessary to provide supporting research evidence and a method of encapsulating the best estimate of relative risk. For each medical condition, it is necessary to present credible estimates of risk, based on evidence from relevant, peer reviewed medical research. Important features of the risk assessment tool are: 
  • The tool gives numerical estimates of risk, rather than an imprecise statement such as "increased risk" or "reduced risk". 
  • The tool has the capability for interaction, allowing users to explore the impact on their personal risk of changing individual risk factors. 
  • The tool utilizes best available medical evidence 

The aim of this project is to provide healthy people with a quantitative assessment of their personal risk of developing some important diseases and some of the factors that influence their risk. This is an ambitious task and we would not claim to have produced the definitive approach. Although we believe this is the most informative collection of disease prediction equations available at the present time they do have limitations. The ones we are aware of are outlined below.

What exactly does a given percentage risk mean?

Someone looking at their risk of lung cancer until the age of 50 should read this model as saying, "Assuming survival to age 50 the chance of developing lung cancer during that time would be (some predicted value)". This approach has the appeal that changing risk factors will have the expected impact on cumulative risk and the mathematics remains transparent. We chose the risk of developing a certain condition rather than the risk of dying from it because for many people the fear of living and dealing with a disabling disease is as frightening as dying from it. 

This is different than lifetime risk calculations, which generally calculate the risk of dying from a given condition. Lifetime risk must take account of the fact that we all die of something in the end and calculating the relative contribution of common competing causes of death at various ages is difficult. Not only that, but the interpretation by users is complex. For example, a user of an interactive model predicting lifetime risk of lung cancer would see their individual risk of lung cancer fall with increasing cigarette consumption, because they would be dying of heart disease and chronic lung disease before they could get lung cancer.

How accurate are these percentages?

These models are good for illustrating the change in risk due to the presence or absence of single risk factors for prediction times of up to 5 years. They are likely to be reasonably good for 15 or 20 years and for combinations of several risk factors. For longer prediction times and varying more than, say, four risk factors the results should be regarded as illustrative rather than precise. The absolute level of risk for an individual may also be wide of the mark because the majority of overall risk remains unexplained in most research studies. This is why "confidence intervals" have not been included. That said these prediction equations do calculate the best estimate of risk that can be provided on the data given. 

Is this useful in the end? We believe it is. We believe that putting some quantification on risk allows users to explore the possible impact on their health of altering what they do. We find this approach more informative than a bland statement of "high risk" that is often value laden or that a certain action will "cut down" a risk without any indication of by how much.

Is risk really reversible?

This is a difficult question to answer, but in many cases the answer seems to be, "yes". This is good news for people with high risks who are older. Intuition might tell you that you are constantly doing damage to your body that accumulates over time, and in many cases that may be true. An example of this is in skin cancer, where the earlier and more often you are badly burned in life, the higher your risk of skin cancer. Staying out of the sun when you are old cannot reverse this risk. 
However, there is good evidence that for heart disease, for example, your risks can be significantly reduced no matter what your age. Cholesterol reduction by medications called "statins" reduces the risk of heart attack, angina or sudden death from heart problems by up to 30%, and this is entirely independent of age. Similarly, blood pressure reduction by drugs reduces the risk of stroke and heart disease by 25% - again entirely independent of age. Because in general it is older people who have the highest risks, they actually stand to benefit the most from treatment. 

The risk for developing heart disease in tobacco users has been shown to decline to a level comparable with a person who has never smoked within 2-3 years of giving up. Furthermore, the risk of having a stroke is reversed after 5-10 years of stopping. Studies have also shown that life expectancy improves even in people who stop smoking later in life (i.e. at 65 years or older). 

The reduction of risk that can be obtained from changing lifestyle habits such as diet, alcohol consumption and exercise is largely unknown. Therefore, the amount of risk reduction that can be expected from optimizing these habits needs to be viewed with caution. Certainly they should not take the place of blood pressure control, cholesterol control, and smoking cessation as goals.

How good is the evidence?

