PRIVACY NOTICE
PETROGLYPH PATHOLOGY SERVICES
NOTICE OF PRIVACY PRACTICES
This notice describes how medical information about you may be used and disclosed and how you can obtain access to this information. Please review it carefully.
1. YOUR HEALTH INFORMATION RIGHTS:
Right to Obtain a Copy of this Notice of Privacy Practices: We will provide you with a paper copy of the current Notice of Privacy Practices upon request. Right to Inspect and Request a Copy of Your Health Record: You have the right to inspect and obtain a copy of your health record, except in limited circumstances defined by federal regulations.
Right to Request Communication of Your Health Information: You have the right to request that confidential communications be made by alternate means (i.e. fax versus mail) or at alternate locations (i.e. addresses versus telephone number). Your request must be made in writing.
2. WE MAY USE AND DISCLOSE PROTECTED INFORMATION FOR THE FOLLOWING PURPOSES:
Treatment: We may use or disclose your protected health information to provide treatment and to coordinate or manage your healthcare and any related services.
Payment: We may use or disclose your protected health information to obtain payment for your healthcare services. We may also use or disclose medical information to bill directly and to obtain payment from third parties that may be responsible for payment.
Healthcare Operations: We may use or disclose your protected healthcare information in order to perform healthcare operations. Healthcare operations include, but are not limited to: quality assessment/improvement activities, risk management, claims management, legal consultation, physician and employee review activities, licensing, and regulatory surveys.
Individuals Involved in Your Care: We may disclose your protected healthcare information to a friend or family member who is involved in your care, unless you ask us not to. Your request must be made in writing. We may disclose information to disaster relief organizations so that family can be notified about your condition and location.
3. WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION WITHOUT YOUR AUTHORIZATION, CONSENT, OR OPPORTUNITY TO OBJECT FOR THE FOLLOWING PURPOSES:
Required by Law: We may use or disclose your protected health information to the extent that the use or disclosure is required by law, but only to the extent and under the circumstances provided by such law.
Public Health: We may use or disclose your protected health information for public health activities such as reporting communicable diseases, injury or disability, ensuring the safety of drugs and medical devices, reporting child and sexual abuse, and for work place surveillance or work related illness and injury.
Communicable Diseases: We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Health Oversight Activities: We may disclose your protected health information to a health oversight agency for activities authorized by law such as audits, administrative or criminal investigations, inspections, licensure or disciplinary action and monitoring compliance with the law.
Abuse, Neglect or Domestic Violence: We may disclose your protected health information to a public health authority that is authorized by law to receive reports of abuse or neglect. In addition, we may disclose your protected health information if we believe you may be a victim of abuse, neglect or domestic violence to the governmental agency or entity authorized to receive such information. This disclosure will be made consistent with the requirements of applicable federal and state laws.
Food and Drug Administration: We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, or to track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.
Legal Proceedings: We may disclose your protected health information in response to court or administrative orders, or under certain circumstances in response to subpoenas, discovery request or other lawful processes.
Law Enforcement: We may disclose your protected health information to identify or locate suspects, fugitives or witnesses, or victims of crime, to report deaths from crime, crimes on the premises, or in emergencies, the commission of a crime.
Coroners, Medical Examiners, Funeral Directors: We may disclose your protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose your protected health information to a funeral director in order to permit them to carry out their duties.
Organ Donation: We may disclose your protected health information to organizations that handle organ procurement and/or eye or tissue transplantation.
Research: We may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure you privacy.
Criminal Activity: We may disclose your health information consistent with applicable federal and state laws if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
Military Activity: We may disclose your health information if you are in the armed forces and information is required by command authorities or for the purposes of a determination by the Department of Veteran Affair of your eligibility for benefits.
Correctional Institutions: We may disclose your protected health information if you are an inmate for your health and the health, and safety of others.
Worker’s Compensation: We may disclose your protected health information as authorized to comply with worker’s compensation laws and other similar legally established programs.
Changes to this Notice: Petroglyph Pathology Services reserves the right to change this Notice. We reserve the right to make the revised or changed Notice effective for information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in our facility.