This notice describes how medical information about you may be used and disclosed and how you can get access to this information.
1. Our Privacy Obligations
Phosphorus Inc. and its wholly owned subsidiaries (“we” or “us”) understand that your health information is personal and we are committed to protecting your privacy. In addition, we are required by law to maintain the privacy and security of your Protected Health Information, to provide you with this Notice of our legal duties and privacy practices with respect to your Protected Health Information, and to notify you in the event of a breach of your unsecured Protected Health Information. When we use or disclose your Protected Health Information, we are required to abide by the terms of this Notice (or other notice in effect at the time of the use or disclosure).
2. Permissible Uses and Disclosures Without Your Written Authorization
In certain situations, which we will describe in Section IV below, we must obtain your written authorization in order to use and/or disclose your Protected Health Information. However, unless applicable law imposes special restrictions on us, we may use and disclose your Protected Health Information without your written authorization for the following purposes:
Treatment. We use and disclose your Protected Health Information to provide treatment and other services to you–for example, to provide genetic counseling consults to you or to consult with your physician about genetic testing results. We may use your information to direct or recommend alternative treatments, therapies, health care providers, or settings of care to you or to describe a health-related product or service. We may also disclose Protected Health Information to other providers involved in your treatment, including additional laboratories.
Payment. We may use and disclose your Protected Health Information to obtain payment for health care services that we provide to you–for example, disclosures to claim and obtain payment from Medicare, Medicaid, your health insurer, HMO, or other company or program that arranges or pays the cost of your health care (“Your Payor”), or to verify that Your Payor will pay for the health care. We may also disclose Protected Health Information to your other health care providers when such Protected Health Information is required for them to receive payment for services they render to you.
Health Care Operations. We may use and disclose your Protected Health Information for our health care operations, which include internal administration and planning and various activities that improve the quality and cost effectiveness of the care that we deliver to you. For example, we may use Protected Health Information to evaluate the quality and competence of our genetic tests such as HeartMap™ and LipidMap™. We may disclose Protected Health Information to our client services team in order to resolve any complaints you may have and ensure that you are satisfied with our services.
Clinical Trials and Other Research Activities. We may use and disclose your Protected Health Information to contribute to important research efforts in accordance with state and federal law. We may also contribute a copy of your Protected Health Information to a secure electronic data warehouse that may be used to support such research efforts. Each research project involving your Protected Health Information, whether conducted through the data warehouse or not, will be approved by an institutional review board that evaluates the risks and benefits of the research. Except in limited cases when the institutional review board finds that it would be appropriate to waive the requirement, we are required to first explain to you how your Protected Health Information will be used, and ask for your authorization to use or disclose your Protected Health Information for research. In addition, in some limited cases, we may use or disclose your medical information before this authorization process to design the research project or do other activities in preparation of the research project.
Compliance with Law. We may use and disclose your Protected Health Information when required to do so by any applicable federal, state or local law, or other lawful process. Public Health and Safety. We may use and disclose your Protected Health Information to prevent disease, assist with product recalls, report adverse reactions to medications, report suspected abuse, neglect, or domestic violence, or to prevent or reduce a serious threat to anyone’s health or safety.
Respond to Organ and Tissue Donation Requests. We may share your Protected Health Information with organ procurement organizations.
Medical Examiners or Funeral Directors. We may share your Protected Health Information with a coroner, medical examiner, or funeral director if you die.
Workers’ Compensation Laws and Other Government Requests. We may use or disclose your Protected Health Information: (1) in response to workers’ compensation claims, (2) for law enforcement purposes or with a law enforcement official, (3) with health oversight agencies for activities authorized by law, and (4) for special governmental functions, such as military, national security, and presidential protective services.
Responding to Lawsuits and Legal Actions. We may share your Protected Health Information in response to a court or administrative order, or in response to a subpoena.
3. Uses and Disclosures That Require Us to Provide You an Opportunity to Agree or Object / Disclosures to Relatives, Close Friends and Other Caregivers.