Our aim in searching for evidence was to identify up to ten high quality, relevant research studies for each topic. We used Medline to search using free text, MeSH terms and thesaurus search terms specific to each medical condition. To narrow the documents we used filters using "risk" and study design type; cohorts, case control, longitudinal, follow up. Searches were limited to studies published in English language and human studies. Although a comprehensive systematic review of the literature on each disease was not possible due to the scope of this project, we feel that the evidence used represents a reasonable cross-section of high-quality literature on the subjects in question. 
What we have done is to seek out plausible values of relative risk to use in the prediction equations. We have used an approach that searches for high quality research studies and have then applied our judgment tempered by Austin Bradford Hill's criteria for causation when selecting which risks to use. Hill's criteria are: strength, consistency, specificity, temporality, biological gradient, plausibility, coherence, experimental evidence and analogy. 

If this sometimes appears somewhat subjective then that is because at times it is a matter of judgment. The judgments have seldom altered the relative risk by more than a small amount. For each risk factor we had to choose a value to use in the model and have been faced at times with a range from which to choose. While a meta-analysis may provide the best point estimate, one is not always available and would be spurious to conduct on the sample of studies we have used for each condition. Given the level of uncertainty surrounding an individual's absolute personal risk we are comfortable with a comparatively lesser degree of uncertainty regarding a risk factor's relative risk.

What is the mathematical model that is used?

The actual mathematical and statistical models and risk coefficients that are used to determine risk are proprietary at this time, but have been validated by the authors and reviewers to be appropriate for use in this setting. 

References: Health Age Calculator

Most recently reviewed:

  1. Kvaavih E, et al. Influence of Individual and Combined Health Behaviors on Total and Cause-Specific Mortality in Men and Women. The United Kingdom Health and Lifestyle Survey. Arch Intern Med 2010; 170 (8): 711-718
  2. Pan A, et al. Red Meat Consumption and Mortality. Results from 2 prospective cohort studies. Arch. Int. Med. Published online March 12, 2012.
  3. Dunstan DW et al. Television Viewing Time and Mortality: The Australian Diabetes, Obesity and Lifestyle Study. Circulation 2010; 121: 384-391

Selected articles from previous reviews:

