THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Ameritox, Ltd. (herein referred to as Ameritox) is committed to protecting the privacy of your personal and health information. At Ameritox, we are committed to protecting the confidentiality of individuals’ laboratory test results and other patient protected health information (PHI) that we collect or create as part of our testing activities. We urge you to read this Notice of Privacy Practices carefully so that you will understand both our commitment to the privacy of your PHI, and how you can participate in that commitment. Should you have any questions about this Notice or our privacy practices, please call us Toll Free at (888) 494-2165 and ask for the Privacy Officer, or send an email to email@example.com, or write to us at the following address:
Attention Privacy Officer
300 East Lombard Street
Baltimore, MD 21202
This Notice is Effective as of May 13, 2008.
Ameritox, and its employees are committed to obtaining, maintaining, using and disclosing patient protected health information (PHI) in a manner that protects patient privacy. We will only use or disclose the PHI we consider necessary to perform a job or complete an activity. This Notice applies to all PHI that we maintain. Your doctor may have different notices regarding his/her use and disclosure of your PHI created in his/her office. Ameritox is required by law to:
Make sure that medical information that identifies you is kept private;
Give you this notice of our legal duties and privacy practices with respect to medical information about you; and
Follow the terms of the notice that is currently in effect.
We reserve the right to change the terms of this Notice of Privacy Practices and to make the provisions of the new Notice of Privacy Practices effective for all PHI that we maintain. The current Notice will be displayed on our website and a copy is available upon request.
HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
Your PHI will be used or disclosed for treatment, payment, or healthcare operations purposes and for other purposes as described below. Not every use or disclosure is listed; however, all of the ways we use or disclose your PHI without your authorization will fall into one of the categories listed below.
We do not need your authorization or permission to use or disclose your PHI for the following purposes:
As a health care provider that provides laboratory testing for ordering physicians, Ameritox uses your PHI as part of our testing process and discloses your PHI to physicians and other authorized health care professionals who need access to your laboratory results to treat you.
We will use your PHI in our billing departments and disclose your PHI to insurance companies, hospitals, physicians, and health plans for payment purposes, or to third parties to assist us in creating bills, claim forms, or getting paid for our services.
For Healthcare Operations
We may use or disclose your PHI in the course of activities necessary to support our health care operations, such as performing quality checks on our testing, for teaching purposes, to obtain accreditation or for developing expected reference ranges for tests that we perform.
Disclosures to Business Associates
Ameritox may disclose your PHI to other companies or individuals who need your PHI in order to provide specific services to us. These other entities, known as “business associates,” must comply with the terms of a contract designed to ensure that they will maintain the privacy and security of the PHI we provide to them or which they create on our behalf. Our business associates must only use your PHI for designated treatment, payment, or health care operations purposes that they perform on our behalf.
Individuals Involved in Your Care or Payment for Your Care
Unless you object, we may release PHI about you to a friend or family member who is involved in your medical care or payment related to your health care.
As Required by Law
We may use or disclose your PHI for various public policy purposes that are required by federal or state law. For example, we are required to disclose your PHI to the Secretary of the U.S. Department of Health and Human Services (“HHS”) upon request.
We may disclose your PHI for public health activities. These activities include, but are not limited to: the prevention or control of disease, injury or disability; reporting reactions to medications or problems with medical devices to the FDA; or reporting abuse or neglect under certain circumstances.
To Avert a Serious Threat to Health or Safety
We may use or disclose your PHI when necessary to prevent a serious threat to your health and safety or that of another person or the general public. Any use or disclosure for this purpose would only be made to someone able to help prevent the threat.
We may disclose your PHI in connection with governmental oversight, licensure, auditing, and other purposes. For example, governmental agencies periodically review our records to ensure that Ameritox is complying with the rules of various regulatory and licensing agencies. HHS and State Health Departments are examples of agencies that oversee aspects of Ameritox’ operations. Other agencies may audit our billing and laboratory records to verify that the health care was provided as claimed or that we were paid correctly.
