Effective date - 10/27/14
NOTICE OF PRIVACY PRACTICES
THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW YOU MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
THIS NOTICE OF PRIVACY PRACTICES APPLIES TO:
Premier Medical, Inc., doing business as Premier Medical Laboratory Services (“PMLS”), which refers to all laboratories, facilities and operations within PMLS, providing toxicology, general chemistry, advanced lipid panel, and genetic laboratory testing services. All employees of PMLS, including, but not limited to, laboratory health care professionals or para-professionals, health care or other service providers, or anyone authorized to enter information into any health record established and maintained by PMLS, either at a PMLS facility or other facility and Although not employees of PMLS, those working through temporary employment agencies or as contract workers, including, but not limited to, laboratory health care professionals or para-professionals, health care or other service providers, or anyone authorized to enter information into any health record established and maintained by PMLS, at a PMLS facility or other facility.
You have certain rights according to a law called the Health Insurance Portability and Accountability Act (“HIPAA”). The following explains your rights as a patient and our responsibilities as a HIPAA-covered laboratory, under this law.
Receive Copies of Your Medical Record
- You may receive an electronic or paper copy of your medical record (e.g.: your lab result) or any other health information we have about you. You may also simply ask to see a copy of your record.
- We may charge you a reasonable cost-based fee and supply the requested record within 30 days of your request.
Ask us to correct your Medical Record
- You may ask us to correct your health information you feel is incomplete or incorrect. Contact us for information.
- We have the right to decline your request, but will give you a reason why we did so, in writing, within 60 days.
- You can request that we contact you in a specific manner (e.g.: to a different address or phone number, etc.) and we will accommodate all reasonable requests.
Ask us to limit uses and disclosure of your health information
- You can ask us not to use or share certain health information for treatment, payment, or our health care operations. We are not required to agree to your request, and we may say “no” if it would affect your care or our ability to collect payment.
- If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Receive a List of Those With Whom We’ve Shared Information
- If you ask, we must provide you with a list of times we have shared your health information for the previous 6 years, with whom we shared it and why.
- The list will not include some of the disclosures - such as when you requested the disclosure in writing, or those that we were required to make (to name a few).
- We will provide one such list per year free of charge but will charge a reasonable, cost-based fee if a second is requested within a 12-month period.
Get a Copy of This Privacy Notice
- You may receive a copy of this Notice any time you ask – even if you have agreed to receive it electronically, you may then ask for a paper copy.
You may ask someone to act on your behalf
- If you have a Guardian or you have appointed someone as your Medical Power of Attorney, you have the right to have that person act on your behalf and make decisions about your health information.
- However, before we do anything, we will make sure that this person has the right to act on your behalf.
Complain, if You Feel We Have Violated Your Rights
- If you feel we have violated your HIPAA rights, you may:
- Contact us using the information at the bottom/back of this notice, or
- File a complaint by letter with the U.S. Department of Health and Human Services Office for Civil Rights, 200 Independence Avenue, S.W., Washington, D.C. 20201, or by telephone at 877-696-6775, or electronically by visiting www.hhs.gov/ocr/privacy/hipaa/complaints.
- We will not retaliate against you for filing a complaint.
OTHER USES OR DISCLOSURES OF YOUR HEALTH INFORMATION
Typically, we use or share your health information in the following ways:
- We are allowed to use your health information and share it with others who are providing healthcare to you.
- We only use your information in the process of lab operations, to improve your care, and to contact you when necessary.
To Bill for Services
- We are allowed to use your information to bill and receive payment from health plans or other entities.
YOUR CHOICES ABOUT WHICH INFORMATION WE SHARE
For certain health information, you can choose the information you can tell us your choices. If you give us written permission (via a signed authorization form) to share your health information, you may revoke it, in writing, at any time, except to the extent we have already relied on the authorization.
You Have Both the Right and the Choice to Tell Us to
- Share information with your family, close friends, or others involved in your care, or share information during disaster relief.
Unless You Give Us Written Permission, We Never Share Your Information
- For Marketing Purposes
- Or, for Profit
OTHER WAYS WE CAN USE OR SHARE YOUR HEALTH INFORMATION
Finally, there are other ways we are either required to, or allowed to share your information.
For Public Health and Safety Reasons
- Such as preventing disease, reporting adverse reactions, or preventing or reducing a serious threat to any person’s health or safety.
For Research Purposes
- If we get your permission, we can share your information for health research.
To Comply With the Law
- We must share your information if either state or federal law requires us to.
For Worker’s Comp, Law Enforcement, and Other Government Requests
- We can share for a Worker’s Comp claim
- For law enforcement purposes or with a law enforcement official
- With health oversight agencies for legally-authorized activities
To Respond to Legal Actions
- We must share health information in response to a court or administrative order or a subpoena.
To Business Associates
- We can disclose your health information to businesses that perform certain business functions for us. These businesses are required to maintain the same privacy of your health information.
De-Identified Information and Limited Data Sets
- We may use and disclose your health information if it is de-identified or contained in limited data sets. De-identification and limited data sets both require removal of certain information that would make it unlikely you could be directly identified.
CHANGES IN TERMS OF THIS NOTICE
PMLS reserves the right to make changes to this notice and to our privacy policies from time to time. Changes adopted will apply to any health information we maintain about you. PMLS is required to abide by the terms of our notice currently in effect. When changes are made, we will promptly update this notice and post the information on the PMLS website at www.premiermedinc.com. Please review this site periodically to ensure that you are aware of any such updates.
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- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice and provide you with a copy of the notice.
- We will not use or share your information other than as described here unless you tell us we can in writing.
OUR PRIVACY COMMITMENT TO YOU
We understand that health information about you and your health is personal. As a CLIA-certified laboratory (under the Clinical Laboratory Improvement Amendments of 1988) and a HIPAA-covered laboratory, we have an indirect treatment relationship with you in that our interaction is mainly with your health care provider. Since we receive and maintain a record of your health information for testing and diagnostic services, please be assured that we are committed to protecting your health information.
If you have questions about this Notice of Privacy Practices, or want to submit a specific privacy request, or file a complaint, please use the following methods to contact us:
- Premier Medical Laboratory Services
- Privacy & Security Officer
- 6000A-1 Pelham Road
- Greenville, SC 29615
- Phone: 877-335-2455
- Fax: 877-889-9157
- E-Mail: email@example.com