  1. Mitrou PN, Kipnis V, Thiébaut ACM, et al. Mediterranean Dietary Pattern and Prediction of All-Cause Mortality in a US Population: Results From the NIH-AARP Diet and Health Study. Archives of Internal Medicine. 2007;167(22):2461-8.
  2. Sofi F, Cesari F, Abbate R, et al. Adherence to Mediterranean diet and health status: meta-analysis. British Medical Journal. 2008;337:a1344-50.
  3. White, IR, Altmann, DR, Nanchahal, K. Alcohol consumption and mortality: modeling risks for men and women at different ages. BMJ 2002 Vol 325: 191
  4. Gaziano, JM et al. Light to Moderate Alcohol Consumption and Mortality in the Physician’s Health Study Enrollment Cohort. J Am Coll. Card. 2000: Vol 35. No 1.
  5. Thun, MJ et al. Alcohol consumption and Mortality among Middle-Aged and Elderly US Adults. NEJM 1997; 337: 1705-1714
  6. Khaw, KT, et al. Combined Impact of Health Behaviours and Mortality in Men and Women: The EPIC Norfolk Prosepctive Population Study. PLoS
  7. Med 5(1): e12. doi:10.1371/journal.pmed.0050012 (January 8, 2008)
  8. Benetou, V. et al. Conformity to traditional Mediterranean diet and cancer incidence: Greek EPIC cohort. British J. Ca. (1 July, 2008) 99, 191-195
  9. Kushi, L.H. et al. American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention: Reducing the Risk of Cancer With Healthy Food Choices and Physical Activity CA Cancer J. Clin. 2006; 56 (5):254-281
  10. Chlebowski RT, et al. Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women's Intervention Nutrition Study. J Natl Cancer Inst. 2006 Dec 20;98(24):1767-76.
  11. Michels, K.B., "A prospective study of variety of healthy foods and mortality in women." Int J Epidemiol 01 Aug 2002; 31(4): 847-54.
  12. Katzmarzyk, P.T., "Adiposity, adipose tissue distribution and mortality rates in the Canada Fitness Survey follow-up study." Int J Obes Relat Metab Disord 01 Aug 2002; 26(8): 1054-9.
  13. Andersen, L.B., "All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work." Arch Intern Med 12 Jun 2000; 160(11): 1621-8
  14. Prescott, E., "Importance of light smoking and inhalation habits on risk of myocardial infarction and all cause mortality. A 22 year follow up of 12 149 men and women in The Copenhagen City Heart Study." J Epidemiol Community Health 01 Sep 2002; 56(9): 702-6
  15. Fraser, G.E., "Association among health habits, risk factors, and all-cause mortality in a black California population.", Epidemiology, Mar 1997; 8 (2): 168-74.
  16. Tilling, K., "Estimating the effect of cardiovascular risk factors on all-cause mortality and incidence of coronary heart disease using G-estimation: the atherosclerosis risk in communities study." American Journal of Epidemiology 15 Apr 2002; 155(8): 710-8
  17. Yuan et al, "Follow up study of moderate alcohol intake and mortality among middle-aged men in Shanghai, China", BMJ 1997 314:18-23
  18. Fuchs et al, "Alcohol consumption and mortality amongst women", NEJM 1995 332:1245-1250
  19. Wannamethee et al, "Lifelong teetotallers, Ex drinkers and Drinkers: Mortality and the incidence of major coronary heart disease events in middle aged British men", International Journal of Epidemiology 1997 26:523-531
  20. Thun et al, "Alcohol consumption and mortality among middle aged and elderly US adults", NEJM 1997 337:1705-1713
  21. Hart et al, "Alcohol consumption and mortality from all causes, coronary heart disease and stroke: results from a prospective cohort study of Scottish men with 21 yrs follow up", BMJ 1999:318:1725-9
  22. "Diabetes mellitus, coronary heart disease incidence and death from all causes in African American and European American women". The NHANES I epidemiologic follow up study
  23. Lotufo et al , "Diabetes and all cause and coronary heart disease mortality among US male physicians", Arch Intern Med 2001; 161:242-7
  24. Lotufo et al, "Diabetes and all cause and coronary heart disease mortality among US male physicians", Arch Intern Med 2001; 161:242-7
  25. Stamler et al, "Relationship of baseline serum cholesterol levels in 3 large cohorts of younger men to long term coronary, cardiovascular and all cause mortality and to longevity", JAMA 2000;284:311-8
  26. Doll and Peto, "Mortality and relation to smoking: 20 yrs observations on male British Doctors", BMJ 1976: 2:1525-1536
  27. Doll et al, "Mortality in relation to smoking:22 years observations on female British doctors", BMJ 5/4/80 p 967-971
  28. Jacobs et al, "Cigarette smoking and mortality risk. Twenty five year follow up of the seven countries study", Arch Intern Med 1999; 159:733-40
  29. I Min Lee et al, "Body weight and mortality, a 27 yr follow up of middle-aged men", JAMA 1993;270:2823-8
  30. Blair et al, "Body weight change, all cause mortality in the multiple risk factor intervention trial", Ann Intern Med 1993;119:749-57
  31. Seidell et al, "Overweight, underweight and mortality. A prospective study of 48287 men and women", Arch Intern Med. 1996;156:958-63
  32. Manson et al, "Body weight and mortality among women", NEJM 1995; 333:677-85
  33. Colditz et al, "Oral contraceptive use and mortality during 12 years of follow up: The Nurses Health Study", Ann Intern Med. 1994;120:821-6
  34. Morris et al, "Loss of employment and mortality", BMJ 1994; 308:1135-9
  35. Martikainen et al, "Income differences in mortality: a register based follow up study of three million men and women", Int Journal of Epidemiology 2001; 30:1397-1405)
  36. Matthews et al, "Chronic work stress and marital dissolution increase risk of post-trial mortality in men from the MRFIT", Arch Intern Med. 2002;162:309-15
  37. Ben Schlomo et al, "Magnitude and causes of mortality differences between married and unmarried men", J Epidemiol Community Health 1993;47:200-5
  38. Kawachi et al, "A prospective study of social networks in relation to total mortality and cardiovascular disease in men in the USA", J Epidemiology and Community Health 1996;50:245-251
  39. "The diet and all cause death rate in the Seven Countries Study", The Lancet July 11, 1981;58-61
  40. Huovinen et al, "Mortality of adults with asthma; a prospective cohort study", Thorax 1997; 52:49-54
  41. Johansen et al, "Important risk factors for death in adults: a 10 yr follow up of the Nutrition Canada survey cohort", CMAJ 136:823-8
  42. Knuiman et al, "Lung function, respiratory symptoms, and mortality. Results from the Busselton Health Study", Ann Epidemiol 1999;9:297-306
  43. Dockery et al, "An association between air pollution and mortality in six US cities", NEJM 1993;329:1753-9
  44. Wannamethee S.G. et al, "Lifestyle and 15 year survival free of heart attack, stroke and diabetes in middle aged British Men", Archives of Internal Medicine 1998:158; 2433-2440
  45. Strandberg T.E. et al, "Blood pressure and mortality during an up to 32 year follow up", Journal of Hypertension 2001:19;35-39.
  46. Haapanen N. et al, "Characteristics of leisure time physical activity associated with decreased risk of premature all cause and cardiovascular disease mortality in middle aged men", American Journal of Epidemiology, 1996:143;870-80.
  47. Keil U., et al, "Classical risk factors and their impact on incident non-fatal and fatal myocardial infarction and all cause mortality in southern Germany (MONICA Augsburg cohort)", The European Heart Journal 1998:19;1197-1207.