Judicial and Administrative Proceedings
We may disclose your PHI as required to comply with court or administrative orders. We may also disclose PHI in response to discovery requests or other legal process in the course of a judicial or administrative proceeding, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
We may release medical information if asked to do so by a law enforcement official:
- In response to a court order, subpoena, warrant, summons or similar process;
- To identify or locate a suspect, fugitive, material witness, or missing person;
- About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
- About a death we believe may be the result of criminal conduct;
- About criminal conduct on our premises; and
- In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
Coroners, Medical Examiners and Funeral Directors
We may release medical information to a coroner, medical examiner or funeral directors under certain circumstances if it is necessary for them to carry out their duties.
In most cases, we will ask for your written authorization before using your information or sharing it with others in order to conduct research. Under some circumstances, we may use and disclose your health information without your authorization if we obtain approval through a special approval process to ensure that any disclosures for research pose a minimal risk to your privacy. Under no circumstances would we allow researchers to use your name or identity publicly.
Specialized Government Functions
We may disclose your PHI for military and veterans activities, national security or intelligence purposes, or to correctional institutions, or to law enforcement officials having custody of an inmate.
Military and Veterans
If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release information to components of the Department of Veterans Affairs to determine whether you are eligible for certain benefits.
We may disclose your PHI as necessary to comply with requirements of workers’ compensation or similar programs that provide benefits for work-related injuries or illness without regard to fault. For example, workers compensation programs may require that we provide the results of laboratory testing as part of the case file.
Note Regarding State Law
For all of the above purposes, in cases where state law is more restrictive than federal law, we are required to follow the more restrictive state law. For example, some states require physician authorization to release laboratory test results to patients, and other states prohibit a laboratory from releasing test results directly to a patient.
YOUR RIGHTS CONCERNING PRIVACY AND CONFIDENTIALITY
You or your authorized or designated personal representative have the right to inspect and copy your PHI. However, federal and state laws generally prohibit a laboratory from providing laboratory results directly to patients. If your request to access PHI is denied, you may request that the denial be reviewed.
You have the right to request amendments to your PHI if you believe that your PHI is incorrect or incomplete. We may deny your request under certain circumstances but you will have notice and the opportunity to respond to any denial.
You have the right to request an “accounting of disclosures”. This is a list of the disclosures we made of medical information about you. The list does not include uses and disclosures that have been made for treatment, payment, or health care operations; disclosures that were made to you or with your authorization or consent; or disclosures that are incidental to other permissible disclosures (such as someone overhearing a conversation between you and your doctor.) To request this list or accounting of disclosures, you must submit your request in writing to the address listed on the first page of this notice. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003.
You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. We are not required to agree to your request to restrict disclosures for treatment, payment or health care operations.
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. We will accommodate all reasonable requests.
Notice of Privacy Practices
You have the right to request a paper copy of this Notice.
If you believe your privacy rights have been violated you have the right to register a complaint with Ameritox or the Secretary of the U.S. Department of Health and Human Services. Ameritox will not retaliate against any individual for filing a complaint. You may file a complaint by calling us at (888) 494-2165 and asking for the Privacy Officer or by writing to us at the address located at the beginning of this Notice.
How to Exercise Your Rights
Write to us with your specific written request and be sure to include sufficient information for us to identify all of your records. You may also contact us at firstname.lastname@example.org to request an access form. Ameritox will consider your request and provide you a response within a reasonable timeframe. Should we deny your request, you have the right to ask for the denial to be reviewed by another healthcare professional designated by Ameritox. For additional details, or for instructions regarding how to exercise these rights, call us at (888) 494-2165 and ask for the Privacy Officer.
Other Uses of Medical Information
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written authorization. If you provide us authorization to use or disclose medical information about you, you many revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You must understand that we are unable to take back any disclosures we have already made with your permission.
HOW TO CONTACT US
If you have questions or concerns regarding the privacy or confidentiality of your PHI, or you wish to register a complaint, please write us at the address located at the beginning of this notice or by phone at (888) 494-2165 and ask for the Privacy Officer or send an e-mail to email@example.com.
CHANGES TO THIS NOTICE
Ameritox reserves the right to amend this Notice of Privacy Practices at any time to reflect changes in our privacy practices. Any such changes will be applicable to and effective for all Protected Health Information (PHI) that we maintain including PHI we created or received prior to the effective date of the Notice revision.