Notice of Privacy Practices
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.
The words “we,” “our,” “us” and “laboratory” in this Notice of Privacy Practices refer to Orange County Pathology Medical Group, Inc., doing business as Pathology Diagnostic Consultants, Inc. “You” and “your” refer to yourself as a patient or to your personal representative, legal guardian, administrator or other legal representative as required or permitted by law.
This is your Health Insurance Portability and Accountability Act (“HIPAA”) Notice of Privacy Practices from Orange County Pathology Medical Group, Inc., a provider of clinical and anatomic pathology laboratory services. We are required to provide this Notice to you upon your request (or in the event we furnish healthcare treatment services to you directly). PLEASE READ IT CAREFULLY.
In this Notice, we describe how we, in our laboratory practice, use and disclose your personal health information. This covers information that identifies you and concerns your healthcare treatment, payment for healthcare services, or is used by us in our laboratory operations. Your personal health information is commonly provided to us by way of a written requisition and accompanying documentation when your doctor submits to us a specimen obtained from you for laboratory testing. Without your personal health information, we could not perform the requested laboratory test(s).
The types of uses and disclosures that we may make concerning your personal health information are described below. However, please be assured that we will not use or disclose your personal health information for fund-raising activities; and we will not disclose personal health information about you to another company for their use in marketing products or services to you.
Treatment. Your health information may be used by laboratory staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests performed by us will be reported to your doctor who submitted the specimen to us for testing, and to other physicians and institutions as directed by your doctor. You may also direct us to provide your specimen and personal health information to another doctor or institution of your choosing for a “second opinion.” Test results we report to your doctor will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members.
Payment. Your health information may be used to seek payment from your health plan, from other sources of coverage such as an automobile insurer, or from banks or credit card companies that you may use to pay for services. For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated.
Health Care Operations. Your health information may be used as necessary to support the day-to-day activities and management of our laboratory. For example, information on the services you received may be used to support budgeting and financial reporting, activities to evaluate and advance the quality of laboratory services, or disclosed to others as part of a potential merger or acquisition involving our business in order to make an informed business decision regarding any such prospective transaction. We may also use your personal health information to send you treatment interval reminders; for example, reminding you it is time to schedule your next pap test.
Law Enforcement. Your health information may be disclosed to law enforcement agencies to support government audits and inspections, to facilitate law-enforcement investigations, and to comply with government-mandated reporting.
If you or your estate is involved in a lawsuit or a dispute, we may disclose your personal health information to comply with a court order or administrative ruling. We may also disclose personal health information about you in response to a subpoena, discovery document, or other lawful process by someone else involved in the dispute—provided there have been attempts to notify you of the request, or to obtain a protective order shielding your personal health information from production in a specified proceeding or proceedings.
Public Health Reporting. Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases to the state’s public health department.
To Avert a Serious Threat to Health or Safety. We may disclose your personal health information to avert a serious threat to public health or safety. Federal, state or local agencies involved in disaster relief, as well as private disaster relief or assistance agencies, may be entitled to your personal health information to carry out their responsibilities in specific disaster situations.
Other Uses and Disclosures Requiring Your Authorization. Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision to revoke your authorization.
YOUR RIGHTS CONCERNING YOUR PERSONAL HEALTH INFORMATION CREATED OR MAINTAINED BY US
You have certain rights under the federal privacy standards. These include:
Right To Inspect and Copy Your Personal Health Information. You have a limited right to inspect and obtain a copy of your personal health information that we created or maintain. To inspect or copy your personal health information, you must submit a written request to Attention: Privacy Manager, Orange County Pathology Medical Group, Inc., 805 W. La Veta Avenue, Suite 104, Orange, CA 92868. To receive a copy of your personal health information, you may be charged a fee for the costs of copying, mailing or other services and costs related to our compliance with your request. Please understand, however, that certain types of personal health information will not be made available for inspection and copying. These include diagnostic report(s) on specimens obtained from you by your treating physician and submitted by him or her to us. Another federal law (“CLIA”) prevents us from sharing with you directly our diagnoses on specimens obtained from you. Also, we will not permit inspection or copying of personal health information collected by us in connection with, or in reasonable anticipation of, any claim or legal proceeding. If we deny your written request to inspect or copy your personal health information, you may request that the denial be reviewed. An individual chosen by us and who was not involved in the original decision to deny your request will review our denial.
Right to Amend Or Submit Corrections to Your Personal Health Information. You may submit a written request asking that we correct or amend your personal health information—provided you also state the reason in the request. Submit your request and underlying reason(s) to us at: Attention: Privacy Manager, Orange County Pathology Medical Group, Inc., 805 W. La Veta Avenue, Suite 104, Orange, CA 92868. We may deny your request if it is not in writing or does not include a written reason for the request. We may also deny your request if you ask us to amend personal health information that:
Right to Request Restrictions. We will consider your written request to limit or restrict our use or disclosures of your personal health information, provided you tell us (1) what information you want to limit; (2) whether or not you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply (for example, disclosures to your spouse, significant other, parent, child, etc.). However, we are not required to grant your request, and will notify you of our decision. Any request to restrict or limit our use or disclosure of your personal health information must be submitted in writing to Attention: Privacy Manager, Orange County Pathology Medical Group, Inc., 805 W. La Veta Avenue, Suite 104, Orange, CA 92868.
Right to a List of Disclosures of Your Personal Health Information. You have the limited right to submit a written request for a list of the disclosures we have made that concern your personal health information. However, we are not required to furnish you with a list of disclosures made (1) for your healthcare treatment, (2) to obtain payment for our services, (3) for our laboratory operations, (4) to law enforcement or corrections personnel, (5) to protect national security, or (6) those disclosures which you have authorized or which were previously made directly to you. To obtain a list of disclosures made for purposes other than those listed above, please submit your request in writing to: Attention: Privacy Manager, Orange County Pathology Medical Group, Inc., 805 W. La Veta Avenue, Suite 104, Orange, CA 92868.
Right to Request Confidential Communications. You have the right to make a written request concerning the time, place and manner that we communicate with you about your personal health information. For example, you may request that we not telephone you, or that we should communicate only by e-mail (provided we offer communications by e-mail). We will generally honor your request if we determine it is reasonable, or if you tell us that communicating with you in another manner may place you in danger. To request confidential communications, please specify how and where you want to be contacted and mail that request to: Attention: Privacy Manager, Orange County Pathology Medical Group, Inc., 805 W. La Veta Avenue, Suite 104,Orange, CA 92868.
Right to File a Complaint. If you believe your privacy rights have been violated, you should bring the matter to our attention by sending a letter describing the cause of your concern. In addition, you may file a complaint in writing with the Secretary of the Department of Health and Human Services. Please submit a written complaint to us at: Attention: Privacy Manager, Orange County Pathology Medical Group, Inc., 805 W. La Veta Avenue, Suite 104, Orange, CA 92868. You will not be penalized or otherwise retaliated against for filing a complaint.
Contact Person. The name and address of the person you may contact for further information concerning our privacy practice is: Attention: Privacy Manager, Orange County Pathology Medical Group, Inc., 805 W. La Veta Avenue, Suite 104, Orange, CA 92868.
Revisions to This Notice of Privacy Practices. We reserve the right to revise, amend or modify the terms of this notice at any time. We reserve the right to make the revisions, amendments or modifications effective for personal health information we already have about you as well as any personal health information we receive in the future.
Effective Date of Notice of Privacy Practices. The effective date of this notice and any revised, amended or modified notice appears on the bottom right of each page. Upon request, we will mail the most recently revised notice to you, or send it by e-mail—but only if we offer e-mail delivery and you agree to it.