The HealthTools™ assessment is an educational tool made available to you at no charge.  It is designed for adults 18 years and older living in the United States.  It was developed using current national standard guidelines.

Your participation in completing the HealthTools assessment is voluntary and you may exit the HealthTools assessment at any time. The HealthTools assessment is for personal use only.  It is not intended to diagnose, treat or prevent medical or other health conditions.  If you have a medical emergency, call 911 immediately.

The HealthTools assessment questionnaire is a series of questions about important personal health behaviors that can put you at increased risk for injury, illness and disease. It identifies your specific modifiable health risks and suggests simple actions you can take to maintain or improve your current and future health. It does not cover all of the health risks that could be of concern to you, especially if you are pregnant or have a serious health problem.

The Health Risk Assessment is not a substitute for information given to you by a licensed healthcare provider, nor is it a substitute for a medical exam. If you have any concerns about your health or if the Health Risk Assessment raises any questions consult a licensed healthcare professional.  Always consult a licensed healthcare professional for diagnosis and treatment of any medical condition or before starting a diet or exercise program.

The HealthTools assessment is strictly voluntary. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) ensures that the security and privacy of your personal health information remains confidential.  The HealthTools assessment is compliant with Title II of the Genetic Information Nondiscrimination Act of 2008. When questions about family medical history are included, you will not be required to answer those questions in order to complete the HealthTools assessment.

A personalized summary of the results and recommendations based on your responses to the HealthTools assessment questionnaire will be ready for you within minutes after completing the questionnaire. Your personalized summary will be displayed on a webpage within the HealthTools assessment and you may choose to use the “email my report” function from the results page send a copy of your personalized summary to an email address that you provide.  The webpage displaying your personalized summary will expire when you close your web browser and will not be retrievable via HealthTools assessment.  Please note, if you do not close your web browser, your personalized summary may be accessible by a subsequent user utilizing the web browser’s “back” button.

Section 2 – Disclaimer Review and Approval

Health Grades, Inc. designed and licenses the HealthTools assessment. Healthgrades hosts and operates the HealthTools assessment pursuant to a license agreement entered with its licensee and in compliance with the Terms of Use & Privacy Policy entered between its licensee and each HealthTools assessment user.


This HealthTools assessment is for general information purposes only.  It should not be used during a medical emergency or for diagnosis or treatment purposes.  If you have a medical emergency, call 911 immediately.  Always consult a licensed healthcare professional for diagnosis and treatment of any medical condition or before starting a diet or exercise program.