We may disclose your Protected Health Information to a family member, other relative, a close personal friend or any other person identified by you when you are present for, or otherwise available prior to the disclosure, if: (1) we obtain your agreement or provide you with the opportunity to object to the disclosure and you do not object; or (2) we reasonably infer that you do not object to the disclosure. If we disclose information under such circumstances, we would disclose only information that is directly relevant to the person’s involvement with your care.
Disclosures for Disaster Relief Purposes. We may disclose your Protected Health Information to public or private entities authorized to assist in disaster relief efforts provided we have given you the opportunity to agree or object to such disclosures.
If you are not present or unavailable prior to us making the above disclosures (e.g., when we receive a telephone call from a family member or other caregiver), we may exercise our professional judgment to determine whether the disclosure is in your best interests. We may also share your Protected Health Information when needed to lessen a serious and imminent threat to health or safety.
4. Uses and Disclosures Requiring Your Written Authorization
For any purpose other than the ones described above in Sections II and III, we only use or disclose your Protected Health Information when you give us your written authorization. For example, we will not share your Protected Health Information for marketing purposes or sell your Protected Health Information without your written authorization. We also may only use or disclose psychotherapy notes without your written authorization for limited purposes.
You may revoke your authorization, except to the extent that we have taken action in reliance upon it, by requesting a revocation form from the Privacy Officer and submitting a completed form.
5. Your Individual Rights
For Further Information; Complaints. You can complain if you feel we have violated your rights by contacting our Privacy Officer using the contact information at the end of this notice. You may also file a written complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.s
Right to Request Additional Restrictions. You may request restrictions on our use and disclosure of your Protected Health Information for treatment, payment and health care operations. While we will consider all requests for additional restrictions carefully, we are not required to agree to a requested restriction. If you pay for a service or health care item out-of-pocket in full, you can ask us not to disclose your Protected Health Information relating to that service or health care item to your health insurer. We will agree unless we are required by law to disclose the Protected Health Information.
If you wish to request a restriction, please contact our Privacy Officer to obtain a request form and submit the completed form. We will send you a written response.
Right to Receive Communications by Alternative Means or at Alternative Locations. You may ask us to contact you using alternative means (for example, by home or office phone) or to send you correspondence at alternative locations. We will agree to all reasonable requests.
Right to Inspect and Copy Your Health Information. You may ask to inspect or receive copies of your medical record file and any billing records maintained by us. Under limited circumstances, we may deny access to a portion of your records. If you would like to access to your records, please contact our Privacy Officer to obtain a records request form and submit the completed form. If you request copies, we may charge you a reasonable, cost-based fee.
Right to Amend Your Records. You have the right to request that we amend your medical record file or billing records. If you would like to amend your records, please contact our Privacy Officer to obtain an amendment request form and submit the completed form. We may decline your request, but will provide you an explanation in writing within sixty (60) days of the denial.
Right to Receive An Accounting of Disclosures. Upon request, you may obtain an accounting of certain disclosures of your Protected Health Information made by us for the six (6) years prior to the date of your request. If you request an accounting more than once during a twelve (12) month period, we may charge you a reasonable cost-based fee for the accounting statement.
Right to Receive Paper Copy of this Notice. Upon request, you may obtain a paper copy of this Notice, even if you originally agreed to receive the Notice electronically.
Right to Choose Someone to Act For You. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your Protected Health Information. We will make sure this person has the authority and can act for you before we take any action.
This Notice is effective on November 3,2016. 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 your Protected Health Information that we maintain, including any information created or received prior to issuing the new notice. If we change this Notice, we will post the new notice in our waiting room and on our Internet site at www.phosphorus.com. You also may obtain any new notice by contacting the Privacy Officer.
If you have any questions, requests or concerns, please do not hesitate to contact the Privacy Officer at 1-855-746-7423 or email@example.com.