Please read these Terms of Use & Privacy Policy carefully.  By clicking on the “I agree to these terms” box and then clicking on “Continue”, you agree that these Terms of Use & Privacy Policy govern your access and use of the HealthTools assessment.  You must agree to the terms and conditions of these Terms of Use and Privacy Policy to use the HealthTools assessment.  If you do not agree to these Terms of Use & Privacy Policy, please click on the “X” in the lower left corner of this pop-up box and then exit the HealthTools assessment webpage.


You represent that you are at least 18 years old, a resident of the United States and not subject to the care of a legal guardian.


You acknowledge and agree that this HealthTools assessment is provided by the hospital or other healthcare entity (“Hospital”) identified in the HealthTools assessment and these Terms of Use & Privacy Policy.  You further acknowledge and agree that the Hospital’s Privacy Policy set forth in the Privacy Policy section below will govern the Hospital’s us of the information you provide via the HealthTools assessment.




We are required by law to maintain the privacy of your Protected Health Information (PHI). We may use and disclose PHI without your written authorization for the following purposes:

·Treatment, payment and health care operations

·Inclusion in our facility directory unless you opt out

·To update a family member, other relative, a close personal friend or any other person identified by you when you are present, unless you opt out

·Public health, abuse reporting, and oversight activities

·Judicial and administrative proceedings

·Law enforcement, medical examiner

·Organ and tissue procurement

·Research with an approved waiver

·Health or safety

·Specialized government functions

·Worker's Compensation

·As required by law

·To coordinate your care across multiple providers

·To optimize treatment of chronic conditions

·To focus attention on wellness and prevention

In addition, federal and state law provides special privacy protections for certain highly confidential information. For purposes other than the ones described above, we obtain your written authorization.

You have the following rights related to PHI:

·To submit complaints

·To request restrictions on use/disclosure

·To request alternative means of contact

·To revoke an authorization

·To inspect and copy your health information

·To request to amend your record

·To receive an accounting of disclosures



Genesis Health System (GHS) its employed physicians, certain specialties and its affiliates operate as a single entity to improve health outcome and achieve increased efficiency in the delivery of health care.


We are required by law to maintain the privacy of your PHI and to provide you with this Notice of our legal duties and privacy practices concerning your PHI. When we use or disclose your PHI, we are required to abide by the terms of this Notice (or the notice that was in effect at the time the PHI was used or disclosed).


A.    Uses and Disclosures For Treatment, Payment and Health Care Operations. We may use and disclose your PHI, with exception of "Highly Confidential Information" described in Section IV below, in order to coordinate your health care treatment, to obtain payment for services provided to you and to conduct our "health care operations" as follows:

· Treatment: We will use and disclose your PHI to coordinate your care – For example, to diagnose and treat your injury or illness and to make follow up referrals. In addition, we may contact you by mail, telephone or email to provide appointment reminders or information about treatment alternatives or other health-related benefits and services to optimize the care you receive. We will also disclose your PHI to others who need it to provide you with medical treatment or services. For example, we will send your doctor the results of laboratory tests we perform. In some cases the sharing of your PHI with other healthcare providers may be done electronically, including through an electronic health information exchange.

· Payment: We will use and disclose your PHI to obtain payment for services that we provide to you. For example, we will give information about you to your insurance company so we may receive payment. We will not disclose more information for payment purposes than is necessary.

· Health Care Operations: We may use and disclose your PHI to perform health care operations activities, which include internal administration and planning activities that improve the quality, safety and cost effectiveness of the care that we deliver to you and activities that improve health outcomes. We may also provide your PHI to students who are authorized to receive training at a GHS facility. For example, we may disclose PHI to our Patient Relations representative in order to resolve any complaints you may have or to ensure that you have a comfortable visit with us. We may disclose your PHI, as necessary, to others who we contract with to provide administrative services. This includes our care coordinators and health coaches.

B.    Use or Disclosure for Directory. We may list you in a GHS patient directory if you are admitted to a GHS hospital. Information in the directory may be disclosed to anyone who asks for you by name. The directory listing may include name, general health condition, location, and religious affiliation. Religious affiliation will only be disclosed to members of the clergy. You may object to inclusion in the directory or instruct us not to include specific information. Your information will not be included in the hospital directory if you are in a specific ward, wing, or unit  for a mental illness or developmental disability, HIV/AIDS or substance abuse.

C. Disclosure to Relatives, Close Friends and Other Caregivers. We may disclose your PHI to a member of your family or to someone else who is involved in your medical care or payment for care. We may notify family or friends if you are in the hospital, and tell them your general condition. In the event of a disaster, we may provide information about you to a disaster relief organization so they can notify your family of your condition and location. We will not disclose your information to family or friends if you object and will attempt to get your agreement prior to the disclosure.

D. Fundraising Communications. We may contact you to request a tax-deductible contribution to support important activities of GHS and its affiliated foundations. The money raised will be used to expand and improve the services and programs we provide the community. In connection with any fundraising, we may disclose to our affiliated fundraising foundation(s), certain information about you (your name, address, phone number, e-mail address, age, date of birth, gender, health insurance status, dates of services, departments of service, treating physician information and outcome information). If you do not want to receive any fundraising requests, you may contact the Genesis Health Services Foundation at 563-421-6865.You are free to opt out of fundraising solicitation, and your decision will have no impact on your treatment or payment for services with GHS.

E. Marketing. GHS may provide you with marketing materials in a face-to-face encounter without obtaining your written authorization. In addition, we may communicate with you about products or services we provide relating to your treatment, case management or care coordination, or alternative treatments, therapies, providers or care settings without your Authorization. If you do not want to receive any marketing materials, you may contact Genesis Corporate Communications and Marketing at 563-421-9275.You are free to opt out of marketing solicitation, and your decision will have no impact on your treatment or payment for services with GHS.

F. Public Health Activities. We may disclose your PHI for public health activities, including: (1) to report health information to public health authorities for the purpose of preventing or controlling disease, injury or disability; (2) to report child abuse and neglect to public health authorities or other government authorities authorized by law to receive such reports; (3) to report information about products and services under the jurisdiction of the U.S. Food and Drug Administration; (4) to alert a person who may have been exposed to a communicable disease ormay otherwise be at risk of contracting or spreading a disease or condition; and (5) to report information to your employer as required under laws address work-related illnesses and injuries or workplace medical surveillance.

G. Victims of Abuse, Neglect or Domestic Violence. If we reasonably believe you are a victim of abuse, neglect or domestic violence, we may disclose your PHI to a governmental authority, including a social service or protective services agency, authorized by law to receive such information.

H. Health Oversight Activities. We may disclose your PHI to a health oversight agency that oversees GHS and is charged with responsibility for ensuring compliance with the rules of government health programs such as Medicare and Medicaid.

I. Judicial and Administrative Proceedings. We may disclose your PHI in the course of a judicial or administrative proceeding in response to a legal order or other lawful process.

J. Law Enforcement Officials. We may disclose your PHI to the police or other law enforcement officials as required or permitted by law or in compliance with a court order or a grand jury or administrative subpoena.

K. Decedents. We may disclose your PHI to a coroner, medical examiner or funeral director, as authorized by law.

L. Organ and Tissue Procurement. We may disclose your PHI to organizations that facilitate organ, eye or tissue procurement, banking or transplantation.

M. Research. Medical research is vital to the advancement of medical science. Federal regulations permit use of PHI in medical research, either with your authorization or when the research study is reviewed and approved by an Institutional Review Board. In some situations, limited information may be used before approval of the research study to allow a researcher to determine whether enough patients exist to make a study scientifically valid.

N. Health or Safety. We may use or disclose your PHI if the disclosure is necessary to prevent or lessen a serious or imminent threat to public safety or to an individual.

O. Specialized Government Functions. We may use and disclose your PHI to units of the government with special functions, such as the U.S. Military or the U.S. Department of State under certain circumstances.

P. Worker's Compensation. We may disclose your PHI to the extent necessary to comply with state law relating to worker's compensation or other similar programs.

Q. As Required by Law. We may use and disclose your PHI if required by law.

R. Business Associates. We may disclose your PHI to third parties who perform services to us or on our behalf that require the use or disclosure of your PHI.


For any purpose other than those described above in Section III, we will  only use or disclose your  PHI with your written authorization. For example, you will need to execute an authorization before we will send your PHI to a life insurance company.

A. Other Organizations Marketing/Sale of PHI. Most uses and disclosures of PHI for marketing purposes will be made only with your written authorization. GHS cannot give or sell lists of patients to a third party for the purpose of the third party marketing its own products. Such a use would require an express written authorization from you.

B. Uses and Disclosures of Your Highly Confidential Information. Federal and state laws have special privacy protections for certain highly confidential information about you, which include: (1) psychotherapy notes; (2) mental health and development disabilities services; (3) alcohol and drug abuse prevention treatment and referral; (4) HIV/AIDS testing, diagnosis or treatment; (5) venereal disease(s); (6) child abuse and neglect; (7) domestic abuse of an adult with a disability; (8) sexual assault; or (9) genetic testing. We will obtain your written authorization in order to disclose highly confidential information. Each state may have different requirements regarding disclosure of such information, including mandatory reporting obligations, in some instances.


A. For Further Information; Complaints. If you desire further information about your privacy rights, are concerned that we have violated your privacy rights, or if you disagree with a decision that we made about access to your PHI, you may contact our Privacy Office. You may also file written complaints with the Secretary of the U.S. Department of Health and Human Services. Upon request, the Privacy Officer will provide you with the correct address for the Secretary. We will not retaliate against you if you file a complaint with GHS or the U.S. Department of Health and Human Services.

B. Right to Request Additional Restrictions. You may request restrictions on our use and disclosure of your PHI (1) for treatment, payment and health care operations, (2) to individuals (such as a family member, other relative, close personal friend, or any other person identified by you) involved with your care or with payment related to your care, or (3) to notify or assist in the notification of such individuals regarding your location and general conditions. For any services for which you paid out-of-pocket in full, we will honor your request to not disclose information about those services to your health plan, provided that such disclosure is not necessary for your treatment. In all other circumstances, we are not required to agree to a requested restriction, but will consider them carefully. If you wish to request additional restrictions, please obtain a request form from our Genesis Privacy Office and submit the completed form to the Genesis Privacy Office. We will send you a written response.

C. Right to Request Special Confidential Communications. You have the right to ask us to communicate with you at a special address or by special means. We will accommodate reasonable written requests.

D. Right to Revoke Your Authorization. You may revoke your Authorization, your Marketing Authorization or any written Authorization obtained in connection with your Highly Confidential  Information except to the extent that we have taken action in reliance upon it, by delivering a written revocation statement to the Genesis Privacy Office at the address below. If needed, you may obtain a sample form of a Written Revocation from the Genesis Privacy Office.

E. Right to Inspect and Copy Your Health Information. You may request access to inspect your medical record file and billing records maintained by us and request copies of the record. You also have the right to direct that we transmit a copy of such information directly to another person designated by you. Under limited circumstances, we may deny you access to a portion of your records and will provide the reason for this denial. If we maintain PHI about you in electronic format, you have the right to a copy of your PHI in the electronic form or format you request, so long as the PHI is readily producible in that form or format. If it is not readily producible in the form or format you request, we will provide it to you in a reasonable alternative format. If you wish to review your records, please obtain a record request form from the Genesis Privacy Office and submit the completed form to the Genesis Privacy Office. The Genesis Privacy Officer will make arrangements for you to inspect your medical record file. If you request copies, we have the right to charge a fee for copy costs.

F. Right to Amend Your Records. You have the right to request that we amend PHI maintained in your medical record file or billing records. If you desire to amend your records, please obtain an amendment request form from the Genesis Privacy Office and submit the completed form to the Genesis Privacy Office. We will comply with your request unless we believe that the information that would be amended is already accurate and complete or other special circumstances apply.

G. Right to Receive an Accounting of Disclosures. Upon request, you may obtain an accounting of a disclosures of your PHI made by Genesis Health System during any period of time prior to the date of your request provided such period does not exceed six (6) years and does not apply to disclosures that occurred prior to April 14, 2003. If you request an accounting more than once during a twelve (12) month period, we may impose a fee for this service.

The following disclosures are not required to be included in the accounting of disclosure treatment, payment, health care operations, information in a patient directory, national security purposes, correctional or law enforcement personnel, or any that you have authorized, or made directly to you.

H. Rights to Receive Paper Copy of This Notice. You have a right to receive a paper copy of this Notice. If you have received this notice electronically, you may receive a paper copy by contacting the Genesis Privacy Office.

I. Right to Receive Notice of a Security Breach. We are required to notify you by first class mail or by email (if you have indicated a preference to receive information by email) of any breach of your unsecured PHI as soon as possible, but no later than sixty (60) days after we discover the breach. "Unsecured PHI" is PHI that has not been made unusable, unreadable, and indecipherable to unauthorized users. The notice will give you the following information:

a. A short description of what happened, the date of the breach and the date it was discovered; b. The steps you should take to protect yourself from potential harm from the breach; c. The steps we are taking  to investigate the breach, mitigate losses, and protect against further  breaches; and

d. Contact information where you can ask questions and get additional information.


A. Effective Date. This notice is effective on April 14, 2003. Amended on October 1, 2012 and September 23, 2013.

B. Right to Change Terms of This Notice. We may change the terms of this Notice at any time. If we change this Notice, we may make the new notice terms effective for all PHI that we maintain, including any information created or received prior to changing the new notice. If we change this Notice, we will post the new notice in waiting areas of Genesis Health System and on our internet site at You also may obtain any new notice by contacting the Genesis Privacy Office.


You may contact the Genesis Privacy Office at:

Genesis Health System Privacy Office

1227 East Rusholme

Davenport, Iowa 52803

Telephone Number (563) 421-7262


Subject to the terms and conditions of these Terms of Use & Privacy Policy, Hospital grants you a non-exclusive, non-transferable license to access and use the HealthTools assessment and any reports provided to you via the HealthTools assessment solely for your personal information purposes.  Hospital and its licensors retain all intellectual property rights in the HealthTools assessment, including any reports, and any enhancements to it.  Hospital, in its sole discretion, may terminate your license to access and use the HealthTools assessment at any time, for any reason and without any prior notice; provided, that, you may continue to access and use any reports in accordance with this license that you saved outside of the HealthTools assessment.   

Reservation of Rights

Hospital and its licensors are the exclusive suppliers of the HealthTools assessment and the exclusive owners of all right, title and interest in and to the HealthTools assessment, including reports, and all intellectual property related to the HealthTools assessment, any enhancements thereto, and any materials provided to you in connection with the HealthTools assessment.  You may not use the HealthTools assessment, including reports, except pursuant to the limited rights expressly granted in these Terms of Use & Privacy Policy.

Warranties Disclaimer


Limitation of Liability


Responsibility for Safety

The HealthTools assessment may advocate or involve physical activity.  You hereby expressly assume all risk associated with any physical activity you undertake in connection the HealthTools assessment or any reports or other information provided via the HealthTools assessment. It is your responsibility to consult with a physician to determine your fitness to engage in any physical activities. It is also your responsibility to use appropriate equipment, clothing and techniques.

Governing Law

THIS USER AGREEMENT, AND YOUR USE AND ACCESS OF THE ASSESSMENT IS GOVERNED BY THE LAWS OF THE STATE OF COLORADO, WITHOUT REGARD TO ITS CONFLICT OF LAWS RULES. JURISDICTION AND VENUE FOR ANY CAUSE OF ACTION ARISING UNDER THIS AGREEMENT SHALL BE IN DENVER, COLORADO. “HOSPITAL” makes no representation that the Assessment is appropriate or available for use in locations outside the United States of America. You agree not to access the Assessment from any country or jurisdiction where its content is illegal or prohibited. If you choose to access the Assessment from outside the United States, you do so on your own initiative and you are responsible for compliance with local laws.

Entire Agreement

You agree that these Terms of Use & Privacy Policy set forth the entire understanding between you and Hospital with respect to the HealthTools assessment. You further agree that if any provision of these Terms of Use & Privacy Policy is held invalid, the remaining provisions shall continue in full force and